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CONTENTS. 


TABLE  OF  CAHEH, 


the  Eye  and  Ea 
Medico-Legal  Kelati 


Medico-legal  Relatioi  a  of  Vision  and  Audition,  ami  of  Injuries  to 


.F.  H.  WOODWARD, 
of  Insurance.     A.  L.  BECKER, 

Aspects  of  Inanity  in  its   Relations  to  Medical  Jurispru- 
dence.    EDWARI 


PAOB 

V 


3 
129 


).  FlSHER, 145 

Mental  Unsoimtlnesin   its  Legal  Relations.     TRACY  (\  BECKER 

and  CHAHLKS  A  BOSK,  x 347 

Care   and   Custo<ly   I   I ncompetent   Pe/sons  and   their    Estates. 

I,  Second  Edition  revised  by  A.  L.  BECKER,    577 
. Ma rria^o and  Divorce.     A.  L.  BECKEU,         .     758 
Medico- Legal  Relatip  of  A'-rays  and  Skiagraphs.     ALBERT    G. 

GEYSER,   .        J .        .        .    771 

Medico-Legal  ExanJation  of  BliM>.l   a:i.l   other  Stains  and  of  the 

Hair.      JAMES  jvixo,      ....  807 


GOODWIN  Bi« 
Me<lico- Legal  Asjx'ct 


IM.KXTO  VOLS.  I.,  II.,  fcl  III.. 


911 


-T 


YYV 


TABLE  OF  CASES  CITEP  IN  THIS  VOLUME. 


A.  v.  A..  19  L.  R.  (Ireland).  403  .  .763 
A.  r.  B.  and  ano.,  1  P.  and  I).  (Eng.), 

.v.'i 766 

Altl'ott  v.  Commonwealth.  21  Ky.  L. 

R.,  1,372;  55  S.  W.  R.,  196. .      '•<»-'. 
513.  .~>M 

Adams,  In  re,  10  Pa.  Dist.  R..  LM7. 

402,  519,  555 

Adams's  Eat.,  In  re,  201  Pa.  St.,  502; 

51  All.  R..  368    555 

A.laiiisu.  State,  123  (la. ,500    456 

Adams  v.  State.  34  Tex.  Cr.,  470;  31 

SW.  Rep.,  372 545 

Adams  r.  Thomas,  81  N.  C.,  296  .  .597 
Arlington  v.  Wilson,  5  Ind..  137.  .399 
.Etna  Life  Ins.  Co.  v.  Davey.  123  U. 

S.,  739;  8  Sup.  Ct.,  331;  31  Law- 
yers'Ed.,  315  139 

.Ktria  Life  Ins.  Co.  v.  Fitzgerald,  165 

Ind.,  317;  75  N.  E.  R.,262;  1  L.  R. 

A.  (N.S.),422    137 

.-Etna  Life  Ins.  Co.  p.  Kaiser,  115  Ky., 

539 135 

.-Etna  Life  Ins.  Co.  r.  Sellers.  l.VJ  Ind., 

370;  56  N.  E.  R.,  97 364,  368 

^Etna  Life  Ins  Co.  r.  Ward,  140  U.  S.i 

76;  11  Sup.  Ct.  R.,  720;  35  Lau 

Ed. ,371 135,  136,  13'.) 

Airington  v    Airington,32  Ark.,  674. 

680 
Alabama  &  V.  Ry.  Co.  v.  Jones,  73 

Miss.,  110.  19 So.  R.,105 364 

Aldrich  v.  Steen,  98  N.  W.  R..   M.-,: 

100  N.  W   R..  311;  71  Neb., 33. 761 
Aldrich  v.  Superior  Ct..  12O  Cal ..  1  >n. 

52Pac  R..148 

Allen  P.  Baker,  86  N.  C., 91  .       . . 768 


Allis  v.  Ridings,  6  Mete.  (Mass.),  415. 

3M 

AJlis  r.  Morton,  4  Gray  (Maw.),  63.  586 
Allison's  I :-! . .  In  re,  104  Iowa,  130;  73 

N.W.  R.,484 567 

Alvord  r.  Alvord,  109  Iowa,  113;  80  N. 

W.  Rep..  306 537,  543 

American  Trust  &  Banking  Co.  v. 

Boone,  29  S.  E.  R.,  182;  40  L.  R. 

A.,  250;  102  Ga.,  202 370 

Ames  v.  Ames  (Ore.),  67  Pac.  R., 

737 525 

Anderson  r.  State,  43  Conn.,  514;  21 

Am.  Hep.,  669 439,460 

Anonymous,  35  Ala.,  226 762, 

764,  765 
Anonymous,  89  Ala.,  291;  7  So.  R., 

100 762,763 

Anonymous,  21  Misc.  (N.  Y.),  765. 

766,  767 

Anonymous,  34  Misc.  (N.  Y.),  109; 

»••«.»  Supp..  547 765 

Anonymous,  11  W.  N.  Cas.,  479.  .765 
Appleby  r.  Brock,  76  Mo..  314 ....  536 
Argo  v.  Coffin,  32  N.  E.  Rep..  679; 

1  U  111. .368 362 

Aringtnn  r.  Short,  3  Hanks  (N.  C.), 

71  587 

Armstrong  v.  State,  30  Fla.,  170;  11 

So.  Rep.,  618 532,  535,  542, 

552,  557,  559,  563 
Arnett'sCom.  r.  Owens,  23  Ky.  L.  R., 

1409;  65  S.  W.  R.,  151 364, 

368  587 
Arnhnut,  In  re,  1  Paige  (N.  Y.).  497. 

m 

Ashley  r.  llolman,  15  S.  C.,  97..  183 


74O171 


VI 


TABLE   OF   CASES   CITED   IN   THIS    VOLUME. 


Ashworth  v.  McNamee  (Colo.  App.), 

70  Pac.  R.,  156 516 

Ash's  Case  (Eng.),  1  Eq.  Cas.  Abr., 

278 762 

Asylum  v.  Craven,  17  Ky.  L.  R.,  667; 

32  S.  W.  R.,  291 383 

Aszman  v.  State,  123  Ind.,  347;  24 

N.  E.  Rep.,  123 487,493 

Atkinson  v.  Medford,  46  Me.,  510.761 
Attaway  v.  State  (Tex.  Cr.  App.), 

55  S.  W.  Rep.,  45 442 

Atwell  v.  Jenkins,  40  N.  E.  Rep.,  178; 

163  Mass.,  362 366 

Auilerson  v.  Auilerson,  42  Vt.,  350. 

595 
Austen  v.  Graham, 8 Moore  P.  C.,  493; 

1  Spinks,  357 398 

Autremont  v.  Fire  Assn.,  48  N.  Y.  St. 

Rep.,  43;   65  Hun,  477;   20  N.  Y. 

Supp.,345 437 

Averills'  Est.,  In  re,  133  Cal.,  414; 

66  Pac,  R.,  14 382 

Avery  v.  Wilson ,  20  Fed.  R.,  856 . . 425 
Ayers  v.  State,  26  S.  W.  R.,  396.  .490 
Aylward  v.  Briggs,  145  Mo.,  604; 

47  S.  W.  R.,  510 517 

Ayres  v.  Russell,  50  Hun  (N.  Y.),  282. 

604 

B.  arse  H.  v.  B.  (1901),  P  39.  .  .765 
Bacon  v.  Bacon  (Mass.),  62  N.  E. 

Rep.,  990 417,  420,  565 

Bacon  v.  Bacon,  76  Miss.,  458;  24 

So.  Rep.,  968 604 

Bacon  v.  United  States  Mut.  Ace. 

Ass'n,  44  Hun  (N.  Y.),  599 141 

Bacon  v.  United  States  Mut.  Ace. 

Ass'n,  123  N.  Y.,  304;  25  N.  E.  R., 

399;  20  Am.  St.  R.,  748;  9  L.  R.A., 

617 136,138 

Bageard  ?;.  Consolidated  Traction  Co. 

(N.  J.),  45  Atl.  R.,  620 428 

Bain  v.  Cline,  33  Pac.  Rep.,  542:  24 

Or.,  175 395,397,411 

Baird  v.  Howard,  36  N.  E.  Rep.,  732; 

51  Ohio  St.,  57 375 

Balke  v.  Rerpass,  77  N.  C.,  193. .  .584 


Baldwin  v.  Golde,  88  Hun,  115;    34 

N.  Y.  Supp.,  587 366 

Baldwin  v.  State,  12  Mo.,  233  . .  .536 
Baldwin's  Est.,  In  re,  13  Wash.,  366; 

43  Pac.  R.,  934 551,  565 

Ball  v.  Kane,  1  Penne.  (Del.),  90;  39 

Atl.  R.,  778 413,  503,  516 

Ball  v.  Smith,  83  Hun  (N.  Y.),  438; 

23  N.  Y.  Supp.,  54 361 

Ballard  v.  Chicag9,  etc.,  Ry.  Co.,  70 

Mo.  App.,  108 363,  364 

Banker  v.   Banker,  63  N.   Y.,  409. 

367,  528,  566 

Banks  v.  Goodfellow,  L.  R.,  5  Q.  B., 

548 388,396,400 

Bannister  v.  Jackson,  46  N.  J.  Eq. 

(1  Dick.),  593,  affirming  ISN.J.Eq. 

(18  Stew.),  702;  17  Atl.,  692. .  .  414 
Baranoski's  Case,  9  Pa.  Co.  Ct.,  264. 

430 
Barber's  Est.,  In  re,  63  Conn.,  393; 

27  Atl.  R.,  973 537,  566 

Barbey  v.  Boardman,  202     Pa.     St., 

185-  51  Atl.  R.,  756.  .392,  405,  408 
Barbineau's  Will,  In  re,  27  Misc.  R., 

417;  59  N.  Y.  Supp 408 

Barbour  v.  Moore,  4  App.  D.  C.,  535. 

503,  504,  517,  520,  521,  556 

Barbour  v.  Moore,  10  App.  D.  C.,  30. 

556 
Barker,  In  re,  2  Johns.  Ch.  (N.  Y.), 

232 579 

Barkley  v.  Barkley  Cemetery  Assn., 

153  Mo.,  300;  54  S.  W.  R.,  482. 

556 
Barkman  v.  Richards  (N.  J.  Pre.),  49 

Atl.  R.,  831 523 

Barlow  v.  Waters,  16  Ky.  L.  R.,  426; 

28  S.  W.  R.,785 419 

Barmley,  Case  of,  3  Atk.,  173 579 

Barnes  v.  Hathaway,  66  Barb.  (N.  Y.), 

452 382 

Barnes  v.  State,  19  Conn.,  398. .  .482 
Barnett  v.  State  (La.),  39  So.  R., 

778 506 

Barnewall  v.  Murrell,  18  So.  R.,  831. 

567 


TABLE    OF   CASES    CITED    IN     1HI>    NuLl'ME. 


Vll 


Barry  r.  United    States    Mut.    Ace. 

Ass'n,  23  Fed.,  712 HI 

Ifctru-line,  In  rt,  34  Misc.  R.  (N.  Y.), 

131;  9  N.  Y.  Ann.Ca*.,  448;  09  N. 

^    Supp.,468 681 

Barth  r.  State,  46  S.  W.  R.,  228;  39 

Tex.  Cr.,  381 504 

Bartholick,  In  re,  5  N.  Y.  Supp.,  842. 

406 
Barton  v.  Goran,  42    Hun    (X.   Y.), 

655 603 

Baucomb  v.  Buscomb,  25  N.  H.,  267. 

763,  764 

Bates  r.  Hyman  (Miss.),  28  So.  Rep., 

567 368 

Baxter  v.  Abbott,  7  Gray  (Mass.),  71. 

531 
Baxter  r.  Baxter,  76   Hun   (N.   Y.), 

98;  27  Supp..  834 568,  576 

Baxter  v.  Earl  Portsmouth,  7  D.  and 

R..614;  9  Alb.  L.J.,30 354 

Baylies  v.Spatilding  (Mass.),  6  N.  E. 

Rep.,  62;    1  N.  E.  Rep.,  914.  399 
Beach.  In  re,  23  App.  Div.  (N.  Y.), 

411;  48  N.  Y.  Supp.,  437 399 

Beach  v.  Supreme  Tent  of  K.  of  T.  M. 

of  the  World,  177  N.  Y..  100;   69 

N.  E.  R..281 143 

Beall  r.  Stokes,  95  Ga.,  375;  22  S.  E. 

R..  637 581 

Beasley  r.  Beasley,  180  111.,  163;    54 

N.  E.  R.,  187 356,  369 

Beaubien  r.Cicot.  12 Mich., 45!' 
Beaumont,  Case  of,  1  Wharton  (Pa.), 

52 579 

Becket,  Matter  of,  103  N.  Y.,  167. 

410 

Beckwith,   Matter  of,   3   Hun.   4-13. 
367, 593 
U.H||,,W'B  Will,  7nrr.67Hun    \    ^ 

ins;  22  N.  Y.  Supp.  290.  .397,  555 
Behrens  r.  McKenzie.  23  Iowa,  333; 

92  Am.  Dec..  428 364,  425 

BehrenHineyer  v.  Kreitz  (III.),  26  N. 

E.,  704  '.....  .1x7 

Bell  r.  McMaater.  29    Hun   (N.    Y.). 

873  ..536 


Bellison  r.  Apland  (Iowa),  89  N.  W. 

Rep.,  22 429 

Bennett,  In  re,  5  N.  Y.  Supp.  199. 

406 
Bennett  v.  Bennett  (Neb.),  91  N    W. 

R.,  409 

Bennett  r.  Bennett  (N.  J.  Pn>.  Ot  . 

26  All.  Rep.,  573;    50  N.  J.  Eq., 

439 384,  3S" 

Bennett  r.  Hibbert,  88  Iowa,  154;  55 

N.W.,93 392,411 

Benton's  Est.,  In  re,  131  Gal.,  472; 

<•>:<  I'ac.  R.,  775 421 

Benton's  Estate,  In  re,  131  Cal.,  472; 

63Pac.  R.,  795 418 

Benton  r.    Boston   City    IIosp.,    HO 

Mass.,  13;    1  N.  E.,  836 607 

Bentz  v.  Northwestern  Aid  Ass'n,  40 

Minn.,  202;   41  N.  W.  R.,  1037;  2 

L.  R.  A.,  784 135 

Berdolt  v.  Berdolt,  56  Neb.,  792;   77 

N.  W.  R.,  399 764 

Beresford  v.  Stanley,  6  Ohio  N.  P.,  38. 

403,  566 

Bernays  v.  United  States  Mut.  Ace. 

Ass'n,  45  Fed.,  455 139 

Berrien,  In  re,  5  N.Y.  Supp.,  37;  12 

id..  385 406 

Berry  v.  Safe  Dep.  &  Tr.  Co.  (Md.), 

53  Atl.  R.,  720;    see  Safe  Dep.  A 

Tr.  Co.  v.  Berry 389,  508,  513 

Bernhardt  v.  State,  82  Wis.,  23;    51 

X.  \V.  Rep.,  1009 487,  491. 

403,  494 

Belts  r.  Belts,  84  N.  W.  R.,  975.  .521 
Bevelot  v.  Lestrade,  153  III.,  625;  38 

N.  E.  R.,  1056 419 

Hcvcr  r.  Spannler  (Iowa),  61  N.  W. 

Rrp.,1072 410 

Bey,  Succession  of,  46  La.  Am.,  773; 

15  So.  R.,297 569 

Bickwcll  r.  Speer.  38  Misc.  R.  (N.  Y.), 

389;   77  N.  Y.  Supp..  920. . .  .356. 
366,  371.381 

Hillings  r.  Met.  Ins.  Co.,  70  Vt.,  477. 

140 
r.  Commonwealth.  22  Ky.  L., 


Vlll 


TABLE    OF   CASES    CITED    IN   THIS   VOLUME. 


760;  58  S.  W.  R.,  817;  22  Ky.  L., 

1161;  60  S.  W.  R.,  190.... 530, 

534 

Blackburn  v.  State,  23  Ohio  St.,  146. 

455 
Blackmann  v.  Edsall  (Colo.  App.), 

68  Pac.  R.,  790 521 

Black's  Est.,  In  re,  132  Cal.,  392;  64 

Pac.  R.,  695 418,  567 

Blair's  Will,  In  re,  16  Daly  (N.  Y. 

Com.  PI.),  540 387 

Blakely's  Will,  Matter  of,  48  Wis., 

294 531 

Blanchard  v.  Nestle,  3  Denio  (N.  Y.), 

47 385,580 

Bleecker  v.  Lynch,  1  Bradf.  (N.  Y.), 

458 402,411 

Blewitt,  In  re,  131  N.  Y.,  541.  ..  .585 
Blewitt,  In  re,  138  N.  Y.,  148;  33 

N.  E.  Rep.,  820 592 

Blinn,  In  re,  99  Cal.,  216;  33  Pac. 

Rep.,  841 424 

Blinn  v.  Schwartz,  63  App.  Div.,  25; 

71  N.  Y.  Supp.,  343;    affd.  177  N. 

Y.,252 355,364,369 

Blough  v.  Parry,  144  Ind.,  463;  43  N. 

E.  R.,  460 384,  567 

Blummer  v.  State  (Ind.),  34  N.  E. 

Rep.,  968 559 

Boardman  v.  Woodman,  47  N.  H., 

120 537 

Boggess  v.  Boggess,  29  S.  W.  Rep., 

1018  ;  127  Mo.,  305 362 

Boggs  v.  Boggs  (Neb.),  87  N.  W.  R., 

39 420 

Boisaubin  v.  Boisaubin,  51  N.  J.  Eq., 

252;  27  Atl.  R.,  624 523 

Bokemper  v.  Hazen,  96  Iowa,  221. 

366 
Boldman  v.  Leng's  Est.  (Mich.),  8 

Det.  Leg.  N.,  175;    86  N.  W.  R., 

148 382 

Boiling  v.  State,  54  Ark.,  588;  16 

S.  W.  R.,  658 436,  457,  463, 

559,  585 

Boiling  v.  Turner,  6  Rand.  (Va.),  584. 

595 


Bonard's  Will,  16  Abb.  Pr.,  N,  S.,  128. 
398,  399 

Bond  v.  Neusch wander,  86  Wis.,  391. 

380 
Bonnemort  v.  Gill,  165  Mass.,  493; 

43  N.  E.  R.,  299 519 

Bonner,  In  re,  33  Misc.   (N.  Y.),  9; 

67  Supp.,  1117 555 

Booker  v.  State,    156   Ind.,  435;    60 

N.  E.  R.,  156;    54  L.  R.  A.,  391 
490,  493 
Boone  v.  Ritchie,  21  Ky.  L.  R.,  864; 

53  S.  W.  R.,  518 419,  567 

Boorman    v.    N.    W.    Mutual    Relief 

Ass'n,  90  Wis.,  144;  62  N.  W.  Rep., 

924 543 

Bordeaux  v.  State,  51  Tex.  Cr.  Rep., 

37 482 

Borgasen  v.  Eklund,  96  111.  App.,  443. 

429 

Borum  v.  Bell,  31  So.  R.  (Ala.),  454. 

381 
Boswell  17.  State,  39  S.  E.  R.,  897, 898; 

114  Ga.,  40 141 

Bough  ton  v.  Knight,  L.  R.,  3  P.  and 

D.,  64,  72 387 

Bovard  v.  State,  30  Miss.,  600 451 

Bowden  v.  People,  12  Hun  (N.  Y.), 

85 502 

Bower  v.  Bower,  142  Ind.,  194;    41 

N.  E.  R.,  523.  .503,  614,  537,  544 
Bower    v.    Bower,    45    N.  E.  Rep  , 

595;   146  Ind.,  393 389 

Bowers,  In  re,  27  Pittsb.  Leg.  J.  (N. 

S.),237 411 

Bowman  v.  N.  WT.  Mut.  Relief  Ass'n, 

90  Wis.,  144;  62  N.  W.  Rep.,  924. 

357 
Boydan  v.  Haberstumpf,  3  Det.  Leg. 

N.,906;88N.  W.  R.,386 429 

Boyle  v.  Northwestern    Mutual    Life 

Ins.  Co.,  95  Wis.,  312;  70  N.  W.  R., 

351 142 

Boynton  v.  Reese,  112  Ga.,  354;  37 

S.  E.  R.,  437 :64 

Brackney  v.  Fogle,  156  Ind.,  535;  60 

N.  E.  R..303..          -.512 


TABLE   OF   CASES   CITED    IN    THIS   VOLUME. 


IX 


Bradley  9,  Palmer.     1«.»3    III..     I 

X.  K.  R..856 516 

Bradley  v.  State,  31  Ind..  41)2     .  .508 
Brad  well  r.  Pitt  si  >iiri:h  A:  \\     1.    I'a- 

Ry.  Co.,  153  Pa.  St.,  105;  25  At  I. 

Il..<>23    429 

Brady  r.  McBride.  39  X.  J.  Eq.,  495. 

525 
Braslu-ars   r.    Kra/.ier.    19   Ky     I.     1; 

l.MS;  43  S.  W.  R..4-J7         371,382 
Brashears  r.  Onne  (Md.K  49  Atl.  Rep., 

620 W 

Bni-<!  r.  Glasgow  Ins.  Co.,  92  Fed., 

760 i::f. 

Broiling  v.  Jordan  (Iowa),  88  N.  W. 

R..  1090 429 

Breeae,  In  re,  82  Iowa,  573 592 

Brennan  r.  People   (Colo.),  80   Pac. 

R.,79 493 

Brick  r.  Brick,  66  X.  Y.,  149. . .  404 
Brigham  v.  Faycrweathcr,  144  Mass., 

48 364 

Broadstreet  r.  Broadst  n-et .  7  Mass., 

474 378 

Brock  r.  State,  22  Ohio  Cir.  Ct    R.. 

364 430 

Brtxlrib  ».  Brodrib,  56Cal.,  583.    :M> 
Broimner's  Will,  In  re,  60  X.  V.  St. 

Rep.,  234 387 

Brooke  r.  Townsend.  7  Gill..  10.  .536 
Brooks.  Appeal  of,  68  Conn.,  294;  36 

Atl.  R..  47 419 

Brooks  r.  Barrett,  7  Pick.  (Mass.),  94. 

666 
Brooks  r.   Pratt,  118   Fed.    R..  725 

(U.  S.C.C.  A..  Mass.) 

Brothers  v.  Bunk    of  Kaukauna,    84 

Wis.,  381;    54  X.   W.,  786.  .356, 

w> 

Brotherton  v.  People.  75  N.  Y.,  159. 

557 
Brower  v.  Fisher,  4  Johns.  N.  Y.  Ch., 

441 tin 

Brower  P.  Supreme    Ixxlge.    74    M<> 

App..490 :{?:<     71 

Brown  c.  Brown.   1    Hagg.  Eccl..  Hi 

764 


Brown  v.  Brown.  1  Hagg.  Eccl.  Rep., 

523 764 

Brown  r.  Brown.  L.  R.,  I  P.  and  M., 

46 768 

Brown  r.  Commonwealth.  7^  Pa.  St.. 

122 451 

Brown  v.  Cory  (Kans.  App.).  "><)  1'ac. 

R..  1097 368 

Brown  r.  Ins.  Co.,  65  Mich.,  306;  32 

N.W.  R.,610 139 

Brown  v.  Mil< -s.  HI  Hun,  453 370 

Brown  r.  Mitchell,  26  8.  W.  R.,  1059. 

518,  536,  540 

Brown  r.  Mitchell  (Tex.),   31  S.   \V. 

Rep.,  621 548 

Brown  v.  State,  40  Fla.,  459;  25  So. 

Rep.,  63 559 

Brown  r.  Ward,  36  Am.  R.,  422.  426; 

53  Mil.,  377 398,  399 

Brownlee  v.  Sweitzer,  49  Ind.,  221. 

594 
Bruguier  r.  Pepin,  76  N.  W.  Rep., 

808;  HX>  Iowa,  432 362 

Brunor,  In  re,  21  App.  Div.,  259;  47 

N.  Y.  Supp..  681 503 

Brush,  Case  of  Rodman  A.,  3  Abb.  N. 

('.  (X.  Y.).  225 444 

Brash's  Will.  In  re,  35  Misc.  R.  (N. 

Y.),  689;  72  X.  Y.  Supp.,  421.. 396, 

399.555 

Bryant  r.  Pierce,  95  Wis.,  331;  70  X. 

W.  R.,  297,  504 503 

Buchanan  r.  Bdsey.65  App.  Div.,  58; 

72  X.  Y.  Supp.,  601...  386,  391.396 
Buchanan  v.  Pierce,  54  Atl.,  383;  205 

Pa.,  123 *. 399 

Buchnn's  Will,  In  re,  16  Misc.  R.  (X. 

Y.).  204;  38  N.  Y.  Supp..  1124 .  .402 
Buckey  v.  Buckey,  38  W.  Vn.,  168; 

18  S.  E.  Rep.,  383 361,  362. 

540.  564.  576 

Buckly  r.  Rice.  Plowd.,  125 529 

Budlong.  Matter  of,  126  X.  Y..  1423; 

B.C.,  38  State  Rep.. 436 394 

Buffalo  Loan.  Trust  and  Safe  Deposit 

Co  v.  Knights  Templar  and  M.  M. 

A.  Ass'n,  126  X.  Y..  450.  458;  27 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


N.  E.  R.,  942;  122  Am.  St.  R.,  839. 

135 
Bulger  v.  Ross,    12    So.    Rep.,    803; 

98  Ala.,  267 389,  390,  523, 

544,  555 
Burdett  v.  Thompson,  L.  R.,  3  P.  & 

D.,72 384 

Bunn  v.  Postell,  33  S.  E.  Rep.,  707; 

107  La.,  490 366,  369 

Burford  v.  Deuthall,2  Atk.,  553.  .582 

Burger  v.  Hill,  1  Bradf.,  360 385 

Burgh,  In  re,  61  How.,  193 593 

Burke,  In  re,  110  N.  Y.,  Supp.,  1004; 

125  App.  Div.,  889. .  .581,  588,  594 
Burnett's  Est.,  201  Pa.,  485;  51  Atl. 

R.,  336;  10  Pa.  Dist.  R.,  145.  .  .395 
Burney  v.  Torrey,  100  Ala.,  157;  14 

So.  Rep.,  685 389,  535,  537,  . 

540,  548 
Burns's  Will,  In  re,  28  S.  E.  R.,  519; 

121  N.  C.,  336 421,  517, 

519,  567 

Burr,  In  re,  17  Barb.  (N.  Y.),9.  ..593 
Burritt  v.  Silliman,    16    Barb.,    198; 

rev'd  13  N.  Y.,  93 413 

Burrows'  Estate,  In  re,  11  Ohio  S.  & 

C.  P.  Dec.,  229;  8  Ohio  N.  P.,  358. 

353,  401 

Burt  v.  Burt,  46  N.  E.  Rep.,  622;  168 

Mass.,  204 380 

Burt  v.  State,  38  Tex.  Cr.  App.,  397; 

40  S.  W.  R.,  1000;  43  S.  W.  R.,  344; 

39  L.  R.  A.,  305 530,  531,  532, 

533,  545,  559,  561 
Burton  v.  State,  25  S.  W.  Rep.,  782; 

33  Tex.  Cr!,  138 433 

Bushw.  Delano,  113  Mich.,  321;    ?1 

N.W.R.,628 504,522 

Bush  v.  Lisle,  89  Ky.,  393;  12  S.  W. 

Rep.,  762 405 

Butler  v.  Ins.  Co.,  45  Iowa,  93.  .  .536 
Butler  v.  Michigan  Mutual  Life  Ins. 

Co.,  108  Fed.,  487 134 

Butler  v.  State,  102  Wis.,  364;  78  N. 

W.  R.,596 455 

Butler  v.  Comyns,  81  111.  App.,  418. 
381,  564 


Buys  v.  Buys,  99  Michigan  354;  58 
N.  W.  Rep.,  331 542 

Caffey  v.  State  (Miss.),  24  So.  Rep., 

315 559 

Caffey  v.  State,  78  Miss.,  645;  29  So. 

Rep.,  396 430 

Cahn  v.  Cahn,  21  Misc.  (N.  Y.),  506; 

48  Supp.,  173 765 

Calderon  v.  Martin,  50  La.  Ann.,  1153; 

23  So.  R.  909 580 

Caldwell  v.  Anderson,  104  Pa.  St., 

199 394 

Calkins's  Estate  v.  Calkins,  112  Cal., 

296;  44  Pac.  R.,  577 520,  523 

Cameron's  Estate,  In  re  (Pa.  Orph. 

Ct.),  14  Pa.  Co.  R.,  247;  3  Pa.  Dist. 

R.,  101 389 

Campbell  v.  Barrera  (Tex.  Civ.  App.), 

32  S.  W.  R.,724 417,520,521 

Campbell  v.  Campbell,  39  Ala.,  312. 

582,  588 

Campbell  v.  Carlisle,    162    Mo.,    634; 

63  S.  W.  R.,701 419,420 

Campbell  v.  McQuiggan  (N.  J.),  34 

Atl.  R.,  383 419 

Cannon  v.  State  (Tex.),  56  S.  W.  R., 

351 501 

Carlin  v.  Baird  (Ky.),  13  S.  W.  Rep., 

434 408 

Carmichael,  In  re,  36  Ala.,  514 580 

Carnagie  v.  Diven,  49  Pac.  R.,  891; 

31  Ore.,  366 356,  362 

Carpenter  v.  Bailey,  94  Cal.,  406. 
390,  546 

Carpenter  v.  Blake,  75  N.  Y.,  12.  .603 
Carpenter  v.  Calvert,83Ill.,62.  .  .566 
Carpenter  v.  Commonwealth,  92  Ky., 

452;  18S.  W.  R.,9 487 

Carpenter,  In  re,  41  Atl.  Rep.,  1042. 

482 
Carr  v.  State,  96  Ga.,  284;  22  S.  E.  R., 

570 431 

Carr  v.  State,  98  Ga.,  89;  27  S.  E. 

Rep.,  148 430 

Carson  r.  Metropolitan  Life  Ins.  Co., 

1  Pa.  Super.  Ct.,  572 142 


TABLE    OF    CASK-    «  I  1  Kl>    IN    THIS    VULl'MK. 


XI 


Carter  v.  State,  12  Tex.,  500;  62  Am. 

Dec.,53«J 450,457 

Carter  r.  Stewart  (Tenn.  Ch.  App.), 

43  S.  W.  R.,366 564 

Carter's  Will,  In  re  (X.  J.  Pre.),  51 

Atl.  R.,  65 411 

Carver's  Will  (Surr.  N.  Y.),  3  MJM-. 

Rep.,  567;  23  N.  Y.  Supp.,  753. 

411 

Casat  r.  State,  40  Ark.,  511 493 

Case,  In  re  (Conn.),  52  Atl.  R.,  403. 

412 
Castro  r.Geil.  42  Pac.  R.,  804;  110 

Cal.,  292 364 

Catlett  r.  State  (Tex.  Cr.  App.),  61 

S  \V.  Rep.,  485 549 

Cawley  v.  State  (Ala.),  32  So.  R., 

227 448,457 

(cut  nil  Ky.  Asylum  r.  Penick.  !!  S. 

W.  Rep.,  92;  19  Ky.  Law  R.,  1583. 

383 

1  fntnil  Mutual  L.  I.  Ass'n  v.  Hender- 
son, 195  111.,  135;  62  N.E.R.,  838. 

Chambers  v.  Chambers,  61  App.  Div., 

299;  70  X.  Y.  Supp.,  483 523 

Chamblee  v.  Broughton,  120  N.  C., 

170;  27  S.  E.  Rep.,  Ill 380 

Chandler,  In  re,  45  La.  Ann.,  696;  12 

So.  R.  884 430 

Chandler  v.  Jost,  96  Ala.,  596;  11  So. 

R.,636 523,555 

Ch  .pin  v.  Mitchell  (Fla.),  32  So.  R.. 

875 .",i:, 

Chapline  v.  Stone,  77  Mo.  App.,  523. 

762 
Chappell  v.  Trent,  90  Va..  849;  19  S. 

E.R.,314 415 

Charter  Oak  Life  Ins.  Co.  v.  Rodell, 

95  U.  S.,232 636 

Chase  v.  Pellerin,  16  La.,  63 586 

Chase  r.  State  (Tex.  Cr.  App.).  U  - 

W.  Rep..  833 430 

Chatham  r.  State.  92  Ala.,  47;  9  S.  R.. 

607 490,492 

Cheney  r.  Price,  90  Hun,  238;  :  7  \ 

Y.Supp.,117 405 


Chesapeake  &  ().  Ry.  Co.  v.  Sauls- 
berry  (Ky.),  66  S.  W.  R.,  1,051. 

376 
Children's  Aid  Society  of  X.  V.  r. 

Loveridge,  70  N.  Y.,  387 414 

Childs,  Ex  parte,  1  C.  E.  Green  (N.  J.), 

498 589 

Choice  v.  State,  31  Ga.,  424 497, 

535 
Choice  v.  State,  66  Ind.,  94;  32  Am. 

R.,99 457 

Chrisman  v.  State,  54  Ark.,  283;  15 

S.  W.  R.,  889 487,  490,  492 

Christensen's  Estate,  In  re,  53  Pac. 

R.,  1003;  17  Utah,  4 12...  536,  541 
Christie,  In  re,  5  Paige  (N.  Y.),  242. 

591 
Cicero,  etc.,  v.  Richter,  85  111.  App., 

591 548 

City  of  Gallatin  v.  Tarwater,  44  S. 

W.  Rep.,  750;  143  Mo.,  40.  .  .  .482 
City  of  Guthrie  v.  Shaffer  (Okl.),  54 

Pac.  R.,  628 421 

City  of  Richmond  v.  Long's  Admrs., 

17  Grat.  (Va.),  375 607 

City  of  St.  Joseph  v.  Harris,  59  Mo. 

App.,  129 482 

Claffey  v.  Ledwith  (N.  J.  Pre.),  38 

Atl.  Rep.,  433;  56  N.  J.  Eq.,  333. 

386 
Clairty  ».  Sheridan,  91  Iowa,  304;  59 

N.  W.  R.,  52 598 

(  lipp  v.  Fullerton,  34  N.  Y.,  190. 
393,404 

Clapp'sCase,20  How.  Pr.  (N.  Y.),  385. 

590 

( Mark.  Matter  of,  5  Misc.,  68 393 

Clark,  Matter  of,  175  N.  Y.,  139,  65 

N.  E.  R.,  139 581,588 

Clark  v.  Clark,  168  Mass.,  523;  47 

N.  E.  Rep..  510 546,  548 

Clark  v  Fisher,  1  Paige,  171 392 

Clark  r.  Hill  69  Mo.  App..  541 . .  .503 
Clark  r.  State,  12  Ohio.  483;  40  Am. 

Dec., 481 636 

Clark's  Will.  In  re.  5  Misc.  Rep.  (N. 

Y.),  68;  25  N.  Y.  Supp..  712. .  .555 


Xll 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


Clarke    v.    Davis,   5  N.  Y.  Surr.    (1 

Redf.),249  393 

Clarke  v.  Eq.  Life  Ass.,  118  Fed.  R., 

374  (U.  S.  C.  C.  A.,  Md.) 374 

Clarke  v.  Irwin  (Neb.),  88  N.  W.Rep., 

783 542,  547,  564,  598 

Clarke  v.  Sawyer,  2  N.  Y.  (2  Comst.), 

498 385 

Clarke  v.  Schell,  84  Hun  (N.  Y.),  28; 

31  N.  Y.  Supp.  1053 555 

Clary  v.  Clary,  2  Ired.  L.,  78.  .  .  .536 
Claussenius  v.  Claussenius,  179  111., 

545;  53  N.  E.  R.,  1006 419 

Claxton  v.  Commonwealth,  30  S.  W. 

Ref.,  228;  17  Ky.  Law  R.,  284. .  433 
Clay  v.  Hammond,  199  111.,  370;  65  N. 

E.  R.,  352 366,  371,  592 

Cleland  v.  State,  65  S.  W.  R.,  189. 

490 
Clements  v.  McGinn  (Cal.),  33  Pac. 

Rep.,  920 422,  504,  565 

Clifford,  In  re  (N.  J.  Ch.),  41  Atl.  R., 

356;  57  N.  J.  Eq.,  14 433 

Cline  v.  Lindsay,  110  Ind.,  337.  .  .389 
Clough  v.  Warsham,  32  Tex.  Civ. 

App.,  187;  74  S.  W.  R.,  350.  ..  .607 
Clum  v.  Barkly,  20  Wash.,  103;  54 

Pac.  Rep.,  962 547 

Cochrane  v.  Amsden,   104  Ind.,  282. 

580,  593 

Cockrill  v.  Cockrill,  79  Fed.,  143;  92 

Fed., 811;  34  C.C.  A.,  254.  374,593 
Coffey  v.  Coffey,  74  111.  App.,  241. 

356 
Coffey  v.  Coffey,  179  111.,  283;  53  N.E. 

R.,590 356 

Coffin  v.  Coffin,  23  N.  Y.,  9 393 

Coghill  v.  Kennedy,  119  Ala,,  641;  24 

So.  R.,  459 416,  419,  519, 

520,  522,  555 

Coit  v.  Patchen,  77  N.  Y.  539 554 

Colah,  In  re,  3  Daly  (N.  Y.),  529.  .596 
Colby  v.  Jackson,  12  N.  H.,  526.  .599 
Cole  v.  Cole,  5  Sneed  (Tenn.),  57. 

762 

Cole's  Trial,  7  Abb.  Pr.  N.  S.,  321. 
439,  440,  442 


Colee  v.  State,  75  Ind.,  511 536 

Coleman's  Estate,  In  re,  6  Pa.  Dist. 

R.,  535 418 

Coleman  v.  Commissioners.  63  Mon. 

(Ky.),239 594 

Coles  v.  Jefferson  Ins.  Co.,  4  W.  Va., 

261;  23  S.  E.  R.,732 132 

Colett  v.  Collett,  1  Curt.  Eccl.  (Eng.), 

678;  1840  Wadd.  Dig.,  138 768 

Collins  v.  People,  194  111.,  506;  62 

N.  E.  Rep.,  902 541 

Collins  v.  Tovvnley  &  Johnson,  21  N. 

J.  Eq.,353 411,415 

Colvin's  Case,  3  Md.  Ch.,  206 588, 

594,  597 
Commercial  Travelers' Mut.  Ace.  Ass'n 

v.  Springsteen,  23  Ind.  App.,  657; 

55  N.  E.  R.,  973 143 

Commonwealth  v.  Earner,  199  Pa.  St., 

335;  49  Atl.  R.,  60 434,435, 

437,  451 
Commonwealth  v.  Berchine,  168  Pa. 

St.,  603;  32  Atl.  Rep.,  109 557 

Commonwealth  v.  Brayman,  136 

Mass.,  438 531,546 

Commonwealth  v.  Brown,  193  Pa.  St., 

507;  44  Atl.  R.,  497 542 

Commonwealth  v.  Buccieri,  153  Pa. 

St.,  535;  26  Atl.  R.,  228;  32  W.  N. 

C.,  113 363,  430,  445,  502, 

531,533 
Commonwealth  v.  Clark,  13  Pa.  Co.  Ct. 

Rep.,  439 482 

Commonwealth  v.  Cloonen,  191  Pa. 

St.,  605;  25  Atl.  R.,  145.  ....  .524 

Commonwealth  v.  Cressinger,  193  Pa. 

St.,  326;  44  Atl.  R.,  433 536 

Commonwealth  v.  Dorsey,  103  Mass., 

412 490,492 

Commonwealth  v.  Dudash,  204  Pa., 

124;  53  Atl.  R.,  756 491 

Commonwealth  v.  Fairbanks,  2  Allen 

(Mass.),  511 531 

Commonwealth  v.  Fritsch  (Pa.  O.  & 

T.),  9  Pa.  Co.  Ct.  R.,  164 457 

Commonwealth  v.  GeraHe,  145  Pa. 

St.,  289  (Pa.  O.  and  T.);  22  Atl. 


TABLE    OP   CASES   CITED    IN   THIS    VOLUME. 


XH1 


Rep.,  464;  23  Pittsb.  L.  J.,   117. 

436,  557,  559 

Commonwealth  r.  Gilbert,  165  Mass., 

I .1:  12  N.  K.  R.,  226 481,  499 

<  'ommonwealth,  ex  rtl.,  v.  Groh,  10 

I'a.  Co.  Ct.,  557 5X6 

Commonwealth  r.  Hawkins,  3  Gray 

(Mass.),    463 492 

Commonwealth  r.  Hays,  It)")  1'a.  St., 

270;  45  All.  R.,  728 580 

Commonwealth   r.    Heidler,   191    Pa. 

St.,  375;  43  All.  R..  211;  44  W.  N. 

C.,  310 557,  559,  560 

Commonwealth  v.   Ilillman.   1S9  Pa. 

St.,  548;  42  All.  R.,  196;  43  W.  N. 

C.,356;  29  Pitts.  L.J.,  268.446,451 
Commonwealth  v.   Hollinger  (Pa.  O. 

&  T.),  2  Dauph.  Co.  Rep..  13.  .  .435 
Commonwealth  r.  Hnllinger,  190  Pa. 

St.,  155;  42  Atl.  R.,  548 560 

Commonwealth   v.   Kilpatrick   (Pa.), 

53  Atl.  R..  774 557 

Commonwealth   ex   rtl.   Kirkbride,  2 

Brewster  (Pa.),  586 601 

Commonwealth  r.  Lutz,  10Kulp(Pa.), 

234 439 

Commonwealth     v.     McMillan,     144 

Pa.  St.,  610;  22  Atl.  Rep.,  1029 . 484 
Commonwealth  r.  Metz,  2  Dauph.  Co. 

R.,360 588 

Commonwealth  r.  Morrissey,  32  N.  E. 

Rep., 664;  157  Mass., 471 482 

Commonwealth   r.  Mosler,  4  Pa.  St., 

264.  457 

Commonwealth     r.     Pomeroy,     117 

Mass.,  143 506,512,513 

Commonwealth  >•   l'n-t.,n.  1  ss  I'M.  St.. 

429;  41  Atl.  R..  534 

Common  wealth     r.     Rich,    14    Gray 

(Mass.),  345 534,  546 

Commonwealth    r.    Rogers,  7    Mrtc 

(Mass.),    500;    4    Am.    Dec.,   458. 

451,473,534,546 

Commonwealth  r.  Schmous,  162  Pa. 

St.,  326;  29  Atl.  R..644.  .  .  i:«).  n:< 
Commonwealth    r.    Wilson,    1    Cray 

(Mass.),  337..  681 


Commonwealth  v.  Wireback,  190  Pa. 

St.,  138;  42  Atl.  R.,  542;  43  W.  N. 

C.,  506 436,  465,  466,  509,  510, 

534.  :,:«),  542,  557,  560,562 
Commonwealth  r.  Woodley,  166  Pa. 

St.,  463;  31  Atl.  R.,  202. ..  .486, 

556,575 

Conaty's  Will,  In  re,  26  Mi.sc.  R.,  104; 

56  N.  Y.  Supp.,  854 535,  539 

Conley  v.  Com.,  17  Ky.  Law  R.,  678; 

32  S.  W.  R..  285 486,  490 

Connecticut  Gen.  Life  Ins.  Co.  v. 

McMunly,  89  Pa.,  363 133 

Connecticut  Mut.  L.  Ins.  Co.  ».  La- 

throp,  111  U.S., 612 531 

Connecticut  Mut.  Life  Ins.  Co.  v. 

Union  Trust  Co.,  112  I".  S.,  250; 

5  Sup.  Ct.,  119;  28  Lawyers'  Ed., 

708 138 

Connor's  Will,  In  re,  61  N.  Y.  Supp., 

910 535 

Continental  Life  Ins.  Co.  v.  Young, 

113  Ind.,  159;  15  N.  E.  R.,  220; 

3  Am.  St.  R.,  630 143 

Converse  r. Converse,  21  Vt.,  168.. 388 
Cook  r.  Standard  Life  and  Ace.  Ins. 

Co.,  84  Mich.,  12;  47  N.  W.  R..  568. 

135 

Cook  r.  State  (Fla.),  35  So.  R.,  665. 

496 
Cook  v.  White.  167  N.  Y.,  588;  00 

N.  E.  R.,  1109 576 

Coombe's  Execr.  r.  Carthew,  43  Atl. 

R.,  1057  (N.  J.) 374 

Coop's  Will,  In  re,  6  N.  Y.  Supp.,  664. 

•Ills 

Cooper,  Matter  of,  5  Law  Bull.,  33S. 

590 
Coot  v.  Ionia  Probate  Judge,  93 

Mich.,  304;  53  N.  W.,  395 592 

Copenroth  r.  Kienby,  83  Ind.,  18. 

366 
Corbett  v.  St.  Vincent's  Industrial 

School,  177  N.  Y.,  16;  68  N.  E.  R., 

997 427.  607 

Corbli's  Will./n  re  (N.  J.  Pre.  Ct.).  52 

Atl.  R.,  996..  ..420 


XIV 


TABLE  OP  CASES  CITED  IN  THIS  VOLUME. 


Cornell  v.  State,  104  Wis.,  527;  80  N. 

W.  R.,  745 530 

Cornell's  Will,  In  re,  163  N.  Y.,  608; 

57  N.  E.  R.,  1007 555 

Cornwell  v.  Riker,  2  Dem.,354. 406, 41 1 

Coryell  v.  Stone,  62  Ind.,  307 531 

Cotrell  v.  Com.  (Ky.),  17  S.  W.  Rep., 

149 544 

Cottell  v.  State,  12  Ohio  C.  C.  R.,  467; 

1  OhioC.  D.,  472 560 

Couch  v.  Gentry,  20  S.  W.  Rep.,  89; 

113  Mo.,  248 389 

Covenhoven's  Case,  Saxt.  Ch.  Cases 

(N.  J.),  19 590 

Cowles  r.  Merchants,  140  Mass.,  377. 

531 
Craig  v.  Southard,  148  111.,  37;  35  N. 

E.  Rep.,  361 538 

Craig  v.  Southard,  162  111.,  209;  44  N. 

E.  R.,  393 566 

Cram  v.  Cram,  33  Vt.,  15 536 

Crandall,  Appeal  of,  63  Conn.,  365; 

28Atl.  R.,531 516,521,539 

Crane  v.  Crane,  62  N.  J.  Eq.,21;  49 

Atl.,  734 767 

Crarimer,  Ex  parte,  12  Vesey,  Jr.,  454. 

580 
Crawford  v.  Christian,  102  Wis.,  51; 

78  N.  W  Rep.,  406 537,  546 

Crawford  v.  Thompson,  161  111.,  161; 

43  N.  E.  Rep.,  617 381 

Creagh  v.Tunstall  (Ala.),  12  So.  Rep., 

713 382 

Creekmore  v.  Baxter  (N.  C.),  27  S.  E. 

Rep.,  994;  121  N.  C.,  31 368 

Crew  v.  State,  23  S.  W.  R.,  14 490 

Critchfield  v.  Easterday,  26  App.  D. 

C.,  89 356 

Crockett  v.  Davis,  81  Md.,  134;  31  Atl. 

R.,  710 531 

Crosby  v.  People,  137  111.,  325;  27  N. 

E.  R.,  49 490,  493 

Cross  v.  Kent,  32  Md.,  581 425 

Crossan  v.  Crossan,  70  S.  W.  R.,  136 

(Mo.) 388,504 

Crouzeilles,  Succession  of,  106  La., 

442;  31  So.  Rep.,  64.  ..  ..413 


Crowley  v.  Crowley,  19  Ky.  Law  Rep., 

285;  40  S.  W.  Rep.,  380 379 

Cruger's  Will,  In  re,  36  Misc.  R.,  477; 

73  N.  Y.  Supp.,  812 405,  406, 

419,  555 

Cudney  v.  Cudney,  68  N.  Y.,  148 .  .  404 
Cummins's  Est.,  In  re,  20  Pa.  Co.  Ct. 

R.,  575;  7  Pa.  Dist.  R.,  198.  ..  421 
Cundell  v.  Haswell  (R.  I.),  51  Atl.  R., 

426 365 

Cunningham  v.  State,  56  Miss.,  269; 

31  Am.  R.,  360 450 

Curland,  In  re,  15  Misc.  R.,  355;  37 

N.  Y.  Supp.,  922 416 

Cushman  v.  United  States  Life  Ins. 

Co.,70N.  Y.,  72 138 

Cutler  v.  Cutler,  103  Wis.,  258;  79  N. 

W.  Rep.,  240 393,  402,  420 

Cutler  v.  Zollinger,  22  S.  W.  Rep., 

895;  117  Mo.,  92 358,  375 

Cutts  v.  Young,  147  Mo  ,  587;  49  S. 

W.  Rep.,  548 363 

Czynski  Case,  14  Med.  Leg.  Jour.,  150. 

481 

Daily      Telegraph     v.     McLaughlin, 

(1904)  App.  Dec.,  776;  73  Law  J.  P. 

C.,  95;  91  Law  T.,  233;  20  Times 

Law  R.,  674 364,  365 

Daly  v.  Daly,  183  111.,  269;  55  N.  E. 

R.,671 392 

Dandurand  v.  Kankakee  Co.,  96  111. 

App.,   464;   63   N.   E.   Rep.,    101; 

aff'dl96Ill.,537;  63  N.  E.R.,  1011. 
381,382 

Darling,  In  re,  6  N.  Y.  Supp.,  191. 

406 
Davenport  v.  Johnson  (Mass.),  65  N. 

E.  R.,392 522 

D'Avignon's  Will,  In  re,  12  Colo.App., 

489;  55  Pac.  Rep.,  936.  .  .412,  539 
Davis  v.  Calvert,  18  Ky.  L.  R.,  975; 

38  S.  W.  R.,  884 355 

Davis  v.  Com.,  16  Va.  L.  J.,  464;  15 

S.  E.  R.,  388 487,  488,  491 

Davis  v.  Cox  (Ky.),  67  S.  W.  R.,  261. 

410 


TABLE  of  CASES  CITED  IN*  THIS  von  ME. 


xv 


Davis  v.  Dem.y,  94  Md.,  390;  50  Ail. 

Rep..  1037 IIJ 

Davis  r.  LatU,  94  Iowa,  727;  li'J  N. 

W.  Hep.,  17 

Davis  v.  Merrill,  47  X.  H.,  208. .  .599 

Davis  v.  State,  35  I  ml..  496 531 

Davis  v.  State,  54  Neb.,  177;  74  X.  \V. 

R.,  599 561 

Davis  v.  State  (Fla.),  32  So.  R.,  822. 

I.'.  1,560 
Davis  v.  U.  8.,  160  T.  S.,  469;  16  Sup. 

Ct.  Dec.,  353 549,  559 

Dean  r.  Dean,  27  Vt..  746 566 

Dean  r.  Phillips,  22  Ky.  Law  Rep., 

1621;  61  S.  W.  Rep.,  10 384, 

391,415 
Deane  r.  Aveling,  1  Rob.  Eccl.,  279, 

298 763 

Deas  v.  Wandell,  3  Supin.  ft.  (T.  & 

C.),  128  (N.  Y.) «»•_• 

De Castro's  Will,  In  r, .  ;_'  MUr.  H.  i.\. 

Y.),  193;  66  Supp.,  239 565 

Deck  v.  Deck,  106  Wis.,  470;  82  N.  W. 

R.,293 556 

Deer  v.  Clark,  3  Add.  Ecc.,  79        :>7'.» 
Defoe  T.  Defoe,  144  Mo.,  458;  46  S. 

W.  H.,  436 520 

DC  Hart  v.  Condit,  51  N.  J.  Eq..  till; 

28  All.,  607 :.!»! 

Deitzman  r.  Mullin,  108  Ky.,  610;  67 

S.  W.  R.,210 761 

Dejarnette  r.  Commonwealth,  75  Va., 

867 455,  531 

Delafield  v.  Parish,  25  N.  Y.,  9.  .386, 

403,  411,565,  :,7u 

Delaplain  v.  f.rubb.  44  W.  Va..  c.lL': 

30  S.  E.  Rep.,  201 362,  H7  1. 

540.  .Vrf) 
De  Lesdernier  r.  DP  Ix>sdernier,45  Ln. 

Ann.,  1364;   14  So.  Rep.,  191.  .380 
Delgado  v.  State,  29  S.  W.  R.,  1070. 

490 

Demeet,  In  re,  27  Hun  (N.  Y.),  480. 

585 
Denning  r.   Butcher,  91    Iowa.    r_'.v 

59  X.  W.   R.,  69 .'..'I     M2, 

.MI;  :,is 


Drains  '.  Dfiinis,  68  Conn.,  186;  34 
L.  R.  A..419;  itti  All.  K*-j>..  34..380 

Denver  Lif<»  I'm.  Co.  r.  Price,  18  Colo. 
App.,  30;  69  Pac.  R.,  313 135 

Denver  Tramway  Co.  r.  Reid  (Col.), 
35  Pac.  R.,  269 428 

DesMoines,  etc.,  r. Chisholm,71  Iowa, 

675 :«;:* 

De  Treville  r.  Ellis,  Bailey  Eq.  (S. 

C.),  35;  21  Am.  Dec.,  519 597 

Devanbagh  v.  Devanbagh,  5  Paige  (N. 

Y.),554 762,  763,70ft 

Deveny  v.  State,  45  Ind.,  208. ..  .482 
Dewey  r.  Allgire,  37  Neb.,  6;  55  N.  W. 

R..  276 357,  362.  364 

Dexter  v.  Hall,  15  Wall.  (U.  S.),  9. 

364,531 

Dickereon  v.  N.  W.  Mut.  L.  I.  Co., 

200  111.,  270;  65  N.  E.   R..  694. 

374,550 

Dickie,  In  re,  7  Abb.  N.  C.  (N.  Y.), 

417 589 

Dickson's  Estate,  In  re,  20  Pa.  Co.  Ct. 

R..  152 504 

Dieffenbach  v.  Grece  (N.  J.  Pre.),  39 

Atl.  Rep.,  536;  56  N.  J.  Eq.,  365. 

407 
Dilleber  v.  Home  Life  Ins.  Co.,  69  N. 

Y..  !>.-><;;  2:>  Am.  Rep.  182.  ...  135 
Di  Lorenzo  v.  di  Lorenzo,  71  App.  Div. 

(N.  Y.),  509,  519;  174  N.  Y.,  467. 

766 
Dimond's  Eat.,  In  re  (Orph.  Ct.),  3 

Pa.  Dist.  Rep.,  554 412 

Directors  of  Infirmary  r.  Merkle.  3 

OhioN.  P..  169 382 

Dischner  r.  Piqtia  Mut.  Aid  Ass'n, 

1 4  S.  1 ). .  436;  K5  X.  W.  R. .  998. .  374 
Dixi.n's  Will,  In  re,  42  App.  Div.  (N. 

Y    .   481;   59   X.   Y.   Supp..   421. 

406,411 

Dobie  v.  Armstrong.  160  X.  Y..  584; 

55  X.  E.  Rep.,  302;  aff'g  27  App. 

Div.,  520;  50  X.  Y.  Supp.,  801. 
396,412,565 

Dodge  r.  Cole  (111.).  37  Am.  Rep.,  11. 

883 


XVI 


TABLE    OF    CASES    CITED   IN    THIS   VOLUME. 


Doe  v.  Reagan,  5  Blackf.,  217;  33  Am. 

Dec.,  466 536 

Doe  v.  Roe,  Edm.  Sel.  Gas.  (N.  Y.), 

344 761 

Doheny  v.  Lacy,  168  N.  Y.,  213. 

553 
Dolbeer's  Estate,  In  re  (Cal.),  86 

Pac.  R.,  695 531,  536 

Dominick  v.  Randolph,  124  Ala.,  557; 

27  So.  Rep.,  481 355, 

537,  542 
Donovan  v.  Bromley,  71  N.  W.  R., 

523  (Mich.) 555 

Dougherty  v.  People,  1  Colo.,  514, 

519 141 

Douglass's  Est.,  In  re,  162  Pa.  St., 

567;  29  Atl.  Rep.,  715.  ..  .390,  412 

Dove  v.  State,  3  Heisk.,  348 536 

Dowdell,  In  re,  169  Mass.,  387;  47  N. 

E.  Rep.,  1033 586,  665 

Dowling  v.  Merchants'  Ins.  Co.,  168 

Pa.,  234;  37  Atl.  R.,  988 133 

Downing  v.  Whitney,  46  App.  Div., 

307;  61  N.  Y.  Supp.,  540 598 

Downesv.  Harper  Hospital,  101  Mich., 

555;  60  N.  W.  R.,  42 427,  607 

Dozier  v.  Fidelity  and  Casualty  Co., 

46  Fed.,  446;  13  L.  R.  A.,  114,  581; 

22  L.  R.  A.,  620 137 

Drakeford  v.  Supreme  Conclave  K.  of 

D.,  61  S.  C.  338;  39  S.  E.  R.,  523. 

143 
Dreier  v.  Continental  Life  Ins.  Co., 

24  Fed.,  670 138 

Drew's  Appeal,  57  New  Hampshire, 

181 595 

Ducker  v.  Whitson,  16  S.  E.  Rep., 

854;  112  N.  C.,  44 363,  569 

Dudley  v.  Sautbine,  49  Iowa,  650; 

31  Am.  Rep.,  165 482 

Duffield  v.  Morris,  2  Harr.,  375.  .  .535 
Dugan's  Est.,  6  Pa.  Dist.  R.,  222. 

413 
Dunahugh's  Will  (Iowa),  107  N.  W. 

R.,  925 399 

Dunaway  v.  Smoot  (Ky.),  67  S.  W. 

R.,  62 389,416,417 


Duncan  v.  Mason  (Ky.),  20  S.  W.,  252. 

362 

Dunham's    Appeal,    27    Conn.,    192. 

535,  536 

Dunn  v.  Dunn,  114  Cal.,  210;  46  Pac. 

Rep.,  5 380 

Durcher  v.  Hill,  29  Mo.,  271 587 

Durham  v.  Durham,  10  P.  D.  (Eng.), 
80 762 

Eakin  v.  Hawkins,  37  S.  E.  Rep.,  622 

(W.  Va.) 367 

Ean  v.  Snyder,  46  Barb.,  230 386 

Early  v.  Standard  Life  and  Ace.  Ins. 

Co.,  113  Mich.,  58;    71  N.  W.  R., 

500;  67  Am.  St.  Rep.,  445 140 

Earp  v.  Edgington,  107  Tenn.,  23; 

64  S.  W.  R.,  40 520 

Ecksines'  Estate,  1  Clark,  224 584 

Edgerly,  7nre,84  N.  W.  Rep.,  653. .  588 
Edgerly  v.  Union  St.  R.  Co.,  36  Atl. 

Rep.,  558;  67  N.  H.,  312 376 

Edington  v.  Mutual  Life  Ins.  Co.,  67 

N.  Y.,  185 140 

Edson's  Will,  In  re,  24  N.  Y.  Supp., 

711 556 

Edwards  v.  Davis  (Ohio),  30  Wkly. 

Law  Bull.,  283 397 

Edwards  v.  Millsaps  (Tex.  Civ.  App.), 

70S.  W.  R.,  357 416 

Edwards  v.  Rives,  35  Fla.,  89;  17  So. 

R.,416 515 

Edwards  v.  State,  38  Tex.  Cr.,  386; 

43  S.  W.  R.,  112;  39  L.  R.  A.,  262. 

380,  501 

Edwards  v.  State  (Tex.),  54  S.  W.  R., 

589 490,501 

Egbers  v.  Egbers,  177  111.,  82;  52  N. 

E.  R.,285 507 

Eggers  v.  Eggers,  57  Ind.,  461 ....  536 
Eisenberg,  Matter  of  (U.  S.  Dist.  Ct. 

S.  D.  of  N.  Y.),  8  Am.  Bk'cy  Rep., 

551 598 

Elder  v.  Schumacher,  18  Col.,  433;  33 

Pac.  R.,  175 363,  364 

Eldredge  v.  Palmer,  185  111.,  618;  57 

N.  E.  Rep.,  770 363,  368 


TABLE    <)K    CASES    CITED    IX    THIS    VOLUME. 


XVII 


Elias  r.  Enterprise  B.  *  L.  AUK. 

<  .  188;  24  S.  E.  R.,  102  :<71 

Klliott  9.  Keith,  102  <Ja.,  117;21»  >  1 

U  .  155 515 

Klliott  v.  Wilby.  13  Mo.  App.,  19. 

666 
Kills  r.  Ellis,  20  Ky.  Law  R.,  438; 

46  S.  W.  Rep.,  521 

Kills  p.  State,  24  S.  W.  Rep.,  894;  33 

Texas  Cr.  App.,  86 537 

Elwood  v.  O'Brien.  74  X.  W.  Rep., 

740;  105  Iowa.  239 355 

Ely's  Est.,  In  re,  16  Misc.  Rep.  (N. 

Y.),  228;  39  N.  Y.  Supp..  177     4i:< 

EUey  v.  Elzey.  1  Houst.  (Del.),  308. 

761.762 

Emerick  r.  Emerick,  49  N.  W.  (Iowa), 

1017 580 

Kmmerich  r.  Thorley.  35  App.  Div.. 

452;  54  N.  Y.  Supp.,  79. ..... .599 

Emswiler,  In  re,  8  Ohio  N.  P.,  132; 

11    Ohio  S.   &    C.    P.    Dec.,    10. 

353,580 

Endowment  Rank  K.  of  P.  r.  Allen. 

104  Tenn.,  623;  58  S.  W.  R.,  241. 

159 
Endowment  Rank  K.  of  P.,  v.  Cog- 

l.ill.  99  Tenn.,  28;  41  S.  W.  R.,  340. 

134 
Englert  r.  Englert,  198  Pa.  St.,  326; 

47  All.  R.,  940 397, 537 

Entwistle  ••  Meikle.  180  111.,  9;  54  N. 

E.  Rep..  217 393, 412 

Equitable  Life  Ins.  Co.  v.  Hazlewood, 

75  Texas,  338;  12  S.  W.  R.,  621; 

16  Am.  St.  Rep..  893;  7  L.  R.  A., 

217 133 

Eslava    v.    Lepretre.    21    Ala..   504. 

586.597 

Eater  v.  Bridgforth,   114  Ala.,  221; 

21  So.  R.,  512 416,523 

Ethridge  v.  Bennett's  Kxrs.,  9  Houst. 

(Del.),  295;  31  All.  Rep.,  813.  .541 
Evans'  Estate,  In  re  (Iowa),  86  N.  W. 

R.,283 391.517 

Evans'  Will,  In  re.  37  Misc.  R.,  337; 

75  N.  Y.  Supp.,  491 892 


Evans  v.  Johnson,  39  W.  Va.,  299; 
23  L.  R.  A.,  137;  19  S.  E.  R.,  623. 

586 
Evers  v.  State,  31  Tex.  Cr.  App.,  318; 

20  S.  W.  R.,  744 490 

Eyre  v.  Shaftsbury,  2  P.  Wms.,  118. 

582 

F.v,  D.,  4  Swab,  and  T.,  86 765 

F.  v.  P.,  orw  F.,  75  L.  T.,  192  .. .765 

Fain  r.  Com.,  78  Ky.,  183 480 

1  'air-child  v.  Bascom,  35  Vt.,  398.  .531 
Falk  r.  Wettram.  120  Cal.,  479;  52 

Pac.  Rep.,  707 356 

Farmer  v.  Farmer,  31  S.  W.  Rep.,  096; 

129  Mo.,  530 393 

Farnham  v.  Pierce,  141  Mass..  203. 

427 
Farnsworth  v.  Noffsinger,  33  S.  E. 

Rep.,  246;  46  W.  Va.,  410 356 

Farnum  v.  Boyd,  56  N.  J.  Eq.,  766; 

41  Atl.  R..  422 389 

Farrell  v.  State,  45  Ind.,  371 482 

Fan-is  v.  Com.,  1  S.  W.  R.,  729. .  .455 
Faulkner  v.  Territory,  6  New  Mex., 

464;  30  Pac.  R.,  905 559, 577 

Feder  v.  Iowa  State  Trav.  Men's 

Ass'n,  109  Iowa,  538;  78  N.  W.  R., 

252;  70  Am.  St.  Rep.,  212;  43  L.  R. 

A.,  693 136.  137 

Feegan's  Estate,  1  Myrick  Prob.  Rep. 

(Cal.),  10 595 

Feigenbaum  v.  Howe,  32  Misc.  R., 

514;  66  N.  Y.  Supp.,  378 368 

Feld  v.  Borodofski,  87  Misc.,  72;  40 

So.  R.,  816 426 

Fenton's  Will,  In  re,  97  Iowa.  192; 

66  N.  W.  R.,99 391,514.525, 

527.544 

Ferrell  v.  State,  43  Tex.,  503. ..  .488 
Ferris  ».  Ferris,  8  Conn.,  166. ..  .762, 

764 
Fidelity  &  Casualty  Co.  r.  Chambers 

(Va.),  24  S.  E.  R.,  896 575 

Fidelity  &  Casualty  Co.  r.  Johnson, 

72  Miss.,  333;  17  So.  R.,  2,  3;  30  L. 

R.  A.,  206  .  ..136 


Xviii 


TABLE  or  CASES  CITED  INT  THIS  VOLUME. 


Fidelity  Trust  Co.,  In  re,  27  Misc.  (N. 

Y.),  118;  57  N.  Y.  Supp.,  361.  .354 
Fielbright  v.  Perry  Co.,  145  Mo.,  432; 

43  S.  W.  R.,  955 399 

Field  v.  Shorb,  99  Cal.,  661;  34  Pac., 

504 365 

Finn,  Matter  of,  54  N.  Y.  State  Rep., 

301 393 

Finn's  Est.,  1  Misc.  (N.  Y.  Surr.),  280; 

22  N.  Y.  Supp.,  1066 392 

Fire  Ins.  Patrol  v.  Boyd,  120  Pa.  St., 

624 427 

First  Nat.  Bk.  v.  McGinity  (Tex.  Civ. 

App.),  69  S.  W.  R.,  495.  ...  368,  537 
Fischer  v.  State,  30  Texas  App.,  502; 

18  S.  W.  Rep.,  90 559, 560,  562 

Fitzgerald,  In  re,  3  Stewart,  59.  .590 
Flach  v.  Gottschalk,  41  Atl.  Rep., 

908;  88  Md.,  368 365,  366 

Flanagan  v.  People,  52  N.  Y.,  467; 

10  Am.  R.,  731 431,  436,  440, 

448,  449 
Flanagan  v.  People,  86  N.  Y.,  559; 

13  Weekly  Dig.,  242 490,  499 

Flanagan  v.  State,  103  Ga.,  619;  30  S. 

&.  R.,  550 455,  479,  503,  505 

Flanagan  v.  State,  106  Ga.,  109;  32 

S.  E.  R.,  80 532 

Flansburgh's  Will,  In  re,  82  Hun,  49; 

31  N.  Y.  Supp.,  177 402,  410 

Flint's  Estate,  In  re,  100  Cal.,  391; 

34  Pac.  R.,  863 523 

Fluck  v.  Rea,  51  N.  J.  Eq.,  233;  27 

Atl.  Rep.,  636 412,414 

Fogarty  v.  State,  80  Ga.,  450;  5  S. 

E.  Rep.,  782 445 

Folger,  In  re,  4  Johns.  Ch.,  169.  .591 
Folt's  Will,  In  re,  71  Hun  (N.  Y.), 

492;  24  N.  Y.  Supp.  1050 539 

Fonville  v.  State,  91  Ala.,  39;  8  So. 

Rep.,  688 487,490,495 

Foot  v.  Aetna.  Life  Ins.  Co.,  61  N.  Y., 

571 134 

Foran  v.  Healy  (Kan.),  85  Pac.  R., 

751 525 

Forbell  v.  Den  ton,  53  App.  Div.,  402; 

65  N.  Y.  Supp.,  1120 598 


Ford  v.  State,  71  Ala.,  385 552 

Ford  v.  State,  73  Miss.,  734;  19  So.  R., 

665 431,  551,  552,  557, 

558,  564 
Foreman,  Matter  of,  54  Barb.,  274, 

affirming  1  Tuck.,  205 394,  399 

Forman  v.  Forman  (Super.  Ct.  of  N. 

Y.),  24  N.  Y.  Supp.,  91? 376 

Fowler  v.  Ramsdell,  4  Alb.  L.  J.,94. 

400 

France  v.  Frantz,  4  Ohio  N.  P.,  278. 

580 
Francis  v.  Wilkinson,  147  111.,  370; 

35  N.  E.  Rep.,  150 361,  362, 

390 
Franklin  Life  Ins.  Co.  v.  Galligan, 

71  Ark.,  295;  73  S.  W.  R.,  102;  100 

Am.  St.  R.,73 132 

Freeman  v.  Mercantile  Ace.  Ass'n, 

156  Mass.,  351;   30  N.  E.  R.,  1013; 

17  L.  R.  A.,  753 143 

French  v.  State,  85  Wis.,  400;  55  N. 

W.  Rep.,  566 430,  433,  586 

French  v.  State.,  93  Wis.,  325;  67  N. 

W.  Rep.,  706 430,  483,  511, 

586 
French  Lumbering  Co.  v.  Theriault, 

107  Wis.,  627;    83  N.  W.  R.,  927; 

51  L.  R.  A.,  910 364,  366,  381 

Fricke,  Matter  of,  19  N.  Y.  Supp., 

315 406 

Friery  v.  People,  54  Barb.,  319;  2 

Keyes,  424 ....487 

Frost  v.  Redford,  54  Mo.  App.,  345. 

597 
Fulb right  v.  Perry  Co.,  145  Mo.,  432; 

46  S.  W.  Rep.,  955 539 

Fulton  v.  Umbehend  (Mass.),  65  N. 

E.  R.,  829 570 

Funk,  In  re,  101  Fed.  Rep.,  244.  .598 
Furlong  v.  Carraher,  102  Iowa,  358; 

71  N.  W.  Rep.,  210 543 

Furlong  v.  Carraher,  108  Iowa,  492; 

79  N.  W.  Rep.,  277 540,  547 

G.  v.  G.,  L.  R.  2  P.  and  D.,  287;  46 
L.  J.  P.  and  M.,  83;  25  L.  T.  Rep. 


TABLE    OF   CASES    CITED    IX    THIS    VOLI'MF.. 


XIX 


N.  S.,  510;  20  Weekly  Rpt.,   KM. 

765 

< !.,  33  Mil..  401 :•  ! 

('..,67  N.  J.  Eq..  30;  5tt  All.  U., 

736 7i;2.  7»-. 

<  lal.le  v.  Rauch,  50  S.  ('.. '.»:>;   27  S.  K. 

H..555 387.  117.  :.M 

Oaines  r.  Fidelity  and  Casualty  Co.. 

Ill  App.  Div.  (N.  Y.),  386. .      I  :•• 
Gale  v.  Mutual  Aid  and  Ace. 

66  Hun  (N.  Y.),  600;  21  Supp., 

893 143 

Gait  r.  Provan.  79  N.  W.  Rep..  357: 

108  Iowa,  561 356 

Galveston,   etc.,  Ry.  Co.   v.   Harris. 

22  Tex.  Civ.  App.,  16;  53  S.  W.  R.. 

599 428 

Camber  v.  Ganiber,  24  App.  Div.,  446; 

48  N.  Y.  Supp.,  501 :.]:. 

Gamble  v.  Gamble,  39   Barb..   373. 

392 
Gammon's  Will,  In  re,  2  Misc.  Rep. 

(N.  Y.),  329;  21  N.  Y.  Supp.  931. 

395.  3<t7 

Gardner  r.  Arnett,  21  Ky.  L.  R..  1: 

508.  W.  R.,  840 768 

Gardner  r.  Day.  95  Me.,  558;  50  Atl. 

R..  892 429 

Gardner  r.  Gardner.  22  Wend.  (N.  Y.), 

526.  rev'g  7  Paige.  112 413 

Gardner  v.  Jones,  126  Cal.,  614;    59 

Pac.  R.,  126 592 

Garland  v.  Smith.  127  Mo.,  567;    28 

S.  W.  R.,  191;   29  S.  W.  R.,  836. 

519 
Garloy  v.  Park  (Ind.  Sup.),  35  N.  E., 

279 407 

Garner  r.  State,  28  Fla..  113;  9  So. 

Rep..  835 487,  490.  493,  494 

Gnrn-tson  r.  Hubbnrd,  81  N.  W.  R«-p.. 

174 

Garrison  r.  Hlauton,  48  Tex..  2!»'' 
Cat*  r.  Hill, 46  La.  Ann..  27;  14  S,, 

R..294 :.7.-. 

Gates  r.  Bain,  2  Strick..  1104..  .354 
Gatley's  Eat.,  In  re,   16  Pa.  Co.  Ct. 

Rep..  09:   4  Pa.  Dint.  R..  52..  .402 


<;<-hrkc  r.  State,  13  Tex.,  568 

Geis  v.  Geis.  116  App.  Div.  (N.  V ... 

362;  101  Supp..  s-45 765 

Genl.  Conv.  (if  New  Jerusalem  Ch.  v. 

Crocker,  7  O.  Co.  Ct.,  327 397 

Gt-nsi'iiHT's  Kstate,  In  re,  170  Pa.  St. 

96;  32  Atl.  R.,  561 528 

<:«-MX   9.  State,  59  N.  J.  Law,  488; 
37  Atl.  R..  ii»;  58  N.  J.  Law,  482; 

:  I  Atl.  R.,  816. ! 431,  448,  450, 

536,  547,  561 

German  Sav.  &  Loan  Soc.  r.  De  Lash- 
mutt,  67  Fed.  R.,  399 364 

<  Irnnon  r.  Duhois,  23   La.  Ann.,  26. 

586 

Gibson  v.  Gibson,  9  Yerg..  329..  .539 
Citi.m's  Will,  In  re,  44  App.  Div.  (N. 
Y.),  621;  60  N.  Y.  Supp.,  65.  .  .401 
ilcs  In  re,  11  Paige  (N.  Y.),  243. 

591 

r.  Bishop,  46  App.  Div.  (N. 
Y.),  350;  61  N.  Y.  Supp.,  467.  .388 
Gilham's    Estate,  In  re  (N.    J.),  52 

Atl.  R.,690 413,  417 

Gillespie  r.  Gouly,  120  Cal.,  515;  52 

Pac.  Rep..  816 381 

Gillespie  v.  Thompson,  7  Ind.,  353. 

591 
Gilman  v.  Ayer  (N.  J.  Pre.),  47  Atl. 

R.,  1049 396 

Ginrich  r.  Rogers,  96  N.  W.  R.,  156 

(Neb.) 364 

Givin  r.Givin  (Idaho), 48 Pac.  R., 295. 

398,  416.  520 

Glasscock  v.  Tatc.  107  Tenn.,  486;  64 

S.  W.  i:.-|>.,715 381 

(Jlavin  r.  R.  I.  Hoap..  12  R.  I.,  411. 

607 
Gli-M.  Ex  partf,  4  Dramas.  Eq.  (S.C.). 

.'.If. 761 

Glenn  r.  Glenn,  87  Mo.  App.,  377. 

482 
Goddard  t».  Wcstcott.  32  Mich..  180; 

46  N.  W.  R.,  242 767,  768 

Goldsticker.  Matter  of.  192  N.  Y..  35. 

392 
Goldthorp,  In  re,  94  Iowa.  336;  02 


XX 


TABLE  OF  CASES  CITED  IN  THIS  VOLUME. 


N.  W.  R.,  845 503,  518, 

540,  548 
Goldthorp's  Est.,  In  re  (Iowa),  88  N. 

W.  R.,  944 567 

Gombault  v.  Public  Administrator,  4 

Bradf.,226 410 

Gonzales  v.  State,  31  Tex.  Cr.  App., 

508;  21  S.  W.  R.,  253 484, 

487,  490 
Goodbar  v.  Lidikay,  136  Ind.,  1;  35 

N.  E.  R.,  691 555 

Goodhart  v.  Speer,  7  Ohio  Dec.,  47. 

527 

Goodwin  v.  State,  96  Ind.,  550. 

531 
Gordon  v.  Burns,  135  Mo.,  223; 

54  S.  W.  R.,  546 416 

Gordon  v.  Burns,  141  Mo.,  602;  63 

S.  W.  R.,642 520 

Gordon's  Est.,  In  re,  28  Pittsb.  L. 

J.  (N.  S.),  78 555 

Gorkow's  Est.,  20  Wash.,  563;  56 

Pac.  R.,  385 403 

Goucher  v.  Northwestern  Traveling 

Men's  Ass'n,  20  Fed.,  596 143 

Gould  v.Gould, 78  Conn.,  242;  61  Atl., 

604 766,  767 

Grand  Lodge  A.  O.  U.  W.  v.  Jesse, 

50  111.  App.,  101 373 

Grand  Lodge  v.  Wieting,  168  111.,  408; 

48  N.  E.  Rep.,  59 373,  541, 

542,  546 
Grand  v.  Thompson,  4  Conn.,  203; 

10  Am.  Dec.,  119 531 

Grattan  v.  Metropolitan  Life  Ins.  Co., 

92  N.  Y.,  274;  44  Am.  Rep.,  372. 
132,  138,  139 

Gray,  In  re,  5  N.  Y.  Supp.,  464 . .  403, 

406 

Green,  Matter  of,  67  Hun,  527 ....  393 
Green's  Will,  In  re,  20  N.  Y.  Supp., 

538;  id.,  67  Hun,  527;  22  Supp. 

1112 519,  555 

Green  v.  Green,  145  111.,  264;  33  N. 

E.,  941 389,  390,  409 

Green  v.  State,  59  Ark.,  246;  27  S. 

W.  R.,  5 511 


Green  v.  State,  64  Ark.,  523;  43  S.  W. 

R.,  973 455,  505,  508,  529, 

548 

Greene  v.  Ro worth,  113  N.  Y.,  470. 

553 
Greenwade   v.   Greenwade,    43   Md., 

313 580 

Greenwood  v.  Cline,  7  Or.,  18.  ..  .399 
Gregory's  Estate,  In  re,  133  Cal.,  131; 

65  Pac.  R.,  315 520 

Gresh's  Case  (Pa.  Quarter  Sessions), 

12  Pa.  Co.  Ct.  R.,  295 592 

Gress  Lumber  Co.  v.  Coody  (Ga.),  27 

S.  E.  Rep.,  169 547 

Gribbon  v.   Maxwell,   34  Kansas,  8. 

364,  366 

Gridley  v.  St.  Francis  Xavier  College, 

137  N.  Y.,  327 585 

Griffeth  v.  Griffeth,  162  111.,  368;  44 

N.  E.  R.  820;  55  111.  App.,  474. 

763,  765 

Griffin's  Est.,  Inre,9  Pa.  Dist.  R.,  248; 

23  Pa.  Co.  Ct.  R.,  559 565 

Grimes  v.  Shaw,  2  Tex.  Civ.  App.,  20; 

21  S.  W.  R.,  718 528 

Gring   v.    Lerch,    112   Pa.    St.,    244; 

3  Atl.,  841 768 

Gross,  In  re,  14  State  Rep.,  429.  .403 
Grover  v.  Zook,  44  Wash.,  489;  87 

Pac.,  638 768 

Guetig  v.  State,  66  Ind.,  94;   32  Am. 

R.,  99 456,  514 

Guiteau   Case,    10    Fed.    Rep.,    161. 

443,  475 

Gunn,  Appeal  of,  63  Conn.,  254;  27 

Atl.  R.,  1113 519 

Gurley  v.  Park,  135  Md.,  440;  35 

N.  E.  R.,  279 523 

Gustavenson  v.  State  (Wyo.),  68  Pac. 

R.,    1006 491 

Guthrie's  Appeal,  16  Penn.  St.,  321. 

584 

H.'v.  P.  orse  H.,  3  P.  and  D.,  126. 

763 

Hagan  v.  Sone,  68  App.  Div.,  60;  74 
N.  Y.  Supp.,  109 535 


TABLE    OF   CASES    CITED    IX    THIS    VOLUME. 


xxi 


Hagan  r.  State,  5  Baxt.  (Tenn.),  615. 

508 

Hailes,  In  re,  3  Johns.  Ch.  (N.  Y.), 567. 

50] 
Unities  v.  Hayden,  95  Mich.,  :{:;_':  .">l 

N.W.  R.,911 .YJl.. V_>:< 

Haines  p.  Scott,  35  App.  Div.  ^\ .  ^ 

515;  54  N.  Y.  Supp.,  844 355, 

356,366 
Halbert's  Will,  In  re,  15  Misc.  R.,  30K; 

37  N.  Y.  Supp.,  757 300, 

414,  419 
Hale  v.  Sterp  (Colo.),  42  Pac.  Rep., 

598 375 

Hall  v.  Com.  (Pa.),  12  All.  Rep.,  163. 

445 
Hall  P.  Perry,  87  Me.,  569;  33  Atl. 

Rep.,  160 393,397 

Hall  r.  Wright,  1858,  E.  B.  and  E., 

746 767 

Hall's  WUl,  In  re  (Sun.),  5  Misc.  R. 
N.  Y.),  461;  24  N.  Y.  Supp.,  864. 

386 
Hallenbeck  v.  Cook,  180  111.,  65;  54 

N.  E.  Rep.,  154 392 

Hallet  r.  Patrick,  49  Cal.,  590 584 

Hallott  v.  Hallett,  8  Ind.  App.,  305; 

34  N.  E.  R.,740 383 

Hambleton's  Appeal,  102  Pa.  St.,  5. 

596 
Hamilton  v.  Starr  (Tex.  Civ.  App.), 

27  S.  W.  R.,  587 515 

Hamilton  v.  Traher,  27  Atl.,  229 

M-l.) 583,  597 

H.tmilton's  Est.,  4  Pa.  Dist.  R.,  161; 

16  Pa.  Co.  Ct.  R.,  303 405 

Hampton  v.  Westcott,  49  N.  J.  Eq., 

682;  25  Atl.  Rep.,  254 389 

Il.imrick  v.  State,  34  N.  E.  Rep.,  3; 

134  Ind.,  324 353, 547,  579,  580 

Hanbury  r.  Hanbury,  Probate  Div. 

(1892),  222 ..377,379 

Hanley  v.  Nat.  Loan,  etc.,  Co.,  29  S. 

E.  R.,  1002;  44  W.  Va.,  450.  .  .355 
H •itum  v.  Connecticut  Mutual  Life 

Ins.  Co.,  150  N.  Y..  526;  44  N.  E. 

R..  1099..  ..131,135 


Hannon  v.  Hatmon,  51   Fed.   Rep., 

413 366 

Hansell  r.  Hansell,  13  Pa.  Co.  Ct.  R., 

.")U;  3  Pa.  Dist.  R.,  734 378 

Hanly.  In  re,  26  App.  Div.,  164;  27 

N.  V.  Civ.  Pro.  Rep.,  174;  49  N.  Y. 

Supp..  UiiS 383 

Hardy  v.  Berger,  76  App.  Div.,  393; 

78  N.  Y.  Supp.,  709 365,  367 

Hardy  r.  Merrill,  56  N.  H.,  227.  .536 
Harmony  Lodge,  etc.,  Appeal  of,  127 

Pa.  St.,  269;  18  Atl.  Rep.,  10.  .407 
Harp  v.  Parr,  168  111.,  459;  48  N.  E. 

Rep.,  113 420,  518,  519, 

521,  551 
Harper,  In  re,  68  L.  J.  Prob.  (Eng.), 

48  Prob.,  59;  80  L.  T.  (N.  S.),  458. 

SH 
Harrigan  v.  Harrigan,  135  Cal.,  397; 

67  Pac.  R.,  506 378 

Harris.  In  re  (Del.),  28  Atl.,  329  .  .584 
Harris  r.  Schlinke,  65  S.  W.  Rep., 

172  (Tex.  Civ.  App.) 380 

Harris  v.  State,  18  Tex.  Cr.  App..  287. 
451,457 

Harris  v.  U.  S.,  8  App.  D.  C.,  20.  .488 
Harris's  Will  (Surr.  N.  Y.),  In  re,  19 

Misc.  R.,  388;  44  N.  Y.  Supp.,  341. 

407 
Harrison  v.  Bishop,  131  Ind.,  161; 

30  N.  E.  R.,  1,069 525 

Harrison  v.  Otley,  101  Iowa,  652;  70 

N.  W.  R.,  724 366 

Harrison  r.  Rowan,  3  Wash.  C.  C., 

580 388 

Hart  t'.  Deamer,  6  Wend.,  497.  .  .367 
Hart  v.  Miller  (Ind.  App.),  64  N.  E. 

R.,  239 382.505 

Hartford  Life  and  Annuity  Ins.  Co., 

v.  Gray,  91  111..  159 133 

Hartman  v.  Strickler,  82  Va.,  225. 

418 

Hastings  r.  Rider,  99  Mass.,  622.  .531 
Hathaway,  Matter  of,  80  Hun,  186. 

596 

Hathaway  v.  Ins.  Co.,  48  Vt.,  335. 

536 


XX11 


TABLE    OF    CASES    CITED   IN   THIS    VOLUME. 


Hawe  v.  State,  11  Neb.,  537;  38  Am. 

R.,  375 439,  450 

Hawkins  v.  Grimes,  13  B.  Monroe 

(Ky.),  257 566 

Hawley  v.Griffin  (Iowa),  82  N.  W.  R., 

905 510,  537 

Hawley  v.  Griffin,  92  N.  W.  R.,  113. 

381,  425 

Hawley  v.  Nat'l  Loan,  etc.,  Co.,  44 

W.Va.,450;  29  S.  E.  R.,  1022.  .364 
Hay  v.  Miller,  48  Neb.,  156;  66  N.  W. 

R.,  1115 357,363 

Hayes  v.  Candee  (Conn.),  52  Atl. 

Rep.,  826 547,548 

Hayes  v.  Kerr,  19  App.  Div.  (N.  Y.), 

91;45N.  Y.  Supp.,  1050 362 

Haynes  v.  Hayden  (Mich.),  54  N.  W. 

R.,  911 395 

Hays  v.  Commonwealth  (Ky.),  33  S. 

W.  Rep.,  1104;    17  Ky.  Law  R., 

1147 439 

Head  v.  State,  43  Neb.,  30;  61  N.  W. 

Rep.,  494 492 

Heald  v.  Thing,  45  Me.,  392 532 

Healy  v.  Mutual  Ace.  Ass'n,  133  111., 

556;  25  N.  E.  R.,  52;  23  Am.  St. 

R.,  637;  9  L.  R.  A.,  371 137 

Heath  v.  Koch,  74  App.  Div.  (N.  Y.), 

338;  77  Supp.,  513 555 

Heckman  v.  Adams,  50  Ohio  St.,  305; 

34  N.  E.  R.,  155 586 

Heff  v.  Cox,  5  Ohio  N.  P.,  413 ....  381 
Hegney  v.  Head,  29  S.  W.  Rep.,  587; 

126  Mo.,  619 410,  556 

Hemingway's  Est.,  In  re  (Orphs.  Ct.), 

7  North.  Co.R.  93;  195  Pa.  St.,  91; 

45  Atl.  R.,  726 395,  396,  397 

Hemlock  Poor  Dist.  v.  Hufford,  8 

Kulp  (Pa.),  202 382 

Hempton  v.  State,  111  Wis.,  127;  86 

N.  W.  R.,  596 491,  514, 

526,  527,  536,  546,  552 
Hennell  v.  Board  of  Comrs.,  132  Ind., 

32;  31  N.  E.  R.,  462 425 

Hennessy's  Heirs  v.  Woulfe,  49  La. 

Ann.,  1376;  22  So.  Rep.,  394. 
412,  420 


Henrich  v.  Saier  (Mich.),  82  N.  W.  R., 

879  394,  521 

Henrick  v.  Langford,  108  Cal.,  608; 

41  Pac.  R.,  701 417,  419 

Henrizi  v.  Kehr,  90  Wis.,  344;  63 

N.  W.  Rep.,  285 362 

Henry  v.  Hall,  106  Ala.,  84;  17  So. 

Rep,  187 405,  555 

Henry's  Will  (Surr.  N.  Y.),  In  re,  18 

Misc.  Rep.,  149;    41  N.  Y.  Supp., 

1096 411 

Hepler  v.  Hosack,  197  Pa.  St.,  631; 

47  Atl.  Rep.,  847 548 

Herndon  v.  Vick,  18  Tex.  Civ.  App., 

583;  45  S.  W.  R.,  852.  .  .  .527,  551 
Herr  v.  Cent.  Ky.  Lun.  Asyl.,  17  Ky. 

L.  R.,  320;  30  S.  W.  R.,  971 ...  .427 
Herster  v.  Herster,  122  Pa.  St.,  239; 

16  Atl.  R.,  342 503 

Hertrich  v.  Hertrich  (Iowa),  87  N. 

W.  R.,689 538,539 

Heseman  v.  Vogt,  181  111.,  400;  55  N. 

E.  R.,  151 391,  392,  516, 518 

Hewitt's  Will,  In  re,  31  Misc.  R.,  81; 

64  N.  Y.  Supp.,  571 412,  535 

Hewitt  v.  Taunton  St  Ry.  Co.,  167 

Mass.,  483;  46  N.  E.  Rep.,  106. 
537,  548 

Hickman  v.  State,  38  Tex.,  190.  .532 
Hicks  v.  Marshall,  3  Hun,  327 .  .  367 
Higbie  v.  Guardian  Mut.  Life  Ins.  Co., 

53  N.  Y.,  603,  605,. 143 

Higginbotham  v.  Higginbotham 

(Ala.),  17  So.  R.,  516 417 

Hildreth  v.  Marshall  (N.  J.  Pre.),  51 

N.  J.  Eq.,  241;  27  Atl.  R.,  465.  .418 
Hill  v.  Bahrus,  158  111.,  314;  41  N.  E. 

R.,  912 503,  519 

Hill  v.  Day,  34  N.  J.  Eq.,  150. ..  .591 
Hill  v.  Fly  (Tenn.),  52  S.  W.  Rep.,731. 

404 
Hill  v.  State,  42  Neb.,  503;  160  N.  W. 

R.,916 492 

Hinchman,  Ex  parte,  4  Clark  (Pa.), 

184 586 

Hindman  v.  Hutchinson,  30  Pittsb. 

Leg.  J.  (N.  S.),422 604 


TABLE   OF   CASES    CITED    IX    THIS    VOLUME. 


XX11I 


Hindman  r.  Van  Dyke,  1    J  Pa.  St., 

24ii;  25  All.  R.,  772 519 

Hirley  v.  Kettle  (Tex.  Civ.  App.),  65 

S.  \V.  R.,  48 IM' 

Hite  r.  Commonwealth,  31  S.  E. 

Rep.,  895;  96  Va.,  489 1M. 

536,546 

Hoag,  In  re,  7  Paige  (N.  Y.),  312 .  .  597 
Hobbs,  In  re,  73  Conn.,  262;  47  Atl. 

R.,  678  523 

Hobbs  v.  People,  183  111.,  336;  55  N. 

E.  Rep.,  6'J2 384 

Hoch  v.  Hoch.  197  Pa.  St.,  387;  47 

Atl.  Rep.,  351 363 

Hogmeir's  Appeal,  108  Mich.,  410; 

66  N.  W.  R.,327 536 

Hohn  v.  Interstate  Casualty  Co.  of  N. 

Y.,  115  Mich.,  79;  72  N.  W.  R., 

1105 143 

Holcomb,  In  re  (Iowa),  82  N.  W. 

Rep.,  1000 354 

Holcomb  v.  Holcomb,  95  N.  Y.,  316. 

546 

Holcomb  r.  State,  4  Tex.  125 536 

Holdom  v.  A.  O.  U.  W.,  159  111.,  619; 

31  L.  R.  A.,  67;  43  N.  E.  Rep.,  772. 

374 
Holland  r.  Zollner,  102  Cul.,  633;  36 

Pac.  Rep.,  930 538 

Hollis  r.  Drew  Theological  Seminary, 

95  N.  J.,  166 393 

Holman's  Estate,  In  re,  70  Pac.  R., 

908 415 

Holmberg  r.  Phillips  (Iowa),  78  N.  W. 

It. -p.,  66 403 

Holtzman  v.  Hoy,  19  111.  App.,  459. 

603 
Homire  r.  Halfman,  156  Ind.,  470; 

60  N.  E.  Rep.,  154 429 

Hoope's  Estate,  In  re,  174  Pa.  St., 

:<7:<;34  Atl.  R.,603 526, 

537,569 

Hoover,  In  re,  19  D.  C.,  495 390 

Ilunvor  r.  State,  48  Neb.,  184;  66  N. 

W.  Rep.,  1117 537 

Hoper.  Campbell,  App.  Cas.  (1899), 

1  (Eng.) 397 


Hopkins  ».  Wheeler,  21   R.  I.,  533; 

45  Atl.  Rep.,  551 548 

Hopps  v.  People,  31  111.,  385;  83  Am. 

Dec.,  231 437,  451 

Hopt  v.  People,  104  U.  S.,  631. 
490,  492 

Horn   v.    Pullman,    72   N.    Y.,   276. 

393,  403,  404,  40<i,  411 

Hornish  v.  People,  142  111.,  620;  18 

L.  R.  A.,  237;   32  N.  E.,  677. .  .436 

Horton  v.  U.  S.,  15  App.  D.  C.,  310. 

530,534 

Hosier  v.  Beard,  54  Ohio  St.,  398. 

366 
Houston  v.  State,  26  Tex.  App.,  657; 

14  S.  W.  Rep.,  352 487,  490 

Hovey  v.  Chase,  52  Maine,  304 .  .  580 
Hovey  v.  Harmon,  49  Maine,  269. 

582 
Howard  v.  State,  36  S.  W.  Rep.,  475; 

37  Tex.  Cr.  App.,  494 552 

Howat  v.  Howat's  Exr.,  41  S.  W. 

Rep.,  771;   19  Ky.  Law  R.,  756. 

389.  419 

Howe  v.  Provident  Fund  Soc.,  7  Ind. 

App.,  586;  34  N.  E.  R.,  830.  ...  132 
Howe  r.  Richards  (Iowa),  83  N.  W. 

Rep.,  909 387,  389,  394, 

413,  517,  567 
Howell  v.  Taylor  (N.  J.  Prerog.  Ct.), 

50  N.  J.  Eq.  (5  Dick.),  428;  26  Atl. 

566 389,  402 

Howes  v.  Colboum,  165  Mass.,  385; 

43  N.  E.  R.,  125, 511 

Hoyt's  Est.,  In  re,  10  Kulp  (Pa.),  166. 

384.  391,  551 

Hubbard    r.    Mutual    Reserve    Fund 

Life  Ass'n,   100  Fed.,  719;   40  C. 

C.  A.,  665 140 

Hudson  v.  Adam's  Adm.,  20  Ky.  Law 

R.,  1267;  49  S.  W.  Rep.,  192.  .537 
Hudson  r.  Hughan,  56  Knn.,  152; 

42  Pac.  701 409 

Hudson  r.  Lynn  &  B.  R.  Co.  (Mass.), 

59  N.  E.  Rep.,  67 376 

Huff  v.  Sovereign  Camp,  85  Mo.  App., 

96..  ..374 


XXIV 


TABLE    OF    CASES    CITED    IN   THIS   VOLUME. 


Huggins  v.  Drury,  192  111.,  528;  61 

N.  E.  R.,  652 566 

Hughes  v.  Jones,  116  N.  Y.,  67.  .357, 

367,  369 

Hull's  Will,  In  re  (Iowa),  89  N.  W.  R., 

979 567 

Humboldt,  In  re,  12  Phila.,  424.  .592 
Humpeler  v.  People,  92  111.,  400. 

482 
Hunt  v.  Rabitony,  7  Detroit  Leg. 

News,  447;  84  N.  W.  R.,  59. .  .366 
Hunt  v.  Searcy  (Mo.),  67  S.  W.  R., 

206 587 

Hunt  v.  State  (Tex.  Cr.  App.),  28 

S.  W.  Rep.,  206 559,  564 

Hunter  v.  Edney  orse  H.,  10  P.  D.,  93. 

762 
Hunter  v.  Talbard,  34  S.  E.  Rep.  (W. 

Va.),  737 375 

Hurlburt's  Will,  In  re,  48  App.  Drfc, 

91;  62  N.  Y.  Supp.,  698 555 

Hurlbut,  Matter  of,  26  Misc.,  461; 

57  N.  Y.  Supp.,  648 412 

Hurst  v.  State  (Tex.  Cr.  App.),  40 

S.  W.  R.,264 533,537 

Hurst  v.  State  (Tex.  Cr.  App.),  50  S. 

W.  R.,719 559,561 

Hutchinson  v.  Hutchinson,  152  111., 

347;  38  N.  E.  Rep.,  926 402, 

410 
Hutts  v.  Hutts,  62  Ind.,  214 585 

lago  v.  lago,  168  111.,  339;  48  N.  E. 

Rep.,  30 - 378,  598 

Illinois  Masons'  Benefit  Soc.  v.  Win- 

throp,  85  111.,  537 142 

Imperial  Loan  Co.  v.  Stone,  1  Q.  B., 

599  (Eng.) 365 

Inhabitants  of  Fayette  v.  Chesterville, 

77  Me.,  28;  52  Am.  Rep.,  741 .  .532 
Inhab.  of  Kittery  v.  Dixon,  96  Me., 

368;  52  Atl.  Rep.,  799.  .  .382,  383 
Insurance  Co.  v.  Hunt,  79  N.  Y.,  541. 

366 
Iredale's  Will,  In  re,  53  App.  Div., 

45;  65  N.  Y.  Supp.,  533.... 386, 
397,  403,  410,  533 


Irish  v.  Newell,  62  111.,  196 566 

Isaacs   v.   Jones,    121   Gal.,   257;   53 
Pac.  R.,  793 526 

Jackson  v.  Jackson,  39  N.  Y.,  153, 

reversing  1  Tuck.,  259 392 

James  White  Memorial  Home  v.Haeg, 

68  N.  E.  R.,568;  204  111.,  422.  .391 
Jamison  v.  Culligan,    lol   Mo.,  410; 

52  S.  W.  R.,  224 364,  368 

Jamison  v.  People,  145  111.,  357;  34 

N.  E.  R.,  486 536,  557,  559 

Jaques  v.  Pub.  Adm.,  1  Bradf.  Surr. 

(N.   Y.),  499 ' 762 

Jaroszewski  v.  Allen  (Iowa),  91  N.  W. 

R.,  941 429 

Jenisch,  Re  Isabella,  3  Abb.   N.  C., 

200 430 

Jenkins  v.  Hankins,  98  Tenn.,  545; 

41  S.  W.  Rep.,  1028 426 

Jenkins  v.  State,  93  Ga.,  1;  18  S.  E. 

R.,  992 496 

Jennings  v.   Hennesy,   26   Misc.    (N. 

Y.),  265;  55  Supp.,  833 362 

Jewell  v.  Colby,  24  Atl.,  902;   66  N. 

H.,  399 425 

J.  G.  v.  H.  G.,  33  Md.,  401 ....  763,  764 
John  Hancock  Mut.  Life  Ins.  Co.  v. 

Dick,  117  Mich.,  518;  76  N.  W.  R., 

9;  44  L.  R.  A.,  846 !  .  135 

Johnson,  In  re,  57  Cal.,  529 525 

Johnson's  Will,  In  re  (Surr.),  7  Misc. 

R.  (N.  Y.),  220;  27  N.  Y.  Supp., 

649 386,  519 

Johnson's  Will,  In  re,  57  N.  Y.  State 

Rep.,  846 413 

Johnson  v.  Armstrong  (Ala.),  12  So. 

R.,72 417,508 

Johnson  v.  Cochrane,  159  N.  Y.,  555; 

54  N.  E.  Rep.,  aff'g  91  Hun,  168; 

36  N.  Y.  Supp.,  283 408, 

409,  546 
Johnson   v.  Commonwealth,   23   Ky. 

Law  R.,  856;  64  S.  W.  R.,  467. 

424 
Johnson  v.  Johnson,  187  111.,  86;  58  N. 

E.  Rep.,  237 553,  566 


TABLE    OF    i    I&E8    •  I  IKD    IN    THIS    VOLUME. 


\\V 


Johnson  r.  Johnson,  -1~>  Mo..  .">'.>.">  .  7(>2 
Jthnson  ••.  Kincade.  :<7  N.  ('.,  -470. 

789 
Jnhn.s-.n  r.  State,  45  IS.  \V.  H<-|-..  I ::*'•: 

KM)  Tenn.,  254 4:«» 

,ii>hn»on  r.  State  (Tex.  Cr.  App.),  62 

S.  \\.  Hop.,  756 .545,549 

John.Min  r.  Stevens,  15  Ky.  Law  R., 

177:  LM  S.  W.  R.,  957 565 

.1..!..  -  r.  Angell,  95  Ind.,  376 603 

Ji.ni-s  r.  Collins,  94  Md.,  403;  51  Ail. 

H..  398 532,  538, 

545,  547,  548.  568,  569 
Jones  r.  Galbraith  (Tenn.  Ch.  App.'. 

59  S.  W.  Rep.,  350 :>:>7 

.I..IK-S  r.  Grogan,  98  Ga.,  552;  25  S.  K. 

R.,  590 520 

Jones  v.  Jones  (N.  Y.),  63  Hun.  ti:«): 

17  N.  Y.  Supp.,  905 552 

.lon.'s  r.  Learned,  66  Pac.  R.,  1071 

(Colo.  App.) 586 

Jones  v.  People,  23  Colo.,  276;  47 

Par.  R..  275 509 

Jones  i'.  Roberts,  37  Mo.  App.,  165 . 503 
Jones  P.  Simpson,  171  Mass.,  474;  50 

V  K.  R.,940 416 

Jones's  Will,  In  re  (Surr.),  5  Misc.  R. 

(N.  Y.),  199;  25  N.  Y.  Supp.,  109. 

397,403,411,412 

Jordan  v.  People,  19  Colo.,  417;  36 

Pac.  R.,  218 529,531 

Journeay's  Will,  In  re,  15  App.  Div. 

(N.  Y.),  567;  44  N.  Y.  Supp.,  548; 

aff'd  162  N.  Y.,  611,  646;  57  N.  E. 

Ri-p.,  1113 391,  419,  516 

Jin  Id  r.  Gray,  156  Ind.,  278;  59  N.  E. 

R..  849 380 

Julke  p.  Adam,  1  Redf.  Surr.  (N.  Y.), 

454 414 

K:ii-nclers  r.  Montague,  180  111.,  300; 

I  \.  E.  Rep.,  321 394,  519 

Kaufman's  Estate,  In  re,   117  Cal., 

288;  49  Pac.  R.,  192 393. 

418,  520,  523 

Kaufman  r.  Caughman.  49  S.  C.,  159; 
27  S.  E.  R.,  16. .    .  .516.  519,  538 


Ki-arney  r.  State,  6S  Miss.,  233;  8  So., 

292 436,532,559 

Kearney's  Will,  In  re,  69  App.  Div., 

481;  74  N.  Y.  Supp.,  1045 535 

Ki-vfTe  v.  Nat'l  Ac_.  Soc.,  4  App.  Div. 

(X.  Y.).  392;  38  Supp.,  854.  ...  140 
Keeler  r.  Keeler,  20  X.  Y.  State  Rep., 

439 399 

Keeler 's  Will,  In  r«,  3  X.  Y.  Supp., 

»i29 399 

Keenan  v.  Commonwealth.  44  Pa., 

55;  84  Am.  Dec.,  814 493 

Keener  r.  State,  24  S.  K.  R.,  28;  97 

Ga.,388 560 

Keithley  v.  Stafford,  126  111.,  507;  18 

X.  K.  Rep.,  740 387,  409 

Koithley's  Estate,  In  re.  134  Cal.,  9; 

66  Pac.  R.,  5 538 

Kelch  p.  State  (Ohio),  45  N.  E.  R.,  6. 

560 
Kellogg  v.  Church  Char.  F.,  128 

App.  Div.  (N.  Y.),  214;  112  Supp., 

566 607 

Kellogg  v.  U.  S.,  43  C.  C.  A.,  179; 

103  Feil.,  200 552 

Kelly  r.  Burke  (Ala.),  31  So.  Rep., 

512 369 

Kelly  r.  Commonwealth.  1  Grant 

(Pa.)  Cas.,  484 492 

Kelly  v.  Kelly,  74  X.  W.  Rep.,  899; 

72  Minn.,  19 383 

Kelly  r.  Odell  (111.),  48  N.  E.  R.,  158. 

518 
Kelly  r.  Perrault  (Idaho),  48  Pac.  R., 

45 355 

Kelly  v.  State,  31  Tex.  Crim.  R.,  216; 

20  S.  W.  Rep..  357 484.  487 

Kendriek's  Estate,  In  re.  130  Cal., 

360;  62  Pac.  R.,  605 394,  395, 

:«W.  397.  398 

Kennedy  r.  Johnson,  65  Pa.  St.,  451. 

596.  597 

Kent  r.  Kent,  22  Misc.  (N.  Y.),  408; 

50  N.  Y.  Supp..  339 381 

Kent  r.  West,  33  App.  Div.,  112;  53 

N.  Y.  Supp.,  244 382.  383 

Ken  worth  r.  Williams,  5  Ind.,  375.  580 


XXVI 


TABLE    OP    CASES    CITED    IN    THIS    VOLUME. 


Kenyon  v.  Knights  Templar  and  M. 

M.  A.  Ass'n,  122  N.  Y.,  247.  .  .134 
Kern  v.  Kern,  51  N.  J.  Eq.,  514;  26 

Atl.,831 376,  761 

Ketteman  v.  Metzger,  23  Ohio  C.  C. 

R.,  61 389,  419,  508,  521, 

543,  560 
Keystone  Mut.  Ben.  Ass'n  v.  Jones, 

72  Md.,  363;  20  Atl.  R.,  195.  ...  133 
Kibler,  Ex  parte,  31  S.  E.  Rep.,  274; 

53  S.  C.,  461 381 

Kiedaisch,  Will  of,  13  N.  Y.  Supp., 

255 404 

Kiehne  v.  Wessell,  53  Mo.  App.,  667. 

370,  592 
Kimball  v.  Baumgardner,  16  OhioC. 

C.,  587 370 

Kimball  v.  Fisk,  39  N.  H.,  110.  ...  586 
Kimberly,  Appeal  of,  68  Conn.,  428; 

36  Atl.  R.,  847;  37  L.  R.  A.,  261. 
395,  398,  544 
King,  see  Rex. 
King  v.  Harvey  and  Chapman,  2  Barn. 

and  Cress.,  257 602 

King  v.  King,  42  S.  W.  Rep.,  347;  19 

Ky.  Law  Rep.,  868 389,  567 

King  v.  State,  90  Ala.,  612;  8  So.  R., 

856 490,  491,  493 

King  v.  State,  91  Tenn.,  617;  20  S.  W. 

Rep.,  169 559 

King  v.  State,  64  S.  W.  R.,  245.  .490 
King's  Will,  In  re,  29  Misc.  R.,  268; 

61  N.  Y.  Supp.,  238 391,  512 

Kingsley  v.  Blanchard,  66  Barb.  (N. 

Y.),  317 566 

Kingston  v.  Fort  Wayne,  etc.,  R.  Co., 

112 Mich., 40; 70 N.  W.R.,315.  .428 
Kirkpatrick  v.  Jenkins,  96  Tenn.,  85; 

33  S.  W.  R.,  819 503,  519,  525 

Kischman  v.  Scott,  166  Mo.,  214;  65 

S.  W.  R.,  1031 390 

Kissam  v.  Kissam,  21  App.  Div.,  142; 

47  N.  Y.  Supp.,  270 380 

Knight's  Est.,  167  Pa.  St.,  453;  31 

Atl.  Rep.,  682 403,  411 

Knights  v.  State,  58  Neb.,  225;  78  N. 

W.  R.,508 435,557 


Knights  Templars'  &   Masons'  Life 

Indemnity  Co.  v.  Crayton,  209  111., 

550;  70  N.  E.  R.,  1066 135 

Knights  Templars'  &  Masons'  Life 

Indemnity  Co.  v.  Jamian,  104  Fed. 

R.,  638;  44  C.  C.  A.,  93;  aff'd  Supr. 

Ct.  U.  S.,  187  U.  S.,  197;  23  Supr. 

Ct.  R.,  108 373 

Knox  v.  Knox,  95  Ala.,  495;  11  So. 

R.,  125 418 

Koegel  v.  Egner,  54  N.  J.  Eq.,  623; 

35  Atl.  Rep.,  394.  .  .  .390,  552,  555 
Kolb's  Est.,  In  re,  6  Pa.  Dist.  Rep., 

543 382 

Kostelecky  v.  Scherhart,99  Iowa,  120; 

68  N.  W.  R.,  591 536,  544 

Kraus  v.  Kraus,  9  Ohio  S.  &  C.  P. 

Dec.,  515;  6  Ohio  N.  P.,  248. .  .767 
Krause  v.  Stein,  173  Pa.  St.,  221; 

-33  Atl.  Rep.,  1031  363 

Kroenung  v.  Goehri,  112  Mo.,  641; 

20  S.  W.,  631 356,  362 

Krom  v.  Schoonmaker,  3  Barb.,  647. 

425 
Kuster  v.  Kuster,  37  Misc.  (N.  Y.), 

136;  74  N.  Y.  Supp.,  853 379 

L.  v.  L.,  7  P.  D.,  16 763,  765 

La  Bau  v.  Vanderbilt,  3  Redf.,  384, 

436 386 

Lack  v.  Brecht,  166  Mo.,  242;  65  S.  W. 

R.,  976 368,371 

Lackey  v.  Lackey,  8  B.  Mon.,  107. 

585 
Lacky  v.  Cunningham,  56  Pa.  St., 

373 591 

Lacy  v.  Mann,  59  Kan.,  777;  53  Pac. 

Rep.,  754  375 

Lacy  v.  State,  30  Tex.  App.,  119. 

562 

Lamb  v.  Lamb,  105  Ind.,  456 394 

Lamb  v.  Lippincott,  115  Mich.,  611; 

73  N.  W.  Rep.,  887 542 

Lamb  v.  Lynch,  56  Neb.,  135;  76  N. 

W.  Rep.,  428 537 

Lambert,  In  re,  134  Cal.,  626;  66  Pac. 

R,  851;  55  L.  R.  A.,  856 587 


TABLE   OF   CASES   CITED    IX    THIS   VOLUME. 


XXV11 


Lamoree,  In  re,  32  Barb.  (N.  Y.),  122. 

594 
Lamoureaux  v.  Crosby,  2  Paige  (N. 

Y.)(  422 369 

Lancaster  Co.  Nat.  Bk.  v.  Moore,  78 

Pa.  St.,  407 :«il 

Landfair  v.  Thompson,  112  Ga.,  487; 

37  S.  E.  Rep.,  717 362 

Lanckton  v.  U.  S.,  18  App.  D.  C.,  348. 

448 
Lane  v.  Moore,  151  Mass.,  87;  23  N. 

E.  R.,  387 503 

Lang  r.  Ingalls  Zinc  Co.  (Tenn.  Ch. 

App.),  49  S.  W.  R.,  288 575 

Lang's  Will,  9  Misc.  Rep.  (N.  Y.), 

521 ;  30  N.  Y.  Supp.,  388 ...  393, 395 
Langdon  v.  People,  133  111.,  382;  24 

N.  E.  R.,  874 552 

Lange  v.  Wiegand  (Mich.),  85  N.  W. 

R.,  109;  7  Det.  Leg.  N.,  673..  .512 
Lanier,  In  re,  170  N.  Y.,  7;  62  N.  E. 

Rep.,    761;    68    App.    Div.,    320; 

74  N.  Y.  S.,  70 592 

Lanier,  In  re,  68  App.  Div.,  320; 

74  N.  Y.  Supp.,  70;  170  N.  Y.,  7; 

62  N.  E.  Rep.,  761 383 

Lantes  r.  Davidson,  60  Kan.,  389; 

56  Pac.  R.,  745 551 

Lapey  v.  State,  29  Tex.  App.,  63;  14 

S.  W.  R.,398 494 

Lapham's  Will,  In  re,  19  Misc.  R. 

(N.  Y.),  71;  44  N.  Y.  Supp.,  90. 

397,  550,  569 

Laros  r.  Commonwealth,  84  Pa.  St., 

200 508 

Lasher,  In  re,  2  Barb.  Ch.,  97 590 

Latinier  v.  Sovereign  Camp  Wood- 
men, 62  S.  C.,  145;  40  S.  E.  Rep., 

155 374 

I,atimer  r.  State,  55  Neb.,  609;  76  N. 

W.  R.,  207 492 

Lawrence's  Will.  In  re,  27  Misc.  R., 

473;  59  N.    Y.  Supp.,  174;  aff'd, 

48  App   Div..  83;  62  N.  Y.  Supp., 

673 535 

Lawson  v.  Hilton,  69  App.  Div.  (N. 

Y.),  303;  85  Supp.,  863.  .588,  594 


Layer  v.  Layer,  22  Ky.  L  w  Rep., 

1936;  62   S.  W.   Rep.,   15. 

394,  398,  568 

Leache  v.  State,  22  Tex.  Cr.  App.,  279; 

58  Am.  Rep.,  638;  3  S.  W.  R.,  539. 

457.  552 

Leacocke,    In   re,   Lloyd   and   Goold 

(Eng.  Ch.),  498 595 

Leavell  v.  Western  Ky.  Asyl.  for  the 

Insane,  28  Ky.  L.  R.,  1129;  91  S. 

W.  R.,  671;  4  L.  R.  A.  (N.  S.),  269. 
427,  607 

Le  Barron  v.  Le  Barren,  35  Vt.,  365. 

765 
Le  Donne,  In  re,  173  Mass..  550; 

54  N.  E.  R.,  244 430.  587 

Led  with  v.  Claffy,  18  App.  Div.,  115; 

45  N.  Y.  Supp.,  612 386, 

416,  521.523 

Lee  v.  State  (Ga.),  42  S.  E.  R..  759. 

431 
Lee  v.  State  (Tex.  Cr.  App.),  64  S.  W. 

R.,  1047 423 

IxMining's  Est.,  In  re,  4  Pa.  Dist.  Ct. 

R.,  94;  36  W.  N.  C.,  118  .  .404,  411 
Lenno  v.  State  (Tex.  Cr.  App.).  68 

S.  W.  Rep.,  684 430 

Leonard  v.  State  Mutual  Life  Ass.  Co., 

24  R.  L,  7;   51  Atl.  R.,  1049;  96 

Am.  St.  R.,  698 133 

Leonard  r.  The  Times,  51  111.  App., 

427 381 

Leonard's  Estate,  In  re  (Mich.),  54 

N.  W.  R.,1082 353 

Ixjvis's  Estate,  In  re,  140  Pa.,  179; 

21  Atl.,  242 414 

Lewis,  Matter  of,  57  Misc.  (N.  Y.), 

670 590 

Lewis  v.  Hay  ward,  35  L.  J.  P.  and 

M.,  105 765 

Lewis  r.  Jones.  50  Barb.,  645 413 

Lewis  r.  Mason,  42  App.  Div.,  423;  59 

N.  Y.  Supp.,  123 882 

Liddell  r.  Easton's  Trustees,  9  F.. 

154 788 

Lilly  r.  People,  148  111..  467;  36  N.  E. 

R.,  95 437,  451,  563 


XXV111 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


Lincoln,    In    re,    1    Brewster,    392. 

585,  589 

Lindberg  v.  Davidson,  72  Minn.,  49; 

74  N.  W.  Rep.,  1018 355 

Lindsay  v.  White  (Tex.  Civ.  App.), 

61  S.  W.  R.,  438 529,  530 

Lindsey,  In  re,  44  N.  J.  Eq.,  564; 

s.  c.,  15  Atl.  1 589 

Link  v.  Sheldon,  136  N.  Y.,  1.  .  .  .531 
Linkmeyer  v.  Brandt,  107  Iowa,  750; 

77  N.  W.  R.,  493 392,  525 

Little  v.  Little,  13  Gray  (Mass.),  264. 

761 

Little  v.  State,  61  S.  W.  R.,  483.  .490 
Litton  v.  Grand  Lodge  A.  O.  U.  W., 

84  Mo.  App.,  208 581 

Livingston,  In  re,  1  John.  Ch.  (N.  Y.), 

436 594 

Livingston,  In  re,  9  Paige  (N.  Y.),  440. 

595,  597 

Livingston    v.    Livingston,    56    App. 

Div.  (N.  Y.),  484;  67  N.  Y.  Supp., 

789 381 

Livingston's  Will  (N.  J.),  In  re,  37 

Atl.  Rep.,  770 390 

Lobdell  v.  Laboring  Men's  Mutual  Aid 

Ass'n,  69  Minn.  14;  71  N.  W.  R., 

696;   65  Am.  St.  R.,  542;  38  L.  R. 

A.,  537 143 

Loermecker's  Will,  In  re,  112  Wis., 

461;  88  N.  W.  R.,  215.  .  .  .503,  555 
Loeser's  Est.,  In  re,  3  Pa.  Dist.  Ct.  R., 

817;  167  Pa.  St.  Rep.,  498;  31  Atl. 

Rep.,    732;    35    W.    N.    C.,    543. 

411,  412 

Loewenstein,  Matter  of,  2  Misc.,  323; 

51  St.  Rep.,  423;  21  N.  Y.  Supp., 

231 409 

Loftus  v.  Mahoney,  89  Va.,  576;  16 

S.  E.  R.,  749 363 

Logan  v.  McGinnis,  12  Pa.,  27 539 

Logan  v.  State  (Tex.  Cr.  App.),  53  S. 

W.,  694 549 

Logan's  Estate,  In  re,  195  Pa.  St., 

282;  45  Atl.  R.,  729 520,  555 

London  v.  Preferred  Ace.  Ins.  Co.,  43 

App.  Div.  (N.  Y.),  487 138 


Long  v.  Bowen,  94  Ky.,  540;  23  S.  W. 

Rep.,  343 424 

Long  v.  Long,  2  Hawkes,  189 ....  768 

Long  v.  Long,  9  Md.,  348 364 

Long  v.  Morrison,  14  Ind.,  595.  .  .  .603 
Long  Island  State  Hospital  v.  Stuart, 

22  Misc.  R.  (N.  Y.),  48;  49  N.  Y. 

Supp.,  372 382 

Longley  v.  Commonwealth,  2  Va. 

Supr.  Ct.  Rep.,  600;  37  S.  E.  Rep., 

339 484 

Looby  v.  Redmond,  66  Conn.,  444; 

34  Atl.  Rep.,  102 362 

Look  v.  Choate,  108  Mass.,  116.  .605 
Looney  v.  State,10  Tex.  Cr.  App.,  520; 

38  Am.  Rep.,  646 457 

Lopez  v.  State,  30  Tex.  App.,  487;  17 

S.  W.  R.,  1058 423 

Lorenz  v.  Lorenz,  93  111.,  376 762, 

764 

Lott  v.  Sweet,  33  Mich.,  308 599 

Loudoun  v.  8th  Avenue  Railway  Co., 

16  App.  Div.  (N.  Y.),  152;  44  Supp., 

742 132 

Longhead  v.  Coombs  Co.,  2  Mo.  App. 

Rep.,  1017 375 

Loughney  v.  Loughney,  87  Wis.,  92; 

58  N.  W.  Rep.,  250 539 

Louis  v.  Conn.  Mut.  L.  Ins.  Co.,  58 

App.  Div.  (N.  Y.),  137 135 

Louisiana  W.  E.  Ry.  Co.  v.  Mc- 
Donald (Tex.  Civ.  App.),  52  S.  W. 

Rep.,  649  429 

Louisville  &  N.  R.  Co.  v.  Cummins' 

Admr.,  23  Ky.  L.  R.,  681;  63  S.  W. 

R.,  594 428 

Louisville  etc.  Ry.  Co.  v.  Herr,  35  N. 

E.  Rep.,  556;  135  Ind.,  591 367 

Lovegrove  v.  State,  31  Tex.  Cr.  R., 

491;  21   S.  W.  Rep.,  191.... 436, 

445,  559,  560 

Lowe,  In  re,  64  Hun  (N.  Y.),  633; 

19  N.  Y.  Supp.,  245 592 

Lower  v.  Schumaker,  61  Kan.,  625; 

60  Pac.  R.,  538 376,  592 

Lucas  ?'.  Johnson  (Tex.  Civ.  App.), 

64  S.  W.  R.,823 429 


TABLE    OF   CASES    CITED    I\    THIS    VOLUME. 


XXIX 


Ludlow's  Will.  In  re,  6 Ohio  Dec..  :M  1; 

4  Ohio  N.  R.,  155 566 

Ludwick  v.  Commonwealth,  18  Pa. 

St.,  175 591 

Luhrs  v.  Hancock,  181  U.  S.,  567. .  364 
Lynch  r.  Doran,  96  Mich.,  395;  54  N. 

W.,882 356,  362 

Lyon  ».  Home,  L.  R.  6  Eq.,  655.  .399 
Lyon  v.  Lyon,  230  111.,  366;  82  N.  E. 

R.,  850 767 

M.  r.  B.,  3  Swab  and  T.,  550.  ..  .765 

M.  v.  H.,  3  Swab,  and  T.,  517 765 

Maasr.  Phillips  (Okl.),  61  Pac.  Rep., 

1057 430 

Maas  v.  Territory,  10  Okl.,  714;  63 

Pac.   R.,  960;  53  L.   R.  A.,  814. 

353,  436,  450,  560 

Mabie,  Matter  of,  5  Misc.,  179;  24  N. 

Y.   Supp.,  855 402,  406 

Mackin  v.  State,  56  N.  J.  Law,  495; 

36  Atl.  R.,  1040 436 

Maddox  v.  Maddox,  21  S.  W.  Rep., 

499;  114  Mo.,  35 389,  390,  555 

Mage  v.  State,  60  S.  W.  R.,  55 524 

Makepeace  r.  Bronnenberg,  146  Ind.. 

243;  45  N.  E.  R.,  336 593 

Mallory  v.  The  Travelers    Ins.  Co., 

47  N.  Y.,  52 143 

Mallory  v.  Young,  94  Ga.,  804;  22  S. 

E.  R.,142 504 

Malone's  App.,  79  Pa.  St.,  481 593 

Manatt  v.  Scott,  106  Iowa,  203;  76 

N.  W.  Rep.,  717 394, 409, 

.503,  517,  521 
Mangrum    v.   Commonwealth.   39   S. 

W.  Rep..  703;  19  Ky.  Law  R..  94. 

738 
Manhattan  L.  Ins.  Co.  r.  Beard,  23 

Ky.  L.  R.,  174;  66  S.  W.  R.,  35. 

374 
Manhattan   Life  Ins.  Co.  v.  Carder. 

82  Fed.,  986;  27  C.  C.  A.,  334.  .  139 
Manley's  Exre.  v.  Staples  (Vt.),  26 

Atl.  R.,  630 568 

Mann   r.  Keene  Guaranty  Sav.  Bk., 

83  Fed.,  51..  ..350 


Manogue    v.   Hewell,   13  App.  D.  C., 

455 520 

Mapes  r.  People,  69  III.,  523.  ...482 
Marceau  v.  Travellers    Ins.  Co.,  101 

Cal.,    338;    35    Pac.    Rep.,    856. 
433,688 

Marons  r.  Marons,86  111.  App..  597 . 380 
Mansion  v.  Kennebec  Mut.  Life  Ins. 

Co.,  89  Me.,  266;  36  Atl.  R.,  389; 

56  Am.  St.  R.,  412 132 

Martin,   Matter  of,  98   N.    Y.,    193. 

404,554 

Martin  v.  Bowdoin,  158  Mo.,  379;  59 

S.  W.  R.,  227 394,522 

Martin  v.  Insurance  Co.,  57  N.  J.  Law, 

623;  31  Atl.  R.,  213 133 

Martin    v.  Martin,  54   W..  Va.,  301; 

46  S.  E.  R.,  120  767 

Martin  v.  Mottsinger  (Ind.),  30  N.  E., 

523 586 

Martin  v.  State,  119  Ala.,  1;  25  So. 

R.,  255 559 

Martin  v.  State  of  N.  Y.,  120  App. 

Div.  (N.  Y.),  633 427 

Martin   r.   Thayer,   37   W.    Va.,   38; 

16  S.  E.,489 389.394.397 

Martinez  v.  Moll.  46  Fed.  Rep.,  724 

(U.S.Cir.Ct.  La.) 365 

Marvin,/nre,  1  Dill.,  178;  16  Fed.Cas., 

927 598 

Marvin  r.  Marvin,  3  Abb.  N.  Y.  Ct.  of 

App.,  192 419 

Maryland  Casualty  Co.  v.  Hudgins,  97 

Tex..  124;  76  S.  W.  R.,  145;  64  L. 

R.  A.,  349 141 

Marx  r.  McT.lynn.  88  N.Y..  370.   393 
Mason,  Matter  of,  1   Barb.  (N.  Y.), 

936 590 

Massengale  r.  State  (Tex.),  6  S.  W.  R., 

35 436 

Massie    r.    Commonwealth,    15    Ky. 

Law  R.,  562;  24  S.  \V.  Rep.,  611. 

536,  544 

Masters  v.  Jones  (Ind.),  64  N.  E.  R., 

213 382 

Matchcn  v.  Matchen,  6   Barr  (Pa.). 
332,  378 


XXX 


TABLE    OF   CASES    CITED    IN   THIS   VOLUME. 


Matthiessen  &  Weichers   Ref.  Co.  v. 

McMahon,  38  N.  J.  L.,  536.  .  .  .364 
Mattson  v.  Mattson  (Wash.),  69  Pac. 

R.,  1,087 371,381 

Mattson     v.     Modern      Samaritans, 

91  Minn., 434;  98  N.  W.  R.,330..132 

May    v.    Bradlee,    127    Mass.,    414. 

531,  546 

May  v.  May,  109  Mass.,  252 595 

Maynard  v.  State  (Tex.  Cr.  App.),  39 

S.  W.  R.,  667 515 

Mayo  v.  Jones,  78  N.  C.,  402 566 

Mays  v.  Prewett,  98  Tenn.,  474; 

40  S.  W.  R.,  483 362 

McAffee    v.    Commonwealth,    3    B. 

Mon.,  305 585 

McAnan  v.  Tiffin,  143  Mo.,  667;  45 

S.  W.  R.,  656 364 

McCabe,  Inre,  70  Vt.,  155;  40  Atl.  R., 

52 509,  537,  547 

McCandless   v.    McWha,    22   Penn., 

261 '. 603 

McCarthy,  Matter  of,  48  State  Rep., 

315;  20  N.  Y.  Supp.,  581;  65  Am., 

624 408 

McCarthy  v.   Travelers    Ins.   Co.,  8 

Bissel'sU.  S.  C.  C.  Rep.,  362;  Fed. 

Cas.  No.  8682 137 

McCarty    v.    Commonwealth    (Ky.), 

20  S.  W.  Rep.,  229 487 

McClackey  v.  State,  5  Tex.  App.,  320. 

536 
McClary  v.  Stull,  62  N.  W.  Rep.,  501; 

44  Neb.,  175 392,  393,  400 

Me  Cleary  v.  Barcalow,  6  Ohio  Circuit 

Ct.,481 ....370,379 

McCook  v.  State,  91  Ga.,  740;  17  S. 

E.  Rep.,  1019 487,497 

McCormick    v.    McCormick    (Iowa), 

81  N.  W.  R.,  172 565 

McCoy  v.  Metropolitan  Life  Ins.  Co., 

133  Mass.,  82 133 

McCulloch  v.  Campbell,  49  Ark.,  367; 

5  S.  W.  R.,  540 418 

McCury  v.  Hooper,  12  Ala.,  823.  .586 

McDonald  v.  Morton,   1  Mass.,  543. 

591,  594 


McElroy's  Case,  6  W.  and  S.  (Pa.), 

451 580 

McFadin   v.   Catron,    120   Mo.,   252; 

25  S.  W.  Rep.,  506 412,  417, 

535,  578 
McFarland's  Trial,  8  Abb.  Pr.  N.  S., 

57 434 

McGarvan  v.  Brooks,  16  So.  R.,  936 

(Miss.) 374 

McGee  v.  Hayes,   127  Cal.,  336;  59 

Pac.  R.,  767 526 

McGinnis  v.  Commonwealth,  74  Pa. 

St.,  245 591 

McGinniss  v.  Dempsey,  27  Mich.,  363. 

566 
McGlother  v.  Provident  Mut.  Ace.  Co. 

of  Phila.,  89  Fed.,  685;  32  C.  C.  A., 

318 140 

McGovern's  Est.,  In  re,  185  Pa.  St., 

203;  39  Atl.  Rep.,  816 396 

McGraw  v.  McGraw,  50  N.  E.  R.,  526. 

552 
McGraw's  Will,  In  re,  9  App.  Div., 

372;  41  N.  Y.  Supp.,  481 408 

McHugh  v.  Fitzgerald  (Mich.),  61  N. 

W.  Rep.,  354 548 

Mcllroy's  Est.,  In  re,  10  Pa.  D:3t.  R., 

78 399 

Mclntosh  v.  Moore,  22  Tex.  Civ.  App., 

22;53S.W.  R.,611 419,503, 

511 

Mclntyre  v.  People,  38  111.,  514.  .  .487 
Mclntyre  v.  Sholty,  121  111.,  660;  13 

N.    E.    Rep.,  239 425 

McKean's  Will,  In  re,  31  Misc.  R.,  703; 

66  N.  Y.  Supp.,  44 534 

McKee's  Admr.  v.  Purnell,  38  S.  W. 

Rep.,  705;  18  Ky.  Law  Rep.,  879. 

367 
McKenzie  v.  Donnell,  151  Mo.,  461; 

52  S.  W.  R.,  222 368 

McKissock  v.  Groom,  148  Mo.,  459;  50 

S.  W.   Rep.,   115 362 

McLaughlin's  Will,  2  Redf.   (N.  Y. 

Surr.),   504 393,  414 

McLean  v.  Breese,   109  N.  C.,  564. 

597 


TABLE  or  CASES  CITED  i\  THIS  VOLUME. 


XXXI 


McLeod  r.  State,  31  Tex.  Cr.  R.,  331; 

20S.W.R.,749 531,541,562 

McLeroy  v.  State,  120  Ala.,  274;  25 

So.  R.,247 491 

McMahon  v.  McMahon,  186  Pa.  St., 

485;  40  Atl.,  795 767 

McMillin   v.   Wm.    Deering  Co.,   38 

N.  E.  Rep.,  398;  139  Fed.,  70.  .366 
McNaghten's  Case,  10  Clark  &  F.  H. 

L.  Cas.,  200;   1  Car.  &  K.,   130. 

431,  435,  449,  450,  465,  467 

McNairy  Co. ».  McCoin,  45  S.  W.  Rep., 

1070;   101  Tenn.,  74 383 

McNary  v.  Blackburn,  186  Mass.,  141; 

61  N.  E.  Rep.,  885 429 

McQueen  v.  Wilson,  31  So.  R.  (Ala.), 

94 555 

Mead  r.  Stegall,  77  111.  App.,  679.  .366 
Mebany   v.   Mebany,   59   Ind.,   257. 

591 
Medill  v.  Snyder,  61  Kan.,  15;  58  Pac. 

R.,962 395 

Medlockv.Cogburn,  Vol.B.  Rich.  Eq., 

477 585 

Medlock   v.   Merritt,    102   Ga.,   212; 

29  S.  E.  Rep.,  185 .377 

Meehan    r.    Traders    and    Travelers 

Ace.  Co.,  34   Misc.    (N.  Y.),  158; 

68Supp.,821 141 

Meigs  v.  Dexter,  172  Mass.,  217;  52  N. 

E.  R.,  75 357 

Meister  v.  Moore,  96  U.  S.,  76 761 

Memphis   Nat.    Bank    v.    Sneed,   97 

Tenn.,  120;36S.W.  Rep.,  716..365 
Mendenhall  v.  Tungate,  15  Ky.  LAW 

R.,  639;  24  S.  W.  R.,  431 .  .  409,  575 
M.  nncily     v.     Employers'     Liability 

Amur.  Corp.,  148  N.  Y.,  596;  43 

N.  E.  R.,  54;  31  Am.  St.  R.,  716; 

31  L.  R.  A.,  686 139,  141 

Merriam.  Matter  of,  42  N.  Y.  State 

Rep.,  619;   16  N.  Y.  Supp.,  738. 
403,  406 

Merrill   v.    Merrill,    126   Mass.,   228. 

763,765 

Mf-rriman,    In   re,    108    Mich.,    454; 

66  N.  W.  R.,  372.  .  ..503 


Merriman  v.  Merriman,  153  Md.,  631; 

55  N.  E.  R.,  734 568 

Merritt  v.  Merritt,  43  App.  Div.  (N. 

V.),  68;  59  N.  Y.  Supp.,  357. . .  .371 
Merritt  v.  Merritt,  32  Misc.  (N.  Y.)  21; 

66  N.  Y.  Supp.,  123,  aff'd  62  App. 

Div.,  617;  71  N.  Y.  Supp.,  1142. 

356 
Merritt  v.  State,  39  Tex.  Cr.  App.,  70; 

45  S.  W.  Rep.,  21. .  .464,  466,  515, 

541 
Merritt  v.  State,  40  Tex.  Cr.,  359; 

50  S.  W.  Rep.,  384 542 

Messner  v.  Elliott,  184  Pa.  St.,  41; 

39  Atl.  R.,  46 415, 507, 

518,548,551,555 
Metcalf's  Will,  In  re.  16  Misc.  Rep. 

(N.  Y.),  180;  38  N.  Y.  Supp.,  1131. 

410,  520 

Metropolitan  Life  Ins.  Co.  v.  Bergen, 

64  111.  App.,  685 142 

Meyer  v.  Meyer,  49  How.  Pr.,  311. 

767 
Meyer  v.  People,  156  111.,  126;  40  N. 

E.  R.,490 563 

Meyer  v.  St.  Louis  I.  M.  &  S.  Ry.  Co., 

54  Fed.  Rep.,  116 426 

Michigan  Mut.  Life  Ins.  Co.  r.  Leon, 

135  Ind.,  636;  37  N.  E.  R.,  584. 

132 
Middleborough  v.  Rochester,  12  Mass., 

363 761 

Middleditch  r.  Williams,  45  N.  J.  Eq., 

726;  17  At.,  826;  4  L.  R.  A.,  783. 

400,  503 

Miles  v.  Treanor,  194  Pa.  St..  430; 

45  Atl.  Rep.,  368 555 

Mill  v.  Carr,  5  Ind.  App.,  491;  32  N. 

E.  R.,  591 536 

Miller  v.  Miller.  187  Pa.  St..  572; 

41  Atl.  Rep..  277;    43  W.  N.  C., 

84 549 

Miller  v.  Mut.  Ben.  Life  Ins.  Co.,  31 

Iowa,  216;  7  Am.  R..  122  .170 

Miller  v.  Oestrich,  157  Pa.  St..  264: 

27  Atl.  Rep.,  742  .405.420 

Miller  v.  State,  5  ( )hio  St. ,  275 ....  482 


XXX11 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


Miller  v.  State,  3  Wyo.,  657;  29  Pac. 

R.,  186 559,  562 

Miller's  Est.,  In  re,  179  Pa.  St.,  645; 

36  Atl.  Rep.,  139;  39  W.  N.  C.,  397. 

407 
Miller's  Lunacy,  In  re,  Pa.  Dist.  R., 

269 592 

Milligan  v.  Pollard,  112  Ala.,  465; 

20  So.  Rep.,  620 365,  367 

Mills  v.  Cook  (Tex.  Civ.  App.),  56  S. 

W.  Rep.,  697 548 

Mills  v.  Cook  (Tex.  Civ.  App.).  57  S. 

W.  Rep.,  81 421,  548 

Minder  v.  State,  113  Ga.,  772;  39  S. 

E.  Rep.,  284 446,  561 

Mitchell  v.  Copenning  (N.  C.),  32  S. 

E.  Rep".,  798 403 

Mitchells.  Kingman  (Mass.),  5  Pick- 
ering, 431 354 

Mitchell  v.  State  (Fla.),  31  So.  R., 

242 537 

Modawell  v.  Holmes,  40  Ala.,  291.  583 
Modern  Woodmen  v.  Kozak,  63  Neb., 

146;  88  N.  W.  R.,  248 135 

Moett  v.  People,  85  N.  Y.,  379.  .452 
Mohler  v.  Shank's  Est.,  61  N.  W.  R. 

(Iowa),  981 378 

Molton  v.  Henderson,  62  Ala.,  426. 

586 
Moneypenny,  Estate  of,  1  Month.  L. 

Bull.,  7 414 

Montag  v.  People,  141  111.,  75;  30  N.  E. 

Rep.,  887 445,  559 

Moore  v.  Commonwealth,  92  Ky.,  630; 

18  S.  W.  Rep.,  833 559 

Moore  v.  Cross,  87  Tex.,  557;  29  S.  W. 

R.,  1051 355 

Moore  v.  Gubbins,  54  111.  App.,  163. 

519 
Moore  v.  McDonald,  68  Md.,  321; 

12  Atl.  R.,  117 503 

Morain  v.  Devlin,  132  Mass.,  87;  42 

Am.  Rep.,  423 425 

Moran  v.  Moran,  106  Mich.,  8;  63  N. 

W.  R.,  989 364 

Morgan,  In  re,  7  Paige  (N.  Y.),  236. 
367,  589 


Morgan's  Case,  3  Blandf.  Ch.  (Md.), 

332 590 

Mormon  Church  v.  U.  S.,  136  U.  S.,  1. 

582 
Morris  v.  Eighth  Av.  R.  C.,  68  Hun 

(N.  Y.),  39;  22  Supp.,  666 428 

Morris    v.    Gt.     Northern     Ry.    Co. 

(Minn.),    69    N.    W.    Rep.,    628. 

368,  369 

Morris  v.  Morton's  Exrs.,  14  Ky.  Law 

R.,  360;  20  S.  W.  Rep.,  287..  .392 
Morse  v.  Crawford,  17  Vt.,  499;  44 

Am.  Dec.,    349 425,  636 

Morton  v.  Sims,  64  Ga.,  298 586 

Mott  v.  Mott,  49  N.  J.  Eq.,  192.  .  .367 
Motz's  Est.,  In  re  (Cal.),  69  Pac.  R., 

294 567 

Moulor  v.  American  Life  Ins.  Co.  ,111 

U.   S.,  335;   4    Sup.   Ct.,   266;    28 

Lawyer's  Ed.,  447 138 

Mullen  v.  Dunn,  134  Cal.,  247;  66  Pac. 

R.,  209 598 

Munger,  In  re,  38  Misc.  R.,  268;  77 

N.  Y.  Supp.,  648 504,519 

Murphree  v.  Senn,  107  Ala.,  424;  18 

So.  R.,  264 537,  552.  568 

Murphy,  Matter  of,  41  App.  Div.,  153. 

386, 411 

Murphy  v.  Commonwealth,  92  Ky., 

485;  18  S.  W.  R.,  163.  ..  .508,  531 
Murphy's  Exr.  v.  Murphy,  23  Ky.  Law 

R.,  1460;   65  S.  W.  R.,  165.  .  .  .384 
Murry  v.  Hennessy  (Neb.),  67  N.  W 

R.,  470 565 

Murtaugh  v.  City,  44  Mo.,  479 607 

Mutual    Benefit    Ass.  v.  Nancarrow, 

71  Pac.  R.,  423;  18  Colo.  App.,  274. 

143 
Mutual  Benefit  Life  Ins.  Co.  v.  Wise, 

34  Md.,  582 135 

Mutual  Fire  Ins.  Co.  v.   Showalter, 

3  Pa.  Super.  Ct.,  452;  40  N.  W.  E., 

80 426 

Mutual  Life  Ins.  Co.  v.  Hunt,  79  N. 

Y.,  541 367 

Mutual  Life  Ins.  Co.  v.  Lothrop,  111 

U.S.,  612..  536 


TAMLK    OK    «    \-l.-    '  ITK1>    IN    THIS    V<>|. I   MK. 


\\XIII 


Mutual  Life  Ins.  Co.  r.  Selby.  72  Fed..  Newhouse  r.  (i(Ml\vin.  17  Harb.,  230. 

980;   19  C.  C.  A..  331;  44   t      S.  385 

Vpp..  282 133  Now  York  Life  Ins.  Co.»r.  Fletcher. 

Mutual  Life  Inn.  Co.  r.  Stibbe.  46  M«l..  1 17  U.  S..  519;  0  Sup.  Ct.   K..  837; 

302                                  ....  135.  139  29  Lawyers'  Ed..  934 .              .  .  133 

Mutual  Life  Ins.  Co..  r.  Wiswall.  50  Niskern  r.  I'nited  Brotherhood  of  C. 

Kan..  705;  44  Pac.  K..  990 527.  ami  J.  of  A..  93  App.  Div.  (N.  Y.), 

509.  .592          :«>4 .  137 

Mutual   Reserve   Fund    Life  Ass'n  r.  Niven   r.   Kolaiul.   177   Mass..   11;  58 

Karner.  05  Ark..  581;  47  S.  W.  H..  N.  K.  R..  2X2.  .                             580 

850                                        .  .  132.  133  Nobles  /-.  State  of  Georgia.  108  IT.  8., 

Mutual  Res.  Fund  Life  Am'n  r.  Sul-          :«)8 .  . 581.  586 

livan  (Tex.  Civ.   App.).  29  S.  \V.  Noel   r.   Modem    Woodmen.    01    III. 

R..  190  ...  135          App..  597 380 

Mycr's  Kstate.  1    Myriek   Prob.  Rep.  Nonnemacher  r.   Nonnemacher.    159 

iCal.).  178  .  .                               ...596  Pa.    St..   034;   28   Atl.    Rep..   439. 

Myers   r.   Knabe.   51    Kan..   720;   33  376,  511.  504.  568,  761 

Par.  R..  002                           366  Norman  r.  Georgia  Lock  Co.  (Ga.). 

Myers   r.  State   (Tex.   Cr.  App.),  39  18  S.  E.  R.,  27.  .                          .370 

S  W.  Rep..  Ill                         .  .423  Norris  r.  State.  16  Ala..  776         .  .535 

North  r.  Joslin.  59  Mich..  024   .    .583 

Naanes  r.  State.  143  Md..  299;  42  N.  Norton  r.  Moore,  3  Head..  482       .536 

K.  R..609                                   ..520  Norton    r.    Paxton,    110    Mo..    456. 

Nailor  r.  Nailor.  4  Dana.  339 588  390 

National    Fraternity     c.    Karns.    24  Norton  r.  Seton.  3   Phill.  Keel..  147. 

Tex.  Civ.  App..  007;  00  S.  \V.  R..  763 

576..                                           ..134  \yee    /-.     Hamilton.    IK)    Ind..    417. 

Needham  r.  Me.  5  Pick.  (Mass.).  510.  585 

531 

Nelson's   Mst..   In   rr.    132  Cal..    1S2;  <  >.  A:    \V.  Thuin    Co.    r.  Tloczynski. 

04  Pac.  R..294    .              .  .:«M.401.  114  Mich..  149:  72  N.  \Y.  R..  140. 

552.  555  369 

Nelson  r.  K<|iiitablc  Life  Ass'n  Soc..  ( )akes.  In  rr.  8  \M\V  Rep.  (Mass. ).  122. 

73  III.  App..  i:«  .  .      374  599 

Nelson   r.  State  (Tex.  Cr.  App.).  07  (M>enlorf's  Kst..  In  n\  2  I^ick.  I^eg. 

S.  \Y.  R..  320                                  439  N..  43                                      :«)5.  418 

Nenbitt.  /H  n.  2  Phillips.  24.V        580  ()l)enlorfer   r.    Newlnrger   (Ky.).  67 

Nevlinji    r.   Com..   98    Pa.    St..   323.  S.  W.  R..  267                     ..415.520 

490  O'Brien    r.    People.    36   N.    Y..   270. 

Newcomb's    Kxrs.    r.    Newcomb.    Hi  532 

Ky.  Ijiw  R..  370;  27  S.  \V.  Rep..  O'Connell   r.  Beeeher.  21    App.   Div. 

997                                              ..544  (N.    Y.).    47    N.    Y.   Supp..    334. 

Newell  ( .  Newell.  9  Paige  (N.  Y.).  25.  354.  502.  538 

762.  765  O'Connell  r.  People.  S7  N.   Y ..  377. 

New   Kngland   IXMUI  «fc   Trust  Co.   r.  557 

Spitler.  .VI  Kan..  560:  .IS  Pac.  R..  O'Connor  r.  Madison. 98  Mich..  183;  57 

799 .370  N.  W.  Rep..  105.  .390.  41O  543.  54O 


XXXIV 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


O'Dea's  Will,  84  Hun  (N.  Y.).  591; 

33  N.  Y.  Supp.,  463 394,  395 

Odell  v.  Moss,  130  Cal..  352;  62  Pac. 

R.,  555 363 

O'Dwyer's  Will.  61  N.  Y.  Supp.,  903. 

410 

O'Gara  v.  Eisenlohr,  38  N.  Y. ,  296 . 761 
O'Grady  v.  State,  36  Neb..  320;  54 

N.  W.  R.,  556 485,  487, 

491,  492 
Oil  Co.  v.  Mclntire.  44  W.  Va..  296: 

28  S.  E.  R.,  922 586 

Olmstead  v.  Webb,  5  App.  Div.  (N. 

Y.),  38 520 

Omberg  v.  United  States  Mut.  Ass'n, 

101  Ky.,  303;  40  S.  W.  R..  909; 

72  Am.  St.  R..  413 141 

Oneida  Co.  r.  Bartholomew.  82  Hun 

(N.  Y.),  80;  31  N.  Y.  Supp.,  106. 

382 
O'Neil  v.  Nolan,  66  Hun  (N.  Y.).  631; 

21  N.  Y.  Supp.,  222 350 

Orchardson  r.  Cofield,  171  111..  14; 

41  N.  E.  R..  197;  40  L.  R.  A.,  256. 

398,  399,  410 

O'Reilly  v.  Sweeney,  54  Misc.  R.,  408; 

105  N.  Y.  Supp.,  1,033 525 

Orr  v.  Equitable  Mtg.  Co.,  33  S.  E. 

Rep.,  708;  107  Ga.,  499 365 

Orth  r.  Orth  (Ind.),  44  N.  E.  R.,  17. 

555 
Oster  r.  Meyer  (Ky.),  67  S.  W.  R., 

851  586,  587 

Osterhout  v.  Shoemaker,  3  Hill,  513. 
307,  385 

Otis,  In  re,  101  N.  Y..  580 370 

Otis's  Will,  In  re,  1  Misc.  R,  (N.  Y. 

Surr.),  258;  22  N.  Y.  Supp.,  1,060. 

412 
Otte  r.  Hartford  Life  Ins.  Co..  88 

Minn.,  425;  93  N.  W.  R.,  608;  97 

Am.  St.  R..  532 132,  133 

Otto  v.  Doty.  61  Iowa,  23;  15  N.  W. 

R.,518 400 

Ouachita  Baptist  College  v.  Scott,  64 

Ark.,  349;  42  S.  W.  Rep.,  536. 

390 


Overall  ?•.  Avant.  46  S.  W.  Rep.,  1,031 

(Tenn.  Ch.  App.) 356 

Overall  v.  Bland.  11  Ky.  L.  R.,  371; 

12  S.  W.  R.,  273 418 

Overall  v.  State,  15  Lea..  672 552 

Overing's  Case.  1  Blandf.  Ch.  (Md.). 

290 588 

Owens,  In  re.  47  How.  Pr.  (N.  Y.), 

150 594 

P.  v.  L.  orse  P.,  3  P.  D.,  73.  .  .763.  765 

P.  ?-.  P.,  11  Brit.  Col..  369 763 

Packham  v.  Ludwig,  103  Md.,  416; 

03  Atl.  R.,  1,048 537 

Page  v.  Kreky,  137  N.  Y.,  307  375 
Page  v.  L.  &  N.  R.  Co.  (Ala.),  29  So. 

R..  676 371 

Paige.  In  re.  7  Daly  (N.  Y.),  155. 

594 
Paine  r.  Aid  rich,  133  N.  Y..  544; 

30  N.  E.  Rep.,  725 540 

Palmer  v.  Garland.  81  Va.,  444.  .  .583 
Palmer  r.  Hudson  River  State  Hos- 
pital (Kan.),  61  Pac.  R..  506. 

382 

Parker  v.  Marco,  70  Fed.  Rep.,  510. 

366.  375 

Parker  v.  Winona   <fe   St.  P.   R.  Co., 

83  Minn..  212;  86  N.  W.  Rep..  2. 

429 
Parsee  Merchant's  Case,  11  Abb.  Pr. 

N.  S.  (N.  Y.),  209 598 

Parsons  v.  State,  81  Ala.,  577;  7  Am. 

Crim.  Rep. ,889;  60  Am.  R..  193. 

455,  456 

Patten  v.  Cilley.  67  N.  H.,  520;  42  Atl. 

R.,  427 517,  520.  541,  555 

Patterson,  Matter  of.  26  Abb.  N.  C., 

395;  36  State  Rep.,  813;  13  N.  Y. 

Supp.,  463 406 

Patterson  v.  Lamb,  21  Tex.  Civ.  App., 

512;  52  S.  W.  R.,98 503,518 

Patterson  v.  State,  86  Ga.,  70;  12  S. 

E.  R..174 535 

Patton  r.  Thompson,  2  Jones  Eq. 

(N.  C.),  441 596 

Paul  v.  Travelers'  Ins.  Co.,  112  N.  Y., 


TABLE    OF    CASES   CITED    IX    THIS    VOLUME. 


XXXV 


472;  20  N.  E.  R.,  347;  8  Am.  St.  R., 

758;  3  L.  R.  A.,  443 137.  139 

I':iynpr.  Burdette,  84  Mo.  App.,  332. 
364,  376 

Payne  r.  Payne.  46  Minn..  467. 

763 
Peabody  v.  Kendall  (111.  Sup.).  32 

N.  E.  Rep..  674  362 

Peacock  v.  New  York  Life  Ins.  Co., 

20  N.  Y..  293 142 

Pearson's  Case  (Eng.).  2  Lewin  Cr. 

Cas.,  144 497 

Peck.  Matter  of,  6  Dem.  (N.  Y.),  299. 

554 
Peck.  Matter  of,  42  State  Rep.,  898; 

17  N.  Y.  Supp.,  248 412 

Peck  v.  Gary,  27  N.  Y.,  9. . .  .411.  413 
Peery  r.  Peery,  94  Tenn..  328;  29 

S.  W.  R..  1 .503 

Peipho  r.  Peipho.  88  111..  438  .  .763 
Peninsular  Trust  Co.  v.  Barker 

(Mich.).  74  N.  W.  Rep..  508.  ...  398 
People  r.  Allender,  48  Pac.  Rep.. 

1.014;  117  Cal.,  81 433,  560 

People  r.  Barber.  115  N.  Y..  475; 

26  N.  E.  R.,  184 446 

People  r.  Barberi,  47  N.  Y.  Supp., 

168;  2  N.  Y.  Grim.  R.,  89.  .  446 
People  r.  Barker  (N.  Y.  Sup.  Ct.), 

67  Hun.  649;  33  N.  E.  R..745.  .425 
People  r.  Barthleman,  52  Pac.  R., 

112;  120  Cal..  7 538,  559 

People  ».  Bawden.  90  Cal..  195;  27 

Pac.  Rep..  204  .559 

People  r.  Belencia.  21  Cal..  544. .  .492 
People  r.  Bemmerly.  98  Cal.,  299; 

33  Pac.  Rep..  263 559.  560 

People  r.  Beno  Ville.  3  Abb.  N.  C., 

195  430 

People  r.  Beverly  (Mich.).  66  N.  W. 

R..  379..  431,436 

People  r.  Borgettw.  99  Mich..  336; 

58  N.  W.  R..  328 536 

People  r.  Burgle,  55  Pac.  R.,  998; 

123  Cal.,  303 435.502 

People  v.  Burns.  2  N.  Y.  Cr.  R..  415. 

490 


People  v.  Carpenter,  102  N.  Y.,  250; 

4  N.  Y.  Cr.  R.,  187 439, 

448,  452 

People  r.  Casey,  31  Hun,  158.  .  452 
People  r.  Cassiano,  1  N.  Y.  Cr.  R.. 

505;  30  Hun,  388 490 

People  v.  Clendennin,  91  Cal.,  35;  27 

Pac..  418 436 

People  r.  Coleman,  1  N.  Y.  Cr.  R.,  2. 

437,  452 

People  ex  reL  Commissioners  v.  Smith, 

100  N.  Y.,  215 373 

People  v.  Conroy,  2  N.  Y.  Cr.  R.,  247; 

33  Hun.  119;  aff'd  97  N.  Y.,  62. 

490 

People  v.  Corey,  148  N.  Y.,  505.  .494 
People  t\  Creamer.  30  App.  Div..  624. 

587 
People  v.  Crest,  168  N.  Y.,  19;  15  N. 

Y.  Cr.  R..  532;  60  N.  E.  R.,  1,057. 

562 
People  r.  Davis  (Cal.),  36  Pac.  Rep., 

96 433 

People  r.  Dillon,  8  Utah.  92:  30  Pac. 

Rep.,  150 559 

People  r.  Ebanks,  117  Cal..  652; 

49  Pac.  R.,  1,049;  46  L.  R.  A..  269. 

481 
People  r.  Ellsworth,  127  Cal.,  595;  60 

Pac.  R..  161 538 

People  i'.  Eubanks.  86  Cal.,  295;  24 

Pac.  Rep.,  1,014 559 

People  r.  Fellows  (Cal.),  54  Pac.  R.. 

830 483 

People  t'.  Ferraro.  161  N.  Y.,  365: 

14  N.  Y.  Cr.  R..  266;  55  N.  E.  Rep.. 

931 466,  535.  562 

People  v.  Findley.  132  Cal..  301;  64 

Pac.  R.,  472   .  .   552 

People  r.  Finley.  38  Md..  482        450 

People    r.    Fish.     125    N.     Y..    136. 

490.  494 

People   r.   Fogelsong  (Mich.).  74  N. 

W.  R..  730  532 

People  r.  Ford  (Cal.).  70  Par.  R.. 

1 .075  .436 

People  r.  Foy,  138  N.  Y..  664;  53 


XXXVI 


TABLE    OF    CASES    CITED    IX    THIS    VOLUME. 


N.  Y.  St.  Rep.,  265;  34  N.  E.  Rep., 

396 440 

People  v.  Francis,  38  Cal.,  183.  .  .552 
People  v.  Gaynor,  33  App.  Div.,  98; 

53  N.  Y.  Supp.,  86 524 

People  v.  Geiger,  116  Cal.,  440;  48 

Pac.  Rep.,  389 429,  430 

People  v.  Gilmore  (Cal.),  53  Pac.  R., 

806 489,524 

People  v.  Gordon,  103  Cal.,  568;  37 

Pac.  R.,  574 489 

People  v.  Haight.  3  N.  Y.  Cr.  R.,  61; 

13  Abb.  N.  C.,  198 439 

People  v.  Hall,  48  Mich.,  482.  .  .  .531 
People  v.  Hettich,  126  Cal.,  425;  58 

Pac.  R.,  918 434,  557 

People  v.  Hill,  116  Cal.,  562;  48  Pac. 

Rep.,  711 538 

People  v.  Hill,  123  Cal.,  47;  55  Pac. 

R.,  692 524 

People  v.  Hoch,  150  N.  Y.,  291;  44 

N.  E.  R.,976 510,511 

People  v.  Holmes  (Mich.),  69  N.  W. 

R.,  501 434 

People  ?>.  Hubert,  119  Cal.,  216;  51 

Pac.  R.,  394,  684.  ...  450,  464,  466, 

515 

People  r.  Kleim,  1  Edm.  (N.  Y.),  13. 

439,  455 

People  v.   Kloss,    115  Cal.,   567;   47 

Pac.  Rep.,  459..  .433,  486,  524,  575 
People  r.  Knott,  122  Cal.,  410;  55 

Pac.  Rep.,  154 430 

People  v.  Koerner,  154  N.  Y.,  355; 

48  N.  E.  R.,730 511,533 

People  v.  Lane,  100  Cal.,  379:  34  Pac. 

Rep.,  856 487,  489,  493,  563 

People  v.  Larrabee,  115  Cal.,  158;  46 

Pac.  Rep.,  922 .'..433 

People  i;.Leary,  105 Cal., 486;  39  Pac. 

R.,  24 439,440,499 

People  v.  Lee  Fook,  85  Cal.,  300;  24 

Pac.  R.,654 430 

People  v.  Leonardi,  143  N.  Y.,  360; 

38  N.  E.  R..  372  ...  .490,  493,  494 
People  v.  Markell.  20  Misc.  R.  (N.  Y.), 

149;  45  N.  Y.  Supp.,  904 482 


People  v.  Martin,  15  Misc.  R.,  6;  36 

N.  Y.  Supp.,  437 529 

People  v.  McCarthy,  115  Cal.,  255; 

46  Pac.  R.,  1,073* 433,  538, 

541,  557 

People  ?'.  McElvaine,  121  N.  Y.,  250. 

531 
People  >'.  McElvaine,  125  N.  Y., 

596;  26  N.  E.  R.,  929;  36  N.  Y.  St. 

Rep.,  181 430,  437 

People  ?'.  McNulty,  93  Cal.,  437;  36 

Pac.  Rep.,  597 559 

People  r.  Methever,  132  Cal.,  326;  64 

Pac.  R.,  481 480,  483,  489 

People  r.  Miller,  114  Cal.,  10;  45  Pac. 

R.,  986 524 

People  v.  Mills,  98  N.  Y.,  176 490 

People  i>.  Montgomery,  13  Abb.  Pr. 

N.  S.,  207  (N.  Y.);  citing  4  Den.,  9. 

435,  439 

People  ex  rel.  Morrell   r.   Dold,   189 

N.  Y.,  546 587 

People  r.  Mulleins,  25  Misc.  Rep.  (N. 

Y.),  599;  54  N.  Y.  Supp..  414..  .482 
People  v.  Nino,  149  N.  Y.,  317;  43  N. 

E.R..853..- 532,559 

People  v.  Nolan,  7  N.  Y.  Cr.  R.,  134; 

aff'd  11.5  N.  Y..  660 440 

People  ex  rel.  Norton  r.  N.  Y.  Hospi- 
tal, 3  Abb.  N.  C.,  229 421,  551 

People  v.  O'Connell,  62  How.  Pr., 

436,  abstr.  s.  c.,  13  N.  Y.  Weekly 

Dig..  95,  536 435,  483 

People  v.  Odell,  1  Dak.,  197;  46  N. 

W.  R.,  601 489 

People   r.    Osmond,    138   N.    Y..   80. 

442.  462,  563 

People  r.  Otto,  38  Hun,  99;  4  N.  Y. 

Cr.  R.,  154 452,  499 

People  v.Owens,  56  Pac.  R.,  251.  450 
People  v.  Pekarz,  185  N.  Y.,  470.  489 

People  v.  Pine,  2  Barb.,  566 435 

People  r.  Porter,  2  Park  Cr.  R.,  14; 

Coke's  Littleton,  247;    Blackstone 

Comm..  26 487,488 

People  r.  Radley  (Mich.),  8  Det.  Leg. 

N..  467;  86  N.  W.  Rep.,  1,029.  .481 


TABLE   OK    TASKS    CITKIi    IN    THIS    Yol.lMK. 


XXX  VII 


People  r.  UhinelaniliT.  2  N.  V.  Cr.  H.. 

340 ..'...439 

People  r.  Robinson.  2  Park  Cr.  U.. 

2:15 . .  497 

People  r.  Holers,  IS  N.  Y..  9;  citing 

Plowd..  19;  3  T.  Co..  46;  4  Co..  125; 

Hue.  Max.,  V..  7  Can-  and  P.,  297. 

317;  5  Mitss.r.  C.  R..  28;  1  Curt.  C. 

C.R.,1;  2  Park..  223. 235  487.  492 

People  r.  Snnford,  43  Cal..  29 535 

People  r.  St.  Sav.  San..  34  App.  Div. 

(N.  Y.).363 587 

People  r.  Sehmitl.  106  Cal..  48;  39 

Pac.  R..  204 564 

People  r.  Sehuyler.  106  X.  Y.,  298. 

631 
People  r.  Shattuck.  109  Cal..  673;  42 

Pac.  R..  315  .  532 

People  r.  Silvennan.  181  X.  Y..  235. 

431.  434.  439 

People   r.   Slack.   <M)   Mich..   448;   51 

N.  W.  R..  533  .  .481 

People  r.  Siniler.  12.5  X.  Y..  717;  26 

N.  E.  R..  812 531 

People  r.  Spmgue.  2  Park.  Cr. .  43 .  .  435 
People  r.  Stratt,  148  X.  Y..  566;  42 

N.  E.  R..  245 514.  532.  546 

People  r.  Taylor.  34  X.  E.  Rep..  275; 

138  X.  Y..398;  52  X.  Y.  St.  R..  919. 
349.  352,  438.444.  448.452. 

460.  463.  467.  531.  546.  559.  562 
People  r.  Tmvers.  88  Cal..  233;  26 

Pac.  R..  88.  .  .  . 430.  483.  48(5.  560 
People  r.  Tuc/kewitx.  149  X.  Y.. 

240;  43  X.  E.  R..  548 529 

People  r.  Vincent.  95  Cal..  425;  30 

Pac.  Rep..  581    .  .  .487.  489 

People  r.   Waltz.  50   How.   Pr..  214. 

440.  449.  452 

People  r.  VVahvorth.  4  X.  Y.  Cr.  Rep.. 

355 452 

People  r.  Walworth.  4  X.  Y.  St.  R.. 

717 ..448 

People  r.  Ward.  105  Cal..  335;  38  Pac. 

R.,  945.  .  526.  557.  559.  560 

People  v.  Willey.  2  Park.  Cr.  R..  1«». 

487 


People  r.   Wood.   126  N.   Y..  249;  3ll 

X .  Y .  St .  R . .  963 .          434 .  44X,  5 1 3 

People  r.  Worthington.  |O5Cul..  166; 

38  Pac.  R..  6X9  4X1.  531 
People  r.  Wreden.  .V.I  Cal  .  392  .      535 
People   r    Young.    IO2  Cal..   411;   .'ill 

Pac.  Rep..  770  486 

People  r.  Youngs.  151  N.  Y..  210;  45 

X.  E.  Rep..  460.  .546 

Perego.  Matter  of.  65  Hun.  478;  48 

State  Rep..  496;  20  N.   Y.  Supp.. 

394  4 10 

Pergason  r.  Ktcherson.  91  (in. .785;  18 

S.  n  Rep..  29.  .  394.  517 

Perkins  r.  Perkins  (Iowa).  90  N.  W. 

R..  55 389.  402. 

411.419.519 

Perkins  r  Perkins.  39  X.  H..  163. 

566 
Perret  r.  Perret.  184  Pa.  St..  131; 

39  Atl.  R..33.  520 
Pern-  r.  Hou.se  of  Refuge.  63  Md..20. 

427 

Person  r.  Warren.  14  Bari...  488.385 

Petefish  r.  liecker.   176  III..  448;  52 

X.  E.  R..  7 1          . 389.  51 1 .  537.  548 

Peters.   In    rr   (Pa.).    10    Kulp..  93. 

424 

Peters  r.  Peters.  59  X.  W.  Rep..  609, 

101    Mich..  291    .  363 

Petersen   r.   Modern   Brotherhood  of 

Am..    125    Iowa.   562:    101    X.   W. 

R..289:  67  L.  R.  A. .631  138 

Petrie  »•.  Shoemaker,  24  Wend..  85. 

385 

Pettel.  In  rr.  2   Paige  (X.  Y.).   174. 

586 

Pet t it .  In  re.  2  Paige.  596  597 

Pflueger  r.  State.  46  Xel...  493:   64  X. 

W.  R..  1.094.  .526.  544.  547 

Phelps     r.    Common  wealth.    17     Ky. 

Law  R..  706;   32  S.    \V.    R..  470. 

531.  560 

Phelps  r.  Hartwell.  1  Maw..  71     531 

Phenix  Ins.  Co.  of  Brooklyn  r.  Weekv 

45  Kan.  751:  26  Pac.  410   .132. 

133 


XXXV111 


TABLE    OF    CASES    CITED    IX    THIS    VOLUME. 


Pidcock   i\  Porter,  68  Pa.  St.,  342; 

8  Am.  Dec.,  181 536 

Pienovi's  Case,  3 City  H.  Rec.  (N.  Y.), 

123 440 

Pigman  v.  State,  14  Ohio,  555 492 

Pike  v.  Pike,  104  Ala..  642;  16  So.  R. 

689 550 

Pile  v.  Pile,  94  Ky..  308;  22  S.  W., 

215 .377 

Pilkington  v.  Gray,  68  L.  J.  P.  C.,  63; 

(Eng.)  App.  Cases  [1899],  401 .  .389 
Pinney's  Will,  27  Minn.,  280.  .  .  .536 
Pirtle  v.  State,  9  Humph.  (Tenn.), 

663 492 

Pitcairn  r.  Pitcairn.  201  Pa.  St.,  368; 

50  Atl.  R.,  963 377 

Pittard  v.  Foster,  12  111.  App.,  132. 

536 
Pitt's  Estate.  In  re  (Wis.),  55  N.  W., 

149 389,  555 

Pittsburgh,  etc.,  Ry.  Co.  r.  Thompson, 

82  Fed.  Rep.,  720;  27  C.  C.  A.,  333. 

421,  422 

Plake  v.  State,  121  Ind.,  433;  23  N. 

E.  R.,  273;  16  Am.  St.  R.,  408. 
455,  456 

Plank,  Ex  parte,  5  Clark  (Pa.),  35. 

588,589 

Plaster  v.  Rigney,  97  Fed.  Rep.,  12; 

38  C.  C.  A.,  25 364,  371,  505 

Pohalski  v.  Mutual  Life  Ins.  Co.,  45 

How.  Pr..  504;  36  N.  Y.  Super.  Ct.. 

234;  56  N.  Y.,  640 138,  139 

Polin  v.  State,  14  Neb.,  540 536 

Pollard  v.  Nyborn,  1  Hagg.  Eccl.. 

725 765 

Pollock  v.  Horn,  13  Wash..  626;  43 

Pac.  R.,885 355,381 

Pollock  v.  U.  S.  Mut.  Ace.  Ass'n. 

102  Pa.  St.,  330 137 

Pones  v.  State  (Tex.  Cr.  App.),  63 

S.  W.  Rep.,  1,021 424 

Poole  v.  Richardson,  3  Mass.,  330. 

531 
Pooler  r.  Cristman,  34  N.  E.  Rep.. 

57;  145  111.,  405 389,411, 

417,  512 


Porter,  In  re,  34  App.  Div.,  147;  54 

N.  Y.  Supp.,  654;  28  Civ.  Pro.  R., 

405 354 

Porter  v.  Rich,  70  Conn.,  235;  39  L. 

R.    A.,    353;    39    Atl.    Rep.,    169. 

586,  587 

Portwood  v.  Commonwealth,  20  Ky. 

L.  R.,  680;  47  S.  W.  R.,  339.  ..  .559 

Post  r.  Mason,  91  N.  Y.,  539 554 

Potter's  Will,  In  re,  161  N.  Y.,  84; 

55  N.  E.   R.,  387;   17  App.  Div., 

267;  45  N.  Y.  Supp.,  563 503, 

504,  539 

Potter  v.  Jones,  20  Or.,  239 390 

Potts  •».'.  House,  6  Ga.,  324;  50  Am. 

Dec.,  329 536,  539 

Pottsville  Mut.  Fire  Ins.  Co.  v. 

Fromm,  100  Pa.,  347 132 

Powell  v.  Powell,  18  Kan.,  371.  .  .762 
Powell  ?-.  Smallwood,  37  S.  E.  Rep., 

551 425 

Powell  v.  State,  25  Ala.,  28 535 

Powers  v.  Mass.  Horn.  Hosp.,  109  Fed. , 

294;  47  C.  C.  A.,  122;  65  L.  R.  A., 

372 607 

Powers'  Exr.  r.  Powers,  52  S.  W.  Rep., 

845;  21  Ky.  Law,  597 396,  518 

Prather  r.  McClelland  (Tex.  Civ., 

App.),  26  S.  W.  R.,  657 565 

Pratt,  7-n  re.  6  N.  B.  R.,  276;  Fed.  Cas. 

11,371 598 

Preferred  Ace.  Ins.  Co.  v.  Robinson, 

33  So.  R.  (Fla.),  1,005;  61  L.  R.  A., 

145 141 

Prentiss  r.  Bates,  88  Mich.,  567 ... 390 
Prentiss  v.  Bates,  93  Mich..  234;  53 

X.  W.  Rep.,  153 403,  508, 

532,  545 
Preston,  Matter  of.  43  Misc.  (N.  Y.), 

550 590 

Preston,  Matter  of,  113  App.  Div. 

(N.  Y.),  732 353,367 

Prine  r.  Prine,  36  Fla.,  676;  18  So. 

R.,  781 761,762 

Pritchard  v.  Henderson,  3  Pennewill 

(Del.),  128;  50  Atl.  R.,  217  .  .  .389. 
391,  402.  403,  417 


TAItl.R    OF    CASKS    CITKI)    IN     THI>    Vol.lMK. 


XXXIX 


Providence  Savings  Life  Ass.  Soc.  r.  Heal  r.  People.  42  X.  V..  270   .  .  .532 

Reutlinger.    08    Ark..    528;    25   S.  Reason  r.  Jones.  119  Mich..  072;  78 

W.  R.,  835   .                                .132  N.  W.  R..  899                             .386 

Prudential  Ins.  Co.  r.   Haley.  91    111.  Redfield's  Eat.,  In  re,   Mr,  Cal.,  037; 

App..  363                                 ...  133  48  Pac.  R..  794.                         .396 

Pyle  r.  Pyle.  158  111..  289;  41  N.  E.  Redmond  r.  Peterson.  102  Cal..  595. 

R..  999 .516.518  380 

Pyott    r.  Pyott,   90    111.    App..  210:  Uee<l.  Matter  of.  20  X.  V.  Supp.,  91; 

aff'd  191  111.. 280:  61  N.  E.  Rep..  88.  2  Connolly.  403                    413. 556 

376.  379.  382.  762  Reed's  Est.  (Minn.).  In  re.  90  X.  W. 

R..  319  .389.  411 

Quaife  r. Chicago,  etc..  H.  Co..4X  \Vis..  Ree<l's  Will.  In  re.  20  X.  V.  Supp..  91 ; 

513 531  2  Con.  Surr.  403                  413.  556 

Quinn  r.  Metropolitan  Life  Ins.  Co..       Reed  r.  State.  62  Miss..  405 532 

10  App.    Div.    (N.    Y.),   483:     41  Keese  »-.  Reese.  89  (la..  645;  15  S.  E.. 

Supp..    1 ,060 133  846  ... .    370 

Regina   »••   Burton.  3  F.  &   F.,  772. 

Ragland    >:  State.   125  Ala..  12:    27  435,  439.  460.  463 

South..   938 53(1  Regina    r.  Cooper.    Mnnn's   Forensic 

Railway  Officials',  etc..  Ass.  r.  Johnson.  Med.,   356..                                  532 

109  Ky..  261;  95  Am.  St.  H..  370.  Regina  r.  Davis  (Eng.).  14  Cox  C.C.. 

137  563 .486 

Rambler  r.Tryon,  7  S.  *  R.  (Pa.), 90:  Regina   r.   Dodwell.  C.  C.  C.,   1878. 

10  Am.  Dec.,  444 531.  536  Mann's  Forensic  Med..  357       .470 

Ramsdell   r.   Ramsdell.  8   Det.    Leg.  Regina  r.  Doody.  6  Cox  Cr.  Cas..  W. 

Xe\vs  (Mich.).  541;  87  X.  W.  R..  81.  500 

355  Regina  r.  (larnlin.   1   Fost.  &  F..  90. 

Ramsdell  r.  Streeter  (N.  J.  Pro.).  4S  500 

Atl.  R..  575.  .                             .  .523  Regina  r.  Haynes.  I  Fost.  and  F..666. 

Rand's  Will.  In  re.  28  Misc.  (X.  V.).  450 

465;  59  Supp..  1.082 555  Regina  r.  Oxford  (Kng.).  9  Car.  &  P.. 

Rapplee's  Will.  In  re.  66  Hun.  558;  21  525    .                                              455 

N.  Y.  Supp..  801    .                      402  Regina     r.     Williams    (Old     Bailey. 

Rather  r.  State  (Tex. ).  9  S.  W.  Rep. .  1886} 500 

69 487  Renfro   r.  City  of  Waco   (Tex.  Civ. 

Rauh   r.  Carpenter.    187   V.  S..   159.  App.).  33  S.  W.  R..  766              .371 

532  Revoir  r.  State.  82  Wis..  295:  52  X. 

Rawdon  r.  Rawdon.  28  Ala..  565.  .762  \\  ..  84                     434.  4.%.  559.  562 

Rawles  v.  American  Mutual  Life  Ins.  Rex.  see  King. 

Co.,  27  N.   Y..  287:  84  Am.   Dec..  Rex  r.   Thomas.   7   Car.    «fc    P..   820. 

280  .                                          ....  135  500 

Raymond  r.  Wathen.  142  Ind.,  367;  Rex  r.  Wright.  R.  and  R.Crini.  Can.. 

41  N.  E.  R..  815                     355. 552  456 

Raynor,  Matter  of.  44  State  Rep..  468:  Reynolds    r.    Equitable    Ace.    Asa'n. 

1*8  N.  Y.  Supp.,  426                       408  59  Hun  ( X.  Y.).  13. 

Rea  r.  Bishop  (Neh.).  59  X.  W.  Rep..  Reynolds  r.  Iowa  and  X.  Ins.  Co..  80 

555                                                 :UW  I o\va .  MM:  46  X   W    R     1 59       1 33 


xl 


TABLE    OF    CASES    CITED    IX    THIS    VOLUME. 


Reynolds  v.  Robinson,  64  N.  Y.,  589. 

sai 

Reynolds  r.  Root,  62  Barb.,  250. 

402 
Reynolds  r.  United  States,  98  IT.  S. 

145 474 

Rhoades  r.  Fuller.  139  Mo.,  179;  40  S. 

W.  R.,  760 366,  527 

Rhode  r.  Rhode,  8  Ohio  S.  &  C.  P. 

Dec.,  684 378 

Rhyner  v.  Menasha,  73  N.  W.  Rep.. 

41;  97  Wis.,  523 429 

Rice  v.  Peel,  15  Johns.,  503  .  .  354,  367 
Rice  v.  Rice,  50  Mich.,  448;  15  N.  W. 

R.,  545 525 

Richards,  Kx  parte,  Brev.  Vol.  B.  (S. 

C.),375 582.594 

Richardson's  Will,  In  re,  51  App.  Div., 

637;  64  N.  Y.  Supp.,  944 396 

Richardson  r.  Adams,  110  Ga.,  425; 

35  S.  E.  R.,648 362 

Richardson  r.  Bly  (Mass.),  63  N.  E. 

R.,  3.. 555,  570 

Richardson  r.  Smart,  2  Mo.  App., 

1.107 568 

Riggin  v.  Board  of  Trustees  West- 
minister College.  160  Mo.,  570;  61 

S.  W.  R.,803 410 

Riley  r.  Carter,  76  Md..  581;  25  Atl. 

R...  667;  19  L.  R.  A.,  489 364 

Riley  r.  Riley,  73  Hun  (N.  Y.),  575. 

763 
Riley  r.  Sherwood,  144  Mo.,  354;  45 

S.  W.  R.,  1,077.  .415,  416,  419,  420 
Riley  v.  State,  44  S.  W.  R.,  498 

(Texas)  448 

Ring  v.  Lawless.  190  111..  520;  60  N.  E. 

Rep..  881 355.  384.  388,  545 

Ring  v.  Ring,  112  Ga.,  854;  38  S.  E. 

Rep.,  330 380 

Ilintelen.  'In  re,  37  Misc.  R.  (N.  Y.), 

462;  75  Supp.,  935 565 

Rintelen,  In  re.  37  Misc.  (N.  Y.),  562; 

75  N.  Y.  Supp..  363;  aff'd  78  N.  Y. 

Supp.,  1,092 414 

Ristine  v.  Johnson,  143  Ind..  44;  42 

N.  E.  Rep.,  310 425 


Roberson  r.  The   Rocnester  Folding 

Box  Co..  171  N.  Y.,  538 132 

Roberts,  /«  re,  3  Johns.  Ch.,  43. 

595 
Roberts'  Estate,  In  re,  197  Pa.  St., 

621;  47  Atl.  R.,  987 593 

Roberts    r.    People,    19    Mich.,    401. 

496,  497 

Robinson's  Will.  In  re,  190  111.,  95; 

60  N.  E.  R.,  194 516,539 

Robinson  7-.  Adams,  62  Me.,  369; 

16  Am.  Rep.,  473 399.  400,  539 

Robinson  v.  Kidd,  59  Pac.  R.  (Kan.), 

863;  62  Pac.  R.,  705 364 

Robinson  r.  Robinson,  203  Pa.  St., 

400;  53  Atl.  R..  253 415,  417, 

419,  503.  520,  555 
Rockford  Ins.  Co.  v.  Nelson,  65  111., 

415 133 

Rodgers.  In  re,  9  Abb.  N.  C.  (N.  Y.), 

141 580,586 

Rodgers  r.  Rodgers,  56  Kan.  483; 

43  Pac.,  779 378 

Rodgers  r.  State  (Tex.  Cr.  App.),  28 

S.  W.  Rep.,  948 438 

Rodgers  r.  Walker,  6  Penn.  St.,  371. 

587 
Rogers.  In  re.  I  Halst.  Ch.  (N.  J.), 

46 591,593 

Rogers.  In  re,  9  Abb.  N.  C.  (N.  Y.), 

141 590 

Rogers  r.  Armstrong  Co.  (Tex.  Civ. 

App.).  30  S.  W.  R.,  848 568 

Rogers  r.  State,  33  Ind.,  543 497 

Rogers  r.  Walker,  66  Pa.  St..  371. 

591 
Rohe's  Will,  In  re,  22  Misc.  Rep.  (N. 

Y.).  415;  50  N.  Y.  Supp..  399.  .392 
Roller  v.  Kling,  49  N.  E.  Rep.,  748; 

150  Ind.,  59 390,  507,  567 

Rollwagen  ?•.  Rollwagen,  3  Hun,  132; 

63  N.  Y.,  518 408 

Ronan  r.  Bluhm.  173  111.,  277;  50  N. 

E.  R.,  694 368 

Ronker  r.  St.  John,  21  Ohio  C.  C., 

339 428 

Root,  ///  re,  8  Paige  (N.  Y.),  625.  .593 


TABLE    OF   CASES    CITED    INT   THIS    VOLUME. 


xli 


Root  v.  London  Guarantee  and  Ac-  Ryan  v.  World  Mut.  Life  Ins.  Co., 

cident  Co.,  92  App.  Div.  (N.  Y.),  41  Conn.,  168;  19  Am.  Rep.,  490. 

518;  86  Supp.,  1055 139  133 

Rorback  v.  Van  Blarcoom,  20  N.  J.  Ryder    v.   Ryder,   66    Vt.,    158;   28 

Eq.,  461 588          Atl.,  1029 767 

Roseman  v.  Carolina  Central  R.  Co.,  Ryder  v.  State,  100  Ga.,  528;  38  L. 

112  N.  C.,  709;  16  S.  E.  Rep.,  766.  R.  A.,  721;  28  S.  E.  Rep.,  246. 

376  559 
Rosenstein  v.  State  (Ind.),  36  N.  E. 

Rep.,  652;  9  Ind.  App.,  290 482      S.  v.  A.,  3  P.  D.,  72 763,  764 

Ross  v.  Pay  son,  160  111.,  349;  43  N.  E.      S.  v.  E.,3  Swab,  and  T.,240 765 

Rep.,  399 362  Sabalot  v.  Populus,  31  La.  Ann.,  854. 

Ross's  Will,  In  re,  65  Hun,  626;  20  762 

N.  Y.  Supp.,  520 519  Safe  Dep.  &  Trust  Co.  v.  Berry  (Md.), 

Rosselot  v.  State,  23  Ohio  C.  C.,  370.          49  Atl.  R.,  401 530,  539, 

430  542,  548 

Rothrock  v.  Rothrock,  22  Or.,  551;  Saffer  v.  Mast,  79  N.  E.  R.,  32;  223 

30  Pac.,  453 405          111.,  108 363 

Round's  Will,  In  re,  25  Misc.  R.  (N.  Salisbury,  In  re,  3  Johns.  Ch.  (N.  Y.), 

Y.),   101:   54   N.   Y.   Supp.,   710.          347 597 

409  Salter  v.  Ely  (N.  J.  Pre.  Ct.),  56  N.  J. 

Rountree,  Ex  parte,  51  S.  C.,  405;  29  Eq.,  357;  39  Atl.  R..  365. .      .  .420 

S.  E.  Rep.,  66 381  Sampson,  In  re,  19  Pa.  Co.  Ct.  R.,  1; 

Roush  v.  Wensel,  15  Ohio  C.  C.  R.,          5  Pa.  Dist.  R.,717 375,  528 

133 507, 537, 542  Sanchez   r.   People,  22  N.   Y.,   147. 

Rowden   v.   Rowden,   28   Ala.,   565.  514 

580  Sander  r.  Savage,  75  App.  Div.,  333; 

Rowson's  Est.,  In  re,  4  Pa.  Dist.  Ct.  78  N  Y.  Supp.,  189. .  .366,  368,  428 

Rep.,  91 407,  410  Sanders  v.  Colman,  97  Va.,  690;  39 

Ruffino's  Estate,  In  re,  116  Cal.,  304;          S.  E.  R.,  621 768 

48  Pac.  R.,  127 394,  523  Sands  v.  Potter,  59  111.  App.,  206. 

Ruffner  v.  Luther,  19  Pa.  Co.  Ct.  R.,  '">"> 

,      349 505  Sartain,  In  re,  14  Eq.  (N.  C.),  231. 

Rush,  In   re,  53   N.  Y.  Supp.,  581.  597 

423,  580      Sawyer  v.  State,  35  Md.,  80 514 

Rusk  v.   Fenton,   14  Bush,  490;  29  Scattergood  v.  Kirt,  192  Pa.  St.,  263; 

Am.  Rep.,  413  (Ky.) 366  43  Atl.  R.,  1030;  44  W.  N.  Cv  313. 

Russell,  In  re,  1  Barb.  Ch.  (N.  Y.),  38. 

585,  590  Schaeffer  v.  State,  61  Ark.,  241;  32 

Rustin  v.  Standard  Life  and  Ace.  Ins.  S.  W.  R.,  679 .  .               . .  508.  544 

Co.,  58  Neb.,  792;  79  N.  W.  R.,  412;  Schaps  r.  Lehner,  54  Minn.,  208.  .366 

76  Am.  St.  R.,  136;  46  L.  R.  A.,  Scherar  v.  Prudential  Ins.  Co.  (Neb.), 

253 140  88  N.  W.  R.,  687.  . 

Ruter  v.  Mut.  Life  Ins.  Co.,  169  U.  S.,  Schieffelin    r.    Schieffelin    (Ala.),   28 

139;  18  Sup.  Ct.,  300;  70  Fed.,  954;  So.  R.,  687..      ..403,416,417,505 

17  C.  C.  A.,  537 501  Schierbaum  r.  Schemme,  157  Mo.,  1; 

R  itherford  v.  Morris,  77  111., 397.  .536  f>7  S.  W.  R.,  262.  .                .413,520 


xlii 


TABLE  OF  CASES  CITED  IN  THIS  VOLUME. 


Schiesler's  Est.,  Inre,  198  Pa.  St.,  81; 

47Atl.  Rep.,966 712 

Schilling  v.  Kankakee  County,  96  111. 

App.,  432 383 

Schlencker  v.  State,  9  Neb.,  241. 

536 
Schmidt  v.  Northern  Life  Ass'n,  83: 

N.  W.  R.,  800  (Iowa);  51  L.  R.  A., 

141 374 

Schmidts.  Ottmann,  46  La.  Ann.,  888; 

15  So.,  310 366,373 

Schmitt  v.  Michigan  Mut.  Life  Ins.  Co. , 

101  App.  Div.  (N.  Y.),  12 138 

Schreiber,  Matter  of,  22  State  Rep., 

892 411 

Schrodt,  In  re,  32  Misc.  Rep.,  540; 

67  N.  Y.  Supp.,  244. 353 

Schroter  v.  Schroter,  56  Misc.  (N.  Y.), 

169 763 

Schuettler  v.  Carman,  98  Iowa,  276; 

67  N.  W.  R.,  249 357,  399 

Schultz  v.  State,  37  Neb.,  481;  55  N. 

W.  R.,  1080 536 

Schuster's  Est.,  In  re,  198  Pa.  St.,  81; 

47  Atl.  Rep.,  966 414 

Schwabacher  v.  People,  165  111.,  618; 

46  N.  E.  R.,  809 496 

Scott  v.  Bassett,  194  111.,  602;  62 

N.  E.  R.,  914 515,  598 

Scott  v.  McKee,  105  Ga.,  256;  31  S.  E. 

R.,  183 538,539 

Scott  v.  State,  12  Tex.  Cr.  App.,  31. 

490 
Scott's  Est.,  In  re,  128  Cal.,  57;  60 

Pac.  R.,  527 396,  569 

Seagrist's  Will,  In  re,  1  App.  Div., 

615;  77  N.  Y.  Supp.,  496 419 

Seagrist's  Will,  In  re,  11  Misc.  R.  (N. 

Y.),  188;  32  N.  Y.  Supp.,  1095. 

406 
Seamen's  Friend  Society  v.  Hopper; 

33N.Y.,619;affirming4Barb.,625. 

394 

Sears  v.  Shafer,  6  N.  Y.,  268 554 

Seawel  v.  Dirst,  70  Ark.,  166;  66  S. 

W.  R.,  1058 357 

Segur's  Will  (Vt.),  44  Atl.  R.,  342 . 398 


Sehr  v.  Lindeman,  153  Mo.,  276; 

54  S.  W.  Rep.,  537 406 

Serell  v.  Serell,  31  L.  J.  P.  and  M. 

55;  2  Swab,  and  T.,  422 764 

Shackleford  v.  Hamilton,  93  Ky.,  80; 

19  S.  WT.  R.,  5 768 

Shaffer   v.    List,  114    Pa.    St.,    486. 

598 
Shakespeare  v.  Markham,  72  N.  Y., 

400 362 

Shanley's  Appeal,  62  Conn.,  325;  25 

Atl.  Rep.,  245 544 

Shannahan  v.  Com.,  8  Bush  (Ky.), 

463;  8  Am.  R.,  465 455 

Shapter  v.  Pillar,  63  Pac.  R.  (Colo.), 

302 580,581,582 

Sharkey  v.  State,  2  O.  C.  D.,  443. 

530,560 

Sharp  v.  Merriman  (Mich.),  66  N.  W. 

R.,  372 392,  510,  542 

Sheanon  v.  Pacific  Mut.  Life  Ins.  Co., 

77  Wis.,  618;  46  N.  W.  R.,  799; 

20  Am.  St.  R.,  151;  9  L.  R.  A.,  685; 
s.  c.  83  Wis.,  507;  53  N.  W.  R.,  878. 

140 
Sheehan  v.  Kearney  (Miss.),  35  L.  R. 

A.,  102;  21  So.  Rep.,  41 503, 

504,  516,  519,  537,  565 
Shell,  In  re  (Col.),  53  L.  R.  A.,  387; 

63  Pac.  R.,  413 418,  523,  553 

Shelleig,  In  re,  11  Ohio  S.  &  C.  P.Dec., 

81 564 

Sherbero  v.  Miller,  65  Atl.,  472  (N.  J. 

Eq.) 355 

Sherbourne  v.  Yuba  Co.,  21  Cal.,  113. 

607 

Sherman,  In  re,  17  R.  L,  356 592 

Shields  v.  Johnson,  47  S.  W.  Rep.,  107. 

430 
Shirley  v.  State,  37  Tex.  Cr.  App., 

475;  36  S.  W.  R.,  267 530 

Shotliff  v.  Modern  Woodmen  of  Am., 

100  Mo.  App.,  138;  73  S.  W.  R., 

326 133 

Shreiner  v.  Shreiner,  178  Pa.  St.,  57; 

35  Atl.  Rep.,  974 397,  411 

Shufflin  v.  People,  62  N.  Y.,  229;  20 


TABLE    OF   CASES   CITED    IN    THIS    VOLUME. 


xliii 


Am.  R.,  483,  aff'g  4   Hun,   10;  6 

Supm.  Ct.  (T.  &  C.),  215 442 

Shults  v.  State.  37  Neb.,  481;  55  N. 

W.  Rep.,  1080 547 

Sibley  v.  Somers  (N.  J.  Ch.),  50  Atl. 

R.,  321 362 

Sickles's  Will,  In  re  (N.  J.  Pre.),  50 

Atl.  R.,  577 215 

Silverthorne,  In  re,  68  Wis.,  372;  32 

N.W.  Rep.,287 404 

Sim  v.  Russell,  90  Iowa,  656;  27  N. 

W.  R.,601 394,517 

Simon  v.  Craft,  182  U.  S.,  427;  21 

Supr.  Ct.  R.,  836 587 

Sims  v.  Sims,  121  N.  C.,  297;  28  S.  E. 

R.,  407;  40  L.  R.  A.,  737.  .376,  378, 

598,  762 

Sinclair  v.  Maritime  Passenger  Assur. 

Co.  (Eng.),  3  El.  and  El.,  478;  4  L. 

T.  (N.  S.),  15;  30  L.  J.  (Q.  B.),  77; 

7  Jur.  (N.  S.),  367 137 

Sindram  v.  People,  1  N.  Y.  Crim. 

Rep.,  448;  affirmed  88  N.  Y.,  196. 

439 
Sinnet  v.  Bowman,  37  N.  E.  Rep., 

885 389 

Sisson  v.  Supreme  Court  of  Honor, 

104  Mo.  App.,  54;  78  S.  W.  R.,  297. 

140 
Skaats's  Will,  In  re,  74  Hun  (N.  Y.), 

462;  26  N.  Y.  Supp.,  494 ...  392, 412 
Skinner  v.  Lewis  (Or.),  67  Pac.  R., 

951 394,  406 

Slevin  v.  Board  of  Police  Pension 

Fund  Commr's,  123  Cal.,  130;    55 

Pac.  R.,785;44L.  R.  A.,  114..  140 
Slingloff  v.  Bruner,  174  111.,  561;  51  N. 

E.  Rep.,  772 404,  505,  566 

Small  j'.  Champeny,  102  Wis.,  61;  78 

N.  W.  R.,  407 525,  552 

Smee  v.  Smee,  L.  R.,  5  P.  D.,  84. 

566 

Smith,  In  re,  12  Pa.  Supr.  Ct.,  649. 

580 
Smith  v.  Com.,  1  Duv.  (Ky.),  224.  449 

Smith  v.  Com.,  93  Ky..  318 434. 

436,  559 


Smith  v.  Day  (Del.).  45  Atl.  R.,  390. 

391.567 

Smith  v.   Henline.   174   III..   184;  51 

N.  E.  Rep..  227 406.416 

Smith  v.  Kay  (Eng.).  7  H.  L.  Can.. 

771 553 

Smith,    Matter   of,   95   N.    Y.,   516. 

404,  554 

Smith    v.    McTlure,    146    Ind.,    123; 

44  N.  E.  R..  1004  .  .  .564 

Smith  v.  Morehead,  59  N.  ('..  360.  762 
Smith  v  Pipkin.  77  N.  ('..  509.  .  .584 

Smith  v.  Ryan,  191  N.  Y..  452 364 

Smith  r.  Smith.  171  Mass..  404;  50 

N.  E.  R.,  933 546.  706.  707 

Smith  v.  Smith,  47  Miss..  211 761 

Smith  v.  Smith,  48  N.  J.  Eq..  500; 

25  Atl.  Rep..  11 396 

Smith  v.  State,  55  Ark.,  259;  18  S.  W., 

237 403.  404 

Smith  v.  State,  31  Tex.  App.;  19  S. 

W.  Rep.,  252 ..559 

Smith  v.  Williamson.  8  Utah,  219;  30 

Pac.  Rep..  753..  .  ..375 

Smith's  Com.,  D.  M.,  r.  Forsythe,  90 

S.W.  R.,  1075;  28  Ky.  L.  R..  1034. 

366 
Smith's  Will,  In  re  (Surr.),  24  N.  Y 

Supp.,  928 394.  397 

Smith's  Will,  52  Wis.,  544;  38  Am. 

Rep.,  750;  8  N.  W.  Rep..  610;  9  N. 

W.  Hep..  665 .  .399 

Sneck  r.  Travelers  Ins.  Co.,  8S  Hun 

(N.  Y.),  94;  34  Supp.,  545 140 

Snell  r.  I*.  S..  16  App.  I).  C..  501 .  509 
Snelling.  Matter  of.  130  X.  Y..  515; 

49  Suite  Rep..  095;  32  N.  E.  R., 

KKX. 393.  400.  411.  Ml 

Snellings'  Will.  In  re  (Surr.).  78  Hun 

(N.  Y.).  211;  28  N.  Y.  Supp..  942. 

386 
Snider  v.  State.  56  Neb.,  309;  70 

N.W.  R..  574 542.500 

Snodgrass  r.  Knight,  43  W.  Vn..  294: 

27  S.  E.  R..  233 550 

Snyder  r.  Sherman,  23  Hun.  I'W. 
3X0.  -M-J 


xliv 


TABLE    OF    CASES    CITED    IN   THIS    VOLUME. 


Snyder  v.  Snyder  (111.),  31  N.  E.,  303. 

580 
Soberanes  v.  Soberanes,  106  Cal.,  1; 

39  Pac.  R.,  39 355 

Soule,  Matter  of,  22  Abb.  N.  C.,  236; 

19  State  Rep.,  532;  3  N.  Y.  Supp., 

259 386 

Soules  v.  Robinson  (Ind.),  60  N.  E. 

R.,  726;  62  N.  E.  R.,  999.  .525,526, 

587 
Southard  v.  Railway  Passengers' 

Ass.  Co.,  34  Conn.,  574 137 

South  Penn.  Oil  Co.  v.  Mclntire,  44  W. 

Va.,  296;  28  S.  E.  Rep.,  922.  ..  .586 
Sovereign  Camp  Woodmen  of  the 

World  v.  Woodruff,  80  Miss.,  546; 

32  So.  R.,  4 143 

Spangler  v.  State,  55  S.  W.  Rep.,  326. 

545 
Sparks's  Will,  In  re,  51  Atl.  R.,  118 

(N.  J.  Pre.) 556 

Speiser  v.  Phoenix  Mut.  Life  Ins.  Co., 

119  Wis.,  530;  97  N.  W.  R.,  207. 133 
Speller's  Estate,  In  re  (Pa.  Co.  Ct.),  2 

Pa.  Dist.  R.,  513 403,  556 

Spencer  v.  State,  69  Md.,  28 450 

Spencer  v.  Terry's  Est.  (Mich.),  8 

Det.  Leg.  N.,  392;  86  N.  W.  R., 

998 391 

Spencer's  Estate,  In  re,  96  Cal.,  448, 

31  Pac.,  453 400,  513 

Spinlock  v.  Noe  (Ky.),  43  S.  W.  Rep., 

31  381 

Sporza  v.  German  Savings  Bk.,  192 

N.  Y.,  8;  84  N.  E.  R.,  406 581, 

582,  587 
Springfield  v.  State,  96  Ala.,  81;  11 

So.  R.,  250 487,490 

Spurgeon  Young  Case  (Chautauqua 

Co.,N.  Y.),  14  Med.Leg.  Jour., 529. 

481 
Squires  v.  State  (Tex.  Cr.  App.),  54 

S.  W.  R.,  770 530 

St.  George  v.  Biddeford,  76  Me.,  593. 

761 
St.  Joseph's  Convent  v.  Garner,  66 

Ark.,  632;  53  S.  W.  Rep.,  298.  543 


St.  Lawrence  Hospital  v.  Fowler,  15 

Misc.  (N.  Y.),  165;  37  N.  Y.  Supp., 

16 382 

St.  Louis  Mut.  L.  Ins.  Co.  v.  Graves, 

6  Bush  (Ky.),  268 536 

St.  Louis,  etc.,  Ry.  Co.,  v.  Bradley,  13 

U.  S.  App.,  68 532 

St.  Louis,  etc.,    Ry.   Co.  v.   Shifflet 

(Tex.  Civ.  App.),  56  S.  W.  Rep., 

697 512,549 

Stafford  v.  Levinger  (S.  D.),  91  N.  W. 

R.,  462 429 

Standard  Life  and  Ace.  Ins.  Co.  v. 

Schmaltz,  66  Ark.,  588;  53  N.  W. 

R.,  49;  94  Am.  St.  R.,  112 137 

Stannart  v.  Barns,  63  Vt.,  244 382 

Stanton  v.  Weatherwax,  16  Barb.  (N. 

Y.),  259 580 

Starr's  Estate,  In  re,  10  Pa.  Super.Ct., 

554 580 

State  v.  Agnew,  10  N.  J.  L.  J.,  165. 

484,  577 

State  v.  Alcom,  137  Mo.,  121;  38  S. 

W.  R.,548 524,  552 

State   v.    Alexander,    30   S.    C.,    74. 

445,  454 

State  v.  Ashley,  45  La.  Ann.,  1036; 

13  So.  Rep.,  738 487 

State  v.  Barber,  74  Mo.,  292 531 

State  v.  Barry  (N.  D.),  92  N.  W.  R., 

809 434 

State  v.  Beard,  47  Mo.,  301 584 

State  v.  Bell,  136  Mo.,  120;  37  S.  W. 

Rep.,  823 560 

State  v.  Beuerman,  59  Kan.,  586;  53 

Pac.  R.,  874 536 

State  v.  Billings,  55  Minn.,  467;  57  N. 

W.  Rep.,  794 586,  672 

State  v.  Boyce,  24  Wash.,  514;  64  Pac. 

R.,  719 534 

State  v.  Bradley  (La.),  45  So.  R.,  120. 

513 
State  v.  Branton  (Or.),  56  Pac.  R., 

267 436 

State  v.  Bronstine,  147  Mo.,  520;  49 

S.  W.  Rep.,  512 544 

£'"'•>  v.  Brooks,  57  Pac.  R.,  1,038; 


TABLE   OF   CASES   CITED    IN    THIS    VOLUME. 


xlv 


23  Mont.,  146 440, 

557,  559 
State  v.  Brooks,  4  Wash.  St.,  328;  30 

Pac.,  147 536,  562 

Stater.  Brown,  36  Atl.  Rep., 458. 421 

State  v.  Brown,  181  Mo.,  192 487 

State  v.  Bruce,  48  Iowa,  536;  30  Am. 

Rep.,  403 493 

State  v.  Callaway,  154  Mo.,  91;  55  S. 

W.  Rep.,  444 442 

State  v.  Christmas,  6  Jones  L.  (N.  C.), 

471 508 

State  v.  Clarke,  47  S.  W.  Rep.,  886; 

147  Mo.,  20 445 

State  v.  Clements,  47  La.  Ann.,  1088; 

17  So.  R.,  502 557 

State  v.  Clevenger,  156  Mo.,  190;  56 

S.  W.  Rep.,  1078 484 

State  v.  Cole  (Del.),  2  Penne.,  344; 

45  Atl.  R.,  391 436,  557 

State  v.  Constantino  (Wash.),  93  Pac. 

R.,  317 504,  513 

State  v.  Crisp,  126  Mo.,  605;  29  S.  W. 

R.,  699 433,531 

State  v.  Cross,  42  W.  Va.,  253;  24  S. 

E.  Rep.,  996 487 

State  v.  Cunningham,  72  N.  C.,  469. 

508 
State  v.  Davis,  9  Houst.  (Del.),  407; 

33  Atl.  R., 483,  487,  494 

State  v.  Davis,  109  N.  E.,  780;  14  S. 

E.,  55 436,  559 

State  v.  Davis  (W.  Va.),  43  S.  E.  R., 

99 491 

State  r.  Dell  Bello,  8  Oh.  S.   &  C. 

P.    Dec.,    455 560 

State  v.  Donovan,  61  Iowa,  369;  16 

N.  W.  Rep.,  206 487 

State  v.   Donovan,    10  N.   D.,  203; 

86  N.  W.  Rep.,  709 482 

State  v.  Dom,  22  Ore.,  591;  30  Pac. 

Rep.,  317 559 

State  v.  Dreher,  137  Mo.,  11;  38  S.  W. 

R.,  567 562 

State  v.  Duestrow,  137  Mo.,  44;  38  S. 

W.  R..  554 561 

State  v.  Erb,  74  Mo..  199   .          .  .  536 


State  r.  Faino  (Del.),  2  Hani.,  153; 

1    Man'.,    492;    41    Atl.    It.,    134. 

490,  524 

State  v.  Fair,  34  \V.  Va.,  84;  11  S.  E. 

Rep.,  737 .  .4X2 

State  v.  Feister.50  Pac.  Rep.,  561 .541 

State  t'.  Felter.  25  Iowa.  67 455 

State  r.  Feltes,  51  Iowa,  495 531 

State    v.    Fiske.   63  Conn.,   388;   28 

Atl.  R.,  572 486,  4K7.  490,  493 

State  v.  Ford  (S.  Dak.),  92  N.  W.  R., 

18 441.492 

State  v.  Geddis.  42  Iowa,  268.  ..  .532 

State  r.  Gosnell,  74  Fed.  Rep.,  734. 

440.  442 

State  r.  Graves.  5  N.  J.  Law  J.,  54. 

577 

State  v.  Graviotte,  22  La.  Ann.,  587. 

513 
State  r.  Haab,  105  La.,  230;  29  So. 

R.,  725 497.  499 

State  r.  Hand,  2  Hardesty  (Del.),  149; 

41   Atl.  Rep.,   192;   1   Man-.,  545. 

483.  597 

State   r.   Hansen,  25  Ore.,  391;   36 

Pac.  Rep.,  296 4S9.  491. 

539.  559 
State  r.   Harrigan,  9  Houst.   (Del.), 

369;  31  Atl.  R..  1052 483.  511 

State  v.  Harrison,  30  W.  Va.,  729;  15 

S.  E.  R.,  982;   18  L.  R.  A..  224. 

430, 448 

State  r.  Hayden,  51  Vt..  296.         536 

State  r.  Hayward.  65  N.  W.  Rep..  63; 

62  Minn.,  474..  .422 

State  f.  Heck,  23  Minn.,  549 482 

State  r.  Helm.  69  Ark.,  167;  61  S.  W. 

Rep..  915 353 

State  r.  Hill.  46  La.  Ann..  27;  14  So. 

Rep.,  294 493.669 

State  r.  Hill  (N.  J.).  47  Atl.  R..  814. 

550 

State  r.  Hurst  (Idaho),  39  Pnc.  Rep.. 

554  .  ..538.540 

State  r.  Jack,  5K  Atl.  R..  833.  .        455 

State    r.    Johnson.    40   Conn..    136. 

492, 497 


xivi 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


State  v.  Jones,  50  N.  H.,  369 474 

State  v.  Judge  8th  Jud.  Dist.,  48 

La.  Ann.,  503;   19  So.  Rep.,  475. 

430,    433,    586 

State  v.  Kalb,  7  Ohio  N.  P.,  547;  5 

Ohio  S.  &  C.  P.  Dec.,  738. .  349,  353 
State  v.  Kale,  124  N.  C.,  816;  32  S. 

E.  R.,892 431,488,496 

State  v.  Kavanaugh  (Del.),  53  Atl. 

R.,  335 483,  492,  576 

State    v.    Kelly,    32    Atl.    R.,    434. 

430,  455 

State  v.  Kindred,  148  Mo.,  270;  49 

S.  W.  Rep.,  845 487 

State  v.  Klinger,  46  Mo.,  224 536 

State  v.  Knight,  95  Me.,  467;  50 

Atl.   R.,  276;   55  L.   R.  A.,   373. 

448,  450 

State  v.  Kraemer,  49  La.  Ann.,  766; 

22  So.  Rep.,  254 483,498 

State  v.  Larkins  (Idaho),  47 Pac.  Rep., 

945 559 

State  v.  Leehman,  2  S.  D.,  171;  49  N. 

W.  R.,  3 450,531,536 

State  v.  Leuth,  50  Ohio  C.  C.  R.,  94. 

509 
State  v.  Levelle,  34  S.  C.,  126;  13 

S.  E.  R.,  319 450 

State  v.  Lewis,  136  Mo.,  84;  37  S. 

W.  Rep.,  806 480 

State  v.  Lewis,  20  Nev.,  333;  22  Pac. 

R.,  241 450,  463 

State  v.  Lyons,  113  La.,  959;  37  So. 

R.,890 448,457 

State  v.  McDaniel,  115  N.  C.,  807; 

20  S.  E.  Rep.,  622 438,  499 

State  v.  Mclntosh,  40  S.  C.,  349;  17 

S.  E.,  446 436 

State  v.  McMurry,  61  Kan.,  87;  58 

Pac.  R.,961 526 

State  v.  Maier,  36  W.  Va.,  757;  15  S. 

E.  R.,  991 436,  448, 536 

State  v.  Marshall  (Ore.),  57  Pac.  R., 

902 514 

State  v.  Mewherter,  46  Iowa,  88. 

457 
State  v.  Miller,  7  Ohio  N.  P.,  458;  5 


Ohio  S.  &  C.  P.  Dec.,  703 434, 

466,  535,  550,  559,  561 
State  v.  Morgan,  40  S.  C.,  345;  18 

S.  E.  R.,937 491 

State  v.  Mowry,  15  Pac.  R.,  282. 

450 
State  v.  Murphy,  118  Mo.,  7;  25  S.  W. 

Rep.,  95 486 

State  v.  Newlin,  69  Ind.,  108 536 

State  v.  Newman,  57  Kan.,  705;  47 

Pac.  R.,  881 510 

State  v.  Novak  (Iowa),  79  W.  N.  R., 

465 556,  557,  561 

State  v.  O'Grady,  3  Ohio  N.  P.,  279. 

430 
State  v.  O'Neil,  51  Kan.,  651;  33  Pac., 

287 436,  486,  487,  490,  491 

State  v.  O'Reilly,  126  Mo.,  597;  29  S. 

W.  R.,  577 491 

State  v.  Paine,  49  La.  Ann.,  1092; 

22  So.  Rep.,  316 430 

State  v.  Palmer,  161  Mo.,  152;  61  S. 

W.  R.,  651 .  .431,  439,  558,  563,  564 
State  v.  Parks,  93  Me.,  208;  44  Atl. 

R.,  899 560 

State  v.  Peel,  23  Mont.,  358;  59  Pac. 

R.,  169 455.530,  545,  560 

State  v.  Pennington,  146  Mo.,  27; 

47  S.  W.  Rep.,  799 430 

State  v.  Peterson,  129  N.  C.,  556; 

40  S.  E.  R.,  9 491 

State  v.  Peterson,  60  Pac.  R.,  809. 

430 
State  v.  Pike,  49  N.  H.,  399;  6  Am. 

R.,533 455 

State  v.  Potts,  100  N.  C.,  457;  6  S.  E. 

R.,  657 460,  483,  499 

State  v.  Probate  Court  Ramsey  Co., 

83  Minn.,  58;  85  N.  W.  Rep.,  917. 

535 
State  v.  Punshon,  133  Mo.,  44;  34  S. 

W.  R.,  25 514 

State  v.  Reddick,  7  Kansas,  143. 

552 
State  v.  Reidell,  9  Del.,  470;  14  Atl. 

R.,  550 461 

State  v.  Rigley,  62  Pac.  R.,  679.  484 


TABLE    OF   CASES    CITED    IN    THIS    VoLfME. 


xlvii 


State  v.  Rippy,  104  N.  C.,  752;  10  S. 

E.  R.,259 481 

State  v.  Robbins  (Iowa),  80  N.  W. 

Rep.,  1061 545,  551,  560 

State  v.  Robinson,  12  Wash.,  491; 

41  Pac.  R.,  884 529 

State  v.  Schaefer,  116  Mo.,  96;  22  S. 

W.  Rep.,  447 436,448, 

559,  563,  577 
State  v.  Scott,  49  La.  Ann.,  253;  21 

So.  R.,  271 561,587 

State  v.  Scott,  41  Minn.,  365;  43  N. 

W.  R.,  62 450 

State  v.  Sewell,  48  N.  C.,  245 552 

State  v.  Shinn,  63  Kan.,  638;  66 

Pac.  R.,  650 482 

State  v.  Smith.  26  Wash.,  354;  67 

Pac.  R.,  70 422,  525 

State  v.  Sneed,  88  Mo.,  138 491 

State  v.  Snow  (Del.),  51  Atl.  R.,  607. 

492 
State  v.  Soper,  148  Mo.,  217;  49  S. 

W.  R.,  1007 450,509, 

532,  541,  542,  547 
State  v.  Sweet.  21  R.  I.,  87;  41  Atl. 

Rep.,  1011 382 

State  v.  Swift,  57  Conn.,  496;  18  Atl. 

Rep.,  664 444 

State  v.  Tincher  (Ind.),  21  Ind.  App., 

142;  51  N.  E.  Rep.,  943 482 

State  v.  Truitt  (Del.).  62  Atl.  R.,  790. 

496 
State  v.  Tyler,  7  Ohio  N.  P.,  443;  5 

Ohio  S.  &  C.  P.  Dec.,  588.  .  .  .349, 

431,439 

State  v.  Van  Tassel,  103  Iowa,  6;  72 

N.  W.  R.,  497 508 

State  r.  Wade,  161  Mo.,  441;  61  S.  W. 

Rep.,  800 434 

State  v.  Ward,  75  Iowa,  637;  36  N. 

W.  Rep.,  765 482 

State  v.  Weaver,  58  Pac.  R.,  109.  489 
State  v.Welsh  (Iowa),  79  N.  W.  Rep., 

369 424 

State  v.  West,  157  Mo.,  309;  57  S.  W. 

R.,  1071 491 

Stater.  Wilcox.  24  Minn..  143.  .  .  .583 


State  v.  Williams,   149  Mo..  496;  51 

S.  W.  Rep.,  88.  .  384 

State  r.  Williamson,  106  Mo.,  162; 

17  S.  W.  R..  172 .536 

State  v.  Wilncr,  40  Wis.,  304 552 

State  v.  Wilson.  104  N.  ('.,  868;  10 

S.  E.  Rep.,  315  .  .  .4S4.487,  4V 
State  r.  Wood  (Iowa),  84  N.  W.  K., 

520 530 

SUite  v.  Wright  (Iowa).  84  N.  W.  R., 

541 514,  530,  531, 

547,564 

State  r.  Zorn,  22  Ore..  591 436, 

484,  494.  536,  662 
State  Bank  r.  Norduff,  2  Kan.  App., 

55;  43  Pac.  Rep..  312 370 

State  Hospital  r.  Fountain,  128  N.  E., 

23;  38  S.  K.  Rep.,  34;  129  N.  C..  90; 

39  S.  E.  R.,734 382 

Statham  r.  Blackford.  SO  Va.,  771; 

178.  E.  Rep.,  233 592 

Stcadman  r.  Steadman  (Pa.).  14  Atl. 

R..  406.  ..  ..418 

Steele  v.  Helen.  2  Man-.  (Del.).  237; 

43  Atl..  153 507.551 

Steinkuehler  r.  Wempner  (Ind.),  81 

N.  E.  R.,482 399 

Sternaman  r.  Metropolitan  Life  In- 
surance Co..  170  N.  Y..  13;  62  N. 

E.  R..  763;  88  Am.  St.  Rep..  625; 

67  L.  R.  A. .318 132.134 

Stevens  r.  Leonard.  154  Ind.,  67; 

56  N.  E.  II..  27  .  .  .  . 401 .  517,  539 
Stevenson  r.  Kinpsley.  8  Pa.  Dist.  K., 

245 -410 

Stevenson  r.  West  Seattle  L.  A  I.  Co. 

(Wash.).  60  Pac.  R..  51 376 

Stover  r.  People's  Mut.  Arc.  Ins. 

Ass..  150  Pa..  132;  24  Atl.  K..  662; 

10  L.  R.  A..  44u...  140 

Stewart.  In  re,  59  Hun.  618..  .411 
Stewart.  Matter  of,  15  X.  V.  Supp.. 

601 •-«» 

Stewart  r.  Taylor.  23  Ky.  L.  R..  577; 

63  S.  W.  R..  783....  587 

Stewart  r.  Lispenard,  2(>  Wend..  255. 

385 


xlviii 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


Stillman,  Matter  of,  29  State  Rep., 
213 410 

Stockmeyer  v.  Tobin,  139  U.  S.,  176. 

365 

Stout  v.  Rigney,  107  Fed.,  545;  46 
C.  C.  A.,  459 598 

Storey,  In  re,  20  111.  App.,  183.  ...  399 

Storms  v.  Allegan  Circuit  Judge 
(Mich.),  57  N.  W.  Rep.,  1,074.592 

Stover  v.  Commonwealth,  92  Va.,  780; 

22  S.  E.  R.,  874 430 

Stuart  v.  State,  1  Baxt.  (Term.),  178. 

559 

Stuckey    v.    Mathes,    24   Hun,    461. 

376,  378,  762 

Sturdevant  Appeal,  71  Conn.,   392; 

42  Atl.,  70 388,  550,  567 

Sullings  v.  Shakespeare,  46  Mich.,  408; 
41  Am.  Rep.,  166;  9  N.  W.  R.,  451. 

132 
Sullivan,  In  re,  24  Misc.  R.  (N.  Y.), 

357;  53  N.  Y.  Supp.,  717 354 

Sullivan  v.  Foley  (Mich.),  70  N.  W. 

R.,   322 419, 

522,  536 

Superintendents  of  the  Poor  v.  Rab- 
bitt,  57  N.  W.  Rep.,  1084;  99  Mich., 

60 382 

Supreme  Council  Order  of  Chosen 
Friends  v.  Garrigus,  104  Ind.,  133; 
3  N.  E.,  818;  54  Am.  R.,  298. 

136 
Supreme  Court  of  Honor  v.  Peacock; 

•  91  111.  App.,  632 374 

Supreme  Court  of  Honor  v.  Turner, 

99  111.  App.,  310 140 

Sutherland  v.  Hawkins,  56  Ind.,  343. 

536 
Sutherland's  Will,  In  re,  28  Misc.  R., 

424;  59  N.  Y.  Supp.,  989 414 

Suydam's  Will,  In  re,  84  Hun,  514; 

23  Supp.,  449 395,  555 

Swank  v.  Swank,  61  Pac.    R.,  846 

(Ore.) 363 

Swartwood  v.  Chance,  131  Iowa,  714; 

109  N.  W.  R.,297 355 

Swenarton  v.  Hancock,  9  Abb.  N.  C., 


326;  84  N.  Y.,  653;  22  Hun,  38. 
387,  416 

Swenson  v.  Swenson,  178  N.  Y.,  54. 

767 
Swift  v.  Carpenter,  18  R.  I.,  545; 

28  Atl.  R.,  936 383 

Swope  v.  Donnelly,  7  Pa.  Dist.  R., 

448;  21  Pa.  Co.  Ct.  R.,  167.  .  .  .503 
Swope  v.  Frazier,  18  Ky.  L.  R.,  649; 

37  S.  W.  R.,  495 586 

Sylvester  v.  Townof  Casey  (Iowa),  81 

N.  W.  R.,  455 428 

Tapp  v.  Hosmer,  14  Mich.,  309. .  .566 

Taylor,  In  re,  9  Paige  (N.  Y.),  611. 

594,  597 

Taylor    v.    Commonwealth,    90    Va., 

109;  19  S.  E.  R.,  739 439,  562 

Taylor  v.  Lovering  (Mass.),  50  N.  E. 

Rep.,  612;  171  Mass.,  303 381 

Taylor  v.  Moore,  23  Ky.  L.  R.,  1572; 

65  S.  W.  R.,612 353,  580,  586 

Taylor  v.  Pegram,  151  111.,  106;  37 

N.  E.  Rep.,  837 384,  390, 

518,  539,  569 
Taylor  v.  State,  105  Ga.,  746;  31  S.  E. 

Rep.,  764 456,479 

Taylor  v.  U.  S.,  7  App.  D.  C.,  27. 
510,  543,  553 

Tebout's    Case,    9    Abb.    Pr.,    211. 

588,  590 

Teegarden  v.  Lewis,  35  N.  E.  R.  (Ind.), 

24 355 

Ten  Eyck  v.  Whitbeck,  156  N.  Y., 

341,353 553 

Terrell  v.  State,  74  Wis.,  278;  42  N. 

W.  Rep.,  243 484 

Territory  v.  Padilla,  8  N.  Mex.,  510; 

46  Pac.  Rep.,  346 516,  546 

Texas  Pac.  Ry.  Co.  v.  Crow,  3  Tex. 

Civ.  App.,  266;  22  S.  W.  R.,  928. 

364 
Thayer  v.  Standard  Life  and  Ace.  Ins. 

Co.,  68  N.  H.,  577;  41  Atl.  R.,  182. 

139 
Thedford  v.  Reade,  25  Misc.  (N.  Y.), 

490;  54  N.  Y.  Supp.,  1007,  382,  383 


TABLE   OF   CASES   CITED    IN    THIS   VOLUME. 


xlix 


Thomas  v.  Carter,  170  Pa.  St.,  272; 

33Atl.  Rep.,81 398 

Thomas  v.  Commercial  Union  Ass. 

Co.,  162  Mass.,  29;  37  N.  E.  R., 

672;  44  Am.  St.  R.t  323 133 

Thomas  v.  Crawford,  118  Mich.,  253; 

76  N.  W.  Rep.,  394 362 

Thomas  v.  Hunsicker,  108  N.  C.,  720. 

380 
Thomas  v.  State  (Fla.),  36  So.  R., 

161 483 

Thompson,  Appeal  of  (Pa.),  16 

Montg.  Co.  Law  R.,  102 565. 

592 
Thompson  v.  Bennett,  194  111.,  57; 

62  N.  E.  R.,  321 521,  566 

Thompson  v.  Hawks,  11  Biss.,  440; 

14  Fed.  R.,902 399 

Thompson  v.  Thompson,  21  Barb., 

107 385 

Thomson,  In  re,  92  Me.,  563;  43  Atl. 

R.,  511 ...551,  565 

Thorpe,  In  re,  64  Vt.,  398;  24  Atl. 

Rep.,  991 592 

Thorpe  v.  Hanscom,  66  N.  W.  R.,  1; 

64  Minn.,  201 370 

Thurman  v.  State,  32  Neb.,  224;  49 

N.  W.  R.,  338 463,  464,  466 

Tibbett's  Estate,  In  re  (Cal.),  69 

Pac.  R.,978 523 

Tiffany  v.  Worthington,  96  Iowa,  566; 

65  N.  W.  R.,817 383 

Tilton  v.  Tilton,  16  Ky.  Law  Rep., 

538;  29  S.  W.  Rep.,  290 379 

Titus  v.  Gage,  70  Vt.,  13;  39  Atl.  R,, 

246 515 

Tome  v.  Stump,  42  Atl.  R.,  902;  89 

Md.,  264 580 

Tomlinson  v.  Tomlinson,  103  Iowa, 

740;  72  N.  W.  R.,  664 362 

Toomes,  Estate  of,  54  Cal.,  509;  35 

Am.  Rep.,  83 533 

Topeka  Water  Supply  Co.  v.  Root, 

56  Kan.,  187;  42  Pac.  R.,  715. 
370,  592 

Townsend  v.  Pepperell,  99  Mass.,  40. 

531 


Townsend  v.  Price,  53  Pac.  Rep.,  668; 

19  Wash.  St. ,415 3H1 

Townsend's  Will,  In  re,  75  Hun  (N. 

Y.),  593;  27  N.  Y.  Supp..  603. .  386 

Towson  v.  Moore,  11  App.  D.  C.,  377. 

420,  503,  505.  553 

Tracy,  Ex  parte,  1  Paige  (N.  Y.),  580. 
582,  585,  590 

Tracy,  Matter  of,  11  State  Rep.,  103. 

411 
Tramwell  v.  Vaughn,  158  Mo.,  214; 

59  S.  W.  R.,79 768 

Traut  v.  Thompson,  4  Conn.,  203. 

535 
Travelers  Ins.  Co.  v.  Dunlap,  160  111., 

642;  43  N.  E.  R.,  765;  52  Am.  St. 

Rep.,  355 141 

Trezevant  v.  Rains,  85  Tex.,  329;  19 

S.  W.,  567 390 

Trezevant  v.  Rains  (Tex.  Civ.  App.), 

25  S.  W.  Rep.,  1092 392, 

420,523 
Trich's  Will,  165  Pa.  St.,  586;  30  Atl. 

Rep.,  1053 392,308 

Trowhridge  v.  Stone's  Admr.,  42  W. 

Va.,  454;  26  S.  E.  R.,  363 515 

True  v.  Ranney,  21  N.  H.,  52 762 

Trumbull  ?>.  Erickson,  97  Fed.  Rep., 

891;  38  C.  C.  A.,  536 428 

Trustees  of  Poor  v.  Jacobs,  6  Houst. 

(Del.),  330 599 

Tucker  v.  Hyatt,  51  N.  E.  Rep.,  469; 

151  Ind.,  332 427 

Tucker  v.  Roach,  139  Md.,  275;  38 

N.  E.  R.,822 ..522 

Tucker  v.  Shaw.  158  111.,  326;  41  N. 

E.  Rep.,  914 422 

Tullis  v.  Kidd,  12  Ala.,  648 531 

Tunison  v.  Tunison.  4  Bradf.,  138.  411 
Turner,  Appeal  of,  72  Conn.,  305; 

44  Atl.  Rep.,  310 389.  417. 

419,537.544,549 

Turner  r.  Cook,  36  Md.,  129 566 

Turner  P.  Houpt.  53  N.  J.  Eq..  526; 

33  Atl.  R.,  28 356.  386 

Turner  r.  Meyers  orse  Turner,  1 

Hagg.Cons.  (Eng.,)414. .  .761,762 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


Turner  v.  Rusk,  53  Md.,  65 399 

Turner  v.  Territory,  82  Pac.  R.,  650. 

450 
Turner  v.  Union  National  Bank,  10 

Utah,  77;  37  Pac..  95 357 

Turner  v.  Utah  Title  Insurance  and 

Trust  Co.,  10  Utah,  61;  37  Pac.,  91. 

357,  363 

Turner   v.    Wells,   Fargo   &  Co.,    10 

Utah,  75;  37  Pac.,  94 357 

Tutow  v.  Tutow,  54  Pa.,  216;  93  Am. 

Dec.,  691 539 

Tyler  v.   Gardiner,   35  N.   Y.,   559. 

554 

Ullrich  v.  N.  Y.  Press  Co.,  23  Misc., 

Rep.  (N.  Y.),  168;  50  N.  Y.  Supp., 

788 425 

Underwood  v.  Thurman,  111  Ga., 

325;  36  S.  E.  R.,  788 520 

Union  Casualty  and  Surety  Co.  v. 

Mondy,    18    Colo.    App.,    395;    71 

Pac.  R.,  677 143 

Union  Cent.  Life  Ins.  Co.  v.  Hughes' 

Adm.,  110  Ky.,  26;  60  S.  W.  R., 

850 140 

Union  Mutual  Life  Ins.  Co.  v.  Payne, 

105  Fed.,  172;  45  C.  C.  A.,  193. 

374 
Union  Pac.  R.  Co.  v.  Botsford,  141 

U.  S.,  250 765 

United  States  v.  Chisholm,  153  Fed., 

808 506 

United  States  v.  Drew,  5  Mas.,  28. 

492 
United  States  v.  Faulkner,  35  Fed. 

R.,  730 451 

United  States  v.  Frizzell,  19  App.  (D. 

C.),48 383 

United  States  v.  German,  115  Fed.  R. 

987  (Ky.  Dist.) 430 

United  States  v.  Guiteau,  3  Grim. 

Law  Mag.,  347 531 

United  States  v.  McGlue,  1  Curt.,  1; 

Fed.  Cas.,  No.  15,679 492 

United  States  v.  Shults,  6  McLean, 

121.  ..506 


United  States  Mut.  Ace.  Ass'n  v. 
Barry,  131  U.  S..  100;  9  Sup.  Ct., 
755;  33  Lawyers'  Ed..  60 136 

United  States  Mut.  Ace.  Ass'n  v. 
Newman,  84  Va.,  52;  3  S.  E.  R., 
805 141 

Upstone  v.  People,  109  111.,  169.  536 

Valentine  v.  Metropolitan  Life  Ins. 
Co.,  106  App.  Div.  (N.  Y.),  487. 

140 

Van  Alstfl.  Hunter,  5  Johns.  Ch.,  148. 

411 
Van  Auken's  Case,  2  Stock.  (N.  J.), 

186 536,  585 

Van  Deusen  v.  Newcomer,  40  Mich., 

90 599,607 

Van  Dusen  v.  Sweet,  51  N.  Y.,  378. 

367,  528 

Van    Guysling    v.    Van    Kuren,    35 

N.  Y.,  70 406,  411 

Van  Huss  v.  Rambolt,  2  Cold.,  139. 

539 
Van  Meter  v.  Darragh,  115  Mo.,  153; 

22  S.  W.  R.,  30 355 

Vanosdel  v.  Hyce,  46  La.  Ann.,  387; 

15  So.,  19 362,  370,  568 

Van  Wyck  v.  Brasher,  81  N.  Y.,  260. 

374 

Varner  v.  Varner,  16  Ohio  C.  C.,  386. 

522 

Vedder,  Matter  of,  6  Dem.,  92 401 

Vedder's  Will,  14  N.  Y.  State  Rep., 

470 399 

Village  of  Fairmount  v.  Meyer,  83 
Minn.,  456;  86  N.  W.  Rep.,  457. 

482 

Virginia  Fire  and  Marine  Ins.  Co.  v. 
Morgan,  90  Va.,  290;  18  S.  E.  R., 

191 133 

Vivian,  Appeal  of,  74  Conn.,  257;   50 

Atl.  R.,  797 503,  522,  538 

Vondal   v.    Vondal,    175   Mass.,  383. 

766,  767 

Von  de  Veld  v.  Judy,  143  Mo.,  348; 

44  S.  W.  R.,  1117 389, 

391,  410,  552,  568 


TABLE   OF   CASES   CITED    IN    THIS   VOLUME. 


W.  v.  H.,  2  Swab,  and  T.,  240 765 

Wabash  Ry.  Co.  v.  Monegan,  94  111. 

App.,  82 428 

Wade  v.  Holbrook.  2  Redf.  (N.  Y.), 

378 403 

Wade  v.  State  (Tex.  Cr.  App.),  63 

S.  W.  R.,878 560 

Wadsworth  v.  Sharpsteen,  8  N.  Y., 

388 369 

Wager,  In  re,  6  Paige  (N.  Y.),  11. 

588 
WVger  v.  Wagoner,  53  Neb.,  511; 

73  N.  W.  R.,937 364 

Wagner  v.  State,  116  Ind.,  181.  .484 
Wagner  v.  Stewart,  143  Ind.,  78; 

42  N.  E.  Rep.,  469 425 

Walker,  In  re,  57  App.  Div.,  1;  67  N. 

Y.  Supp.,647 587 

Walker  v.  Coates,  5  Kan.  App.,  209; 

47  Pac.  Rep.,  158 592 

Walker  v.  People,  26  Hun,  67;  1  N. 

Y.  Cr.  R.,  7 457 

Walker  v.   Russell,    10  S.  Car.,  82. 

590,  731 

Walker  v.  State,  91  Ala.,  76;  9  So. 

R.,  87 490 

Walker  v.  State,  136  Ind.,  663;  36 

N.  E.  Rep.,  356 433 

Walker  v.  State,  46  Neb.,  25;  64  N. 

W.  Rep.,  357 430 

Walker  v.  Walker.  14  Ga.,  242 535 

Walker  v.  Winn,  39  So.,  12  (Ala.). 

365 
Wallace  v.  Frey,  27  Misc.  R.,  29; 

56  N.  Y.  Supp.,  1051 55.1 

Wallis  v.  Brown  (N.  J.),  52  Atl.  R., 

475 581 

Wallis  v.  Luhring.  134  Md.,  447;  34 

N.  E.,  231 390 

Walsh  t?.  People,  88  N.  Y.,  458.  .445 
Walter  v.  Mitchell  (Mont.),  65  Pac. 

R.,  5 427 

Walts  v.  Walts  (Mich.),  86  N.  W.  R., 

1032;  8  Det.  Leg.  N.,  446.  521,  522 
Ward  v.  Chicago  St.  P..  M.  &  O.  Ry. 

Co.,85Wis.,601;55N.  W.  R.,771. 

428 


Ward  v.  Conatsor,  4  Baxt.  (Tenn.), 

64 425 

Ward  r.  State,  96  Ala.,   100;  11  So. 

Rep.,  217.  433 

Wannsley  r.    Darragh,   12  Misc.   (N. 

Y.),  199 366 

Warner  r.  State,  56  N.  J.   L.,  686; 

29  Atl.  R.,  505 491 

Warren's    Devisees    v.  O'Connoll,  23 

Ky.   Law  R.,  260;  62  S.   W.   R., 

890 392 

Washer  r.  Slater,  67  App.  Div..  385; 

73  N.  Y.  Supp.,  425 588. 605 

Waterman    v.    Whitney,    11    N.    Y., 

157;  62  Am.  Dec.,  71 503.  505 

Waters    v.  Reed,    8   Detr.    Leg.   N. 

(Mich.),  899;  88  N.  W.   R.,  394. 

556 
Watson,  Matter  of,  39  N.  Y.  State 

Rep.,  42 411 

Watson  v.  Donnelly,  28  Barb..  653. 

392 
Watters  r.  Mcdreavy,  82  N.  W.  R., 

949 515 

Waugh   r.    Moan.   200   111.,  298;   65 

N.  E.  R.,  713.  .  .384,  388.  390.  503 
Wax's  Estate,  In  re,  106  Cal.,  343; 

39  Pac.  Rep.,  624 538,  548 

Waxmuth  v.  McDonald,  96  111.  App., 

242 429 

Way  mi  re  v.   Jetmore,   22  Ohio  St., 

271 762 

Weaver  v.  Brennan,  146  Pa.  St..  299. 

380 

Weaver's  Apj>eal,   116  Pa.  St..  225. 
590,  593 

Webb,  In  rr.  2  Phillips.  10 594 

Webb    r.  State.  5  Tex.   App.,  506. 

536 

Webster   v.   Woodward,  3  Day,  90. 

354 

Weir    r.    Meyers.    34    Pa.    St.,    667. 

594 
Weis  r.  Ahrenbeck.  5  Tex.  Civ.  App.. 

542;  24  S.  \V    Rep.,  356.  .         367 
Weit/el.  In  rr.  14  N.  B.  R..  466;  Fed. 

Caa.  No.  17,365 fi98 


lii 


TABLE    OF    CASES    CITED    IN    THIS    VOLUME. 


Welch,  In  re,  108  Wis.,  387;  84  N.  W. 

•      R.,  550 564 

Welde  v.  Welde,  2  Lee's  Eccl.  Ca.,  580. 

764 
Welford's  Will,  In  re  (N.  J.  Pre.),  51 

Atl.  R.,  501 556 

Wellman,  In  re,  3  Kan.  App.,  100; 

45  Pac.  R.,  726 587 

Wells,  In  re,  96  Me.,  161;  51  Atl.  Rep., 

868 551 

Wells,   In  re,  67  N.   Y.   Supp.,  631. 

580 
Wendel    v.    Wendel,    30    App.    Div. 

(N.  Y.),  447 763 

Westcott  v.  Sheppard,  51  N.  J.  Eq. 

(6  Dick.),  315 390 

Westerfield  v.  Jackson,  3  N.  Y.  State 

Rep.,  353 367 

Westerman's  Will,  In  re,  29  Misc.  (N. 

Y.),  409;  61  Supp.,  1065 556 

Western  State  Hospital  v.  Conier,  99 
Va.,  702;  40  S.  E.  R.,  52;  3  Va.  Sup. 

Ct.  R.,  539 382 

Wheatley  v.  State,  39  S.  W.  R.,  67. 

559 

Wheeler,    Matter    of,    5   Misc.,    279. 
411,  412,  555 

Wheeler  v.  Grand  Trunk  R.  Co.,  70 
N.  Y.,  607;  50  Atl.  R.,  103;  54  L. 

R.  A.,  955 428 

Wheeler  v.  State,  34  Ohio  St.,  394. 

582 
Wheeler's  Will,  In  re,  56  N.  Y.  State 

Rep.,  709 387 

Wheeler's  Will,  In  re,  5  Misc.  R.  (N. 

Y.    SUIT.),    279;    25    Supp.,    421. 

411,  412,  555 

Wheelock  v.  Godfrey,  100  Cal.,  578, 

35  Pac.  R..  317 538 

Whipple  v.  Eddy,  161  111.,  114;  43  N. 

E.  Rep.,  789 400 

Whitaker  v.   Hamilton,    126   N.   C., 

465;  35  S.  E.  Rep.,  815.  ...  544,  548 

Whitcomb  v.  Hardy,  73  Mnn.,  285; 

76  N.  W.  Rep.,  29 369 

White,  In  re,  1  Barb.  Ch.  (N.  Y.),  43. 

595 


White,  In  re,  2  C.  E.  Green  (N.  J.), 

247 593 

White  v.  Davis,  62  Hun,  622;  17  N.  Y. 

Supp.,  548 356,  546 

White  v.  Farley,  81  Ala.,  563;  8  So. 

Rep.,  215 425 

White  v.   Hinton,  3  Wyo.,  753;   30 

Pac.  Rep.,  953 380 

White  v.  Ross,  48  State  Rep.,  599; 

20  N.  Y.  Supp.,  521 386 

White  v.  State,  30  S.  W.   R.,  556. 

490 

Whitelaw's  Adm.  v.  Whitelaw's  Admr. 

96   Va.,    712;    32   S.    E.    R.,   458. 

507,  517 

Whitelaw's  Exr.  v.  Simes,  90  Va.,  588; 

19  S.  E.  Rep.,  113 546,  555 

Whiteman  v.   Whiteman,    152    Ind., 

263;  53  N.  E.  Rep.,  225 402 

Whitman  v.  Morey,  63  N.  H.,  448; 

2  Atl.  R.,  899 503 

Whitney  v.  Twombly,  136  Mass.,  145. 

389 

Whitten   v.   State,   22   So.    R.,   483. 

489,  493 

Widmayer,  In  re,  74  App.  Div.  (N.  Y.), 

336;  77  Supp.,  665 565,  569 

Widmayer's  Will,  In  re,  34  Misc.  R., 

439;  69  N.  Y.  Supp.,  1014 391, 

412 
Wightman  v.  Wightman,  4  Johns.  Ch. 

(N.  Y.),  343 762 

Wilcox  v.  State,  94  Tenn.,  106;  28  S. 

W.  R.,  312 450,  491,  493 

Wilde's  Will,  In  re,  38  Misc.  R.  (N.), 

149;  77  N.  Y.  Supp.,  315 ...  404, 407 

Wilder   v.   Weakley,    34    Ind.,    181. 

364 
Wilkins  v.  Wilkins,  35  Neb.,  212;  52 

N.  W.  R..  1109 366 

Wilkinson  v.  Pearson,  23  Pa.  St.,  117. 

536 

Wilkinson  v.  Wilkinson,  129  Ala.,  279. 

364 

Wilkinson,  Gaddis  &  Co.  v.  Markert 
(N.  J.),  47  Atl.  R.,  488;  65  N.  J.  L., 
518...  ..381 


TABLE    OF   CASES    CITED    IX    THIS    VOLUME. 


liii 


Will's  Estate,  In  re,  67  Minn.,  335; 

69  N.  W.  R.,  1,090 522 

Wille  v.  Wille,  57  S.  C.,  413;  35  S.E. 

Rep.,  804 362 

Williams,  In  re,  24  App.  Div.,  247; 

48  N.  Y.  Supp.,  475;   aff'd  157  N. 

Y.,  704;  52  N.  E.  R.,  1126. . .  .581 
Williams,  Matter  of,  40  N.  Y.  State 

Rep.,  356;  2  Connolly,  579;  15  N. 

Y.  Supp.,  828,  aff'd  46  State  Rep., 

791;  19  N.  Y.  Supp.,  778 393, 

403,  406,  410 
Williams  v.  Raid,  118  N.  C.,  481; 

24  S.  E.  Rep.,  217 553 

Williams  v.  Hays,  143  N.  Y.,  442; 

38  N.  E.  R.,  449;  26  L.  R.  A.,  153. 

426 
Williams  v.  Hays,  157  N.  Y.,  541; 

52  N.  E.  Rep.,  589 426 

Williams  v.  Lee,  47  Md.,  321 539 

Williams  v.  Robinson,  39  Vt.,  267. 

525 
Williams  v.  Sapieha,  94  Tex.,  430; 

61  S.  W.  R.,  115 364,  368 

Williams  v.  State,  48  Ind.,  306.  .  .482 
Williams  v.  State  (Tex.  Cr.  App.),  53 

S.  W.  R.,859 530,540 

Williams  v.  State,  37  Tex.  Cr.  App., 

348;  39  S.  W.  Rep.,  687 ...  537,  559, 

561 
Williams  v.  Williams,  2  Hun  (N.  Y.), 

Ill 599 

Williams  v.  Williams  (Ky.),  23  S.  W. 

R.,  789 399 

Willis  v.  Lewis,  5  Ired.  (N.  C.),  14. 

594 
Willis  v.  People,  32  N.  Y.,  715;  aff'g 

5  Park  Cr.,  621 440,  448,  452 

Willis  v.  Willis,  12  Penn.  St.,  459. 

587 
Willoughby,  In  re,  11  Paige  (N.  Y.), 

257 596 

Wilsey  v.  Ellis,  89  111.  App.,  632. 

534 
Wilson  v.  Hay's  Exr.,  22  Ky.  Law 

Rep.,  897;  58  S.  W.  Rep.,  773. 

392 


Wilson  v.  State,  60  N.  J.  Law,  171; 

37Atl.  R.,954 491 

Wilson's  Est.,  In  re,  117  Cal.  R.,  262; 

49  Pac.  Rep.,  172 407,  517 

Winslow  v.  Troy,  97  Me.,  130,  133; 

53  Atl.,  1008 762 

Winspear  v.  The  Accident  Ins.  Co. 

(Eng.),  L.  R.,  6  Q.  B.  D.,  42. . .  138 
Wisdom  v.  Shanklin,  74  Mo.  App., 

428 380 

Wiser  v.  Lock  wood,  42  Vt.,  720. .  .762 
Withrow  v.  Smith,  37  W.  Va.,  757; 

17  S.  E.  Rep.,  316 380 

Wolcott  v.  Conn.  Gen.  L.  I.  Co.,  100 

N.  W.  R.,  569;  11  Det.  Leg.  N.,  346. 

364 
Wolcott  v.  United  Life  and  Ace.  Ins. 

Ass.,  55  Hun  (N.  Y.),  98;  8  Supp., 

263 143 

Wolf,  In  re,  9  Kulp.,  523 425 

Wolf,  In  re,  10  Kulp.,  112 588 

Wolf,  In  re  Solomon,  195  Pa.  St.,  438; 

46  Atl.  R.,  72 588 

Wolf  v.  Edwards,  106 La., 477;  31  So. 

Rep.,  58 365 

Wood  v.  Carpenter,  166  Mo.,  465; 

66  S.  W.  R.,  172 507 

Wood  v.  Lane,  29  S.  E.  Rep.,  180;  102 

Ga.,  199 402 

Wood  v.  State,  58  Miss.,  741 536 

Wood  r.  Zibble  (Mich.),  92  N.  W.  R., 

348;  9  Det.  Leg.  N.,  489 521 

Woodford  v.  Buckner,  32  Ky.  L.  R., 

627;  63  S.  W.  R.,  617 567.  568 

Woodward's  Will.  In  re,  167  N.  Y., 

28;  60  N.  E.  R..  233 503.  521 

Woolsey's  Will.  In  re,  17  Misc.  R.  (N. 

Y.),  547;  41  Supp.,  263 575 

Wray  r.  Wray,  19  Ala.,  522 378 

Wright  i'.  Southern  Exp.  Co.,  80 

Fed.  Rep.,  85 421 

Wright  r.  StrtU?.  37  Tex.  Cr.  App., 

627;  40 S.  W.  R..491  .  .490.493.524 
Wright  r.  Waller  (Ala.),  29  So.  Rep.. 

57 375 

Wright  r.  Wright,  139  Mass.,  177; 

29  N*.  E.,  3X0.  .  ..356 


liv 


TABLE    OF    CASES    CITED    IN   THIS    VOLUME. 


Wright's  Est.  (Pa.),  In  re,  51  Atl.  R., 
1031 389,535 

Wurster  v.  Amifield,  67  App.  Div., 
158;  73  N.  Y.  Supp.,  609 355 

Wyman  v.  Gould,  47  Me.,  159 531 

Wyse  v.  Wyse,  155  N.  Y.,  367;  49 
N.  E.  Rep.,  942 546 

Yarb rough  v.  State,  105  Ala.,  43;  16 

So.  Rep.,  758 537 

Yarrow  v.  Yarrow,  Probate  Div. 

(Eng.),92 377 

Yorke's  Estate,  In  re,  6  Pa.  Dist.  R., 

321 507,555 

Youn  v.  Lamont,  56  Minn.,  216; 

57  N.  W.  R.,  478 375,  543, 

564 


Young  v.  Miller,  145  Ind.,  652;  44 
N.  E.  Rep.,  757 390,  569 

Young  v.  Stevens,  48  N.  H.,  133. 

366 

Young  v.  Travelers  Ins.  Co  ,  80  Me., 
244;  13  Atl.  R.,  896 143 

Yturburru's  Est.,  In  re,  134  Cal.,  567; 
66  Pac.  R.,  729 382 

Zeltner  v.  Bodman  Home,  1  Ohio  S. 

&C.  P.  Dec.,  306 363 

Zerega  v.  Percival  (La.),  15  So.  R., 

471 419 

Ziegler's  Will,  In  re,  65  Hun,  621;  19 

N.  Y.  Supp.,  747 397 

Zirkle  v.  Leonard,  61  Kansas,  636; 

60  Pac.  R.,  318 537,543 


FORENSIC  MEDICINE. 


BIOLOGICAL 

(Continued.) 


THE  MEDICO-LEGAL  RELATIONS 


OF 


VISION  AND  AUDITION, 


AND  OF 


INJURIES  TO  THE  EYE  AND  EAR. 


BY 


J.    H.    WOODWARD,    B.S.,    M.D., 

to  the  Metropolitan  Throat  Iloxpital,  umi  to  the  Aeio  York  Tltruat 
and  NOKC  ]{^pital.  New  York  City. 


VISION   AND   AUDITION  AND  INJURIES 
TO  THE  EYE  AND  EAR 

CHAPTER  I. 

ON  THE  ACUTENESS  OF  VISION. 

THE  acuteness  of  vision  of  an  eye-witness  may  have  an  im- 
portant bearing  upon  the  credibility  of  his  testimony.  It  may 
have  an  important  bearing  on  those  cases  of  alleged  direct  or 
indirect  injury  to  the  visual  apparatus,  in  which  the  simulating 
plaintiff  is  actuated  by  revengeful  motives,  or  by  a  dishonest 
desire  for  pecuniary  remuneration  for  his  alleged  hurt.  It  must 
be  taken  into  consideration  likewise  in  those  cases  of  actual  in- 
jury, direct  or  indirect,  to  the  visual  apparatus,  in  which  justice 
would  naturally  side  with  the  injured  party,  to  the  end  .that  the 
degree  of  his  incapacity  may  be  correctly  determined. 

The  visual  apparatus  comprises  the  eyeball  together  with  its 
extrinsic  muscles,  the  optic  nerves,  the  chiasm,  the  optic  tracts, 
and  the  centres  of  visual  perception  in  the  brain.  Acuteness 
of  vision  depends  upon  the  integrity  of  these  structures.  The 
eyeball  is  really  a  living  camera.  Upon  its  retina  is  projected 
an  instantaneous  and  transient  photograph  of  the  objects  seen. 
By  virtue  of  the  transmission  of  such  impressions  upon  the 
retina  to  the  centres  of  vision  in  the  occipital  lobes,  by  the  optic 
nerves,  the  chiasm,  the  optic  tracts,  and  the  prolongations  of  the 
optic  tracts,  the  retinal  image  of  the  object  under  observation 
is  perceived.  If  the  retinal  images  be  true  and  if  impressions 
of  them  be  properly  transmitted  to  a  normal  visual  centre,  the 
perceptions  of  the  object  will  be  correct,  so  far  as  concerns  the 
visual  apparatus.  It  often  happens,  however,  that  the  retinal 
images  are  not  clear  and  distinct;  under  certain  conditions  they 
do  not  represent  the  thing  as  it  is.  The  reason  for  this  must 
often  be  sought  in  the  state  of  the  refraction  of  the  eye. 

By  refraction  of  the  eye  is  signified  "the  influence  of  the 

5 


6  VISION   AND  AUDITION — WOODWARD. 

ocular  media  upon  a  cone  or  beam  of  light,  whereby  a  normal 
or  emmetropic  eye  produces  a  proper  image  of  the  object  upon 
the  retina."  The  ocular  media  which  cause  such  a  deviation 
of  a  cone  or  a  beam  of  light  are  the  cornea,  the  aqueous  humor, 
the  crystalline  lens,  and  the  vitreous  humor.  They  are  spoken 
of  as  the  "  dioptric  system"  of  the  eye.  These  media  together 
constitute  a  lens  which,  in  the  normal,  emmetropic  or  ideal  eye, 
cause  parallel  rays  of  light  (i.e.,  rays  derived  from  infinitely 
distant  objects)  to  unite  at  a  focus  in  the  retina.4  "From  near 
objects,  the  rays  proceed  in  a  diverging  direction,  and  their 
point  of  union  in  the  normal  eye,  consequently,  lies  behind  the 
retina,  and  yet  the  organ  is  capable  of  perceiving  near  objects 
also  accurately.  It  has,  therefore,  the  further  power  of  bringing 
divergent  rays  into  union  on  the  retina.  Now  this  power  of 
bringing  at  will  rays  of  different  direction  into  union  on  the 
retina  is  the  power  of  accommodation  of  the  eye.  .  .  .  The 
change  consists  in  an  alteration  of  the  form  of  the  lens ;  above 
all,  its  anterior  surface  becomes  more  convex  and  approaches 
the  cornea."  3  This  alteration  in  the  form  of  the  lens  is  brought 
about  by  contraction  of  the  ciliary  muscle  by  which  the  zone  of 
Zinn.  or  the  suspensory  ligament  of  the  lens,  is  relaxed,  when, 
by  virtue  of  its  own  elasticity,  the  lens  becomes  more  refract- 
ing. The  accommodation  is  all  positive.  If  we  paralyze  the 
ciliary  muscle  with  atropine,  for  example,  we  can  then  accu- 
rately measure  the  refraction  of  the  eye ;  the  dioptric  system  is 
then  adjusted  for  its  far  point. 

The  emmetropic,  or  normal,  eye  is  not  often  seen.  Emme- 
tropic eyes  are  eyes  in  which,  when  they  are  at  rest,  parallel 
rays  of  light,  that  is,  rays  of  light  proceeding  from  infinitely 
distant  objects,  are  brought  to  a  focus  on  the  retina;  and  in 
which  the  power  to  adjust  the  eye  for  near  objects  remains 
sufficiently  good  to  enable  the  eye  to  read  type  as  small  as 
Jaeger  No.  1,  at  22  centimetres  distance,  until  the  patient  is 
forty  or  forty-five  years  old.  Such  an  eye  is  endowed  with  nor- 
mal refraction  and  accommodation.  And,  inasmuch  as  emme- 
tropia  is  relatively  uncommon,  there  are  deviations  from  the 
normal  refraction.  The  varieties  of  abnormal  refraction,  or 
ametropia,  are  hypermetropia,  astigmatism,  and  myopia,  and 

1  Gould's  "Medical  Dictionary. "          *  Bonders  :     "Refraction  and    Ac- 
3  Ibid.  commodation, "  p.  8. 


ON   THE   ACUTENESS   OP   VISION.  f 

various  combinations  of  astigmatism  with  hypermetropia  and 
myopia. 

The  greatest  number  of  eyes  are  hypermetropic.  The  antero- 
posterior  diameter  of  such  eyes  is  shorter  than  that  of  omme- 
tropic  eyes.  In  technical  terms,  the  "  retina  is  situated  between 
the  dioptric  system  and  the  principal  focus  of  the  eye."  '  Very 
many  eyes  are  astigmatic.  By  astigmatism  we  mean  a  "  state 
of  irregular  refraction  of  an  eye,  usually  congenital,  in  which 
the  rays  of  light  diverging  from  a  single  point  cannot  be  brought 
to  a  focus  at  a  point  on  the  retina;  an  asymmetrical  condition 
of  the  refraction  of  different  meridians  of  the  eye." f  "  Regular 
astigmatism  is  that  error  of  refraction  which  is  due  to  a  differ- 
ence in  the  focal  distance  of  the  two  principal  meridians,  and 
depends  mainly  on  the  curvature  of  the  cornea."  Simple  hy- 
permetropic astigmatism  is  that  variety  of  astigmatism  in 
which  one  of  the  meridians  of  the  cornea  is  emmetropic  and  the 
other  is  hypermetropic  in  their  effect  upon  the  refraction  of 
light.  Simple  myopic  astigmatism  is  that  variety  of  astigma- 
tism in  which  one  of  the  meridians  of  the  cornea  is  emmetropic 
and  the  other  myopic  in  their  effect  upon  the  refraction  of  light. 
Compound  hypermetropic  astigmatism  is  simple  hypermetropic 
astigmatism  plus  hypermetropia.  Compound  myopic  astigma- 
tism is  simple  myopic  astigmatism  plus  myopia.  Mixed  astig- 
matism is  that  variety  of  astigmatism  in  which  one  of  the 
principal  meridians  of  the  cornea  is  hypermetropic  and  the  other 
myopic  in  its  effect  upon  the  refraction  of  light.  Astigmatism 
of  these  varieties  is  regular.  It  may  be  irregular.  Irregular 
astigmatism  may  be  normal  or  abnormal.  "  Normal  irregular 
astigmatism  is  due  to  irregularity  in  the  structure  and  density 
of  the  crystalline  lens,  so  that  an  aberration  of  the  rays  occurs 
as  they  traverse  the  different  sectors,  in  consequence  of  which 
there  is  an  imperfect  coincidence  of  the  images  of  the  different 
sectors.  Its  chief  symptom  is  polyopia."  "  Abnormal  irregu- 
lar astigmatism  is  due  to  some  defect  in  the  curvature  of  the 
cornea,  or  to  some  irregularity  in  the  structure  or  position  of 
the  crystalline  lens."  *  Astigmatism  may  be  acquired,  and  then 
it  is  "  dependent  on  flattening  of  the  cornea  from  inflammatory 

1  Landolt :  "Traite  completd'Oph-          3  Ibid. 

thalmologie, "  iii.,  p.  126.  *  Ibid. 

*  Foster's  "Encyclop.  Med.  Die."          &  Ibid. 


f 


SNELLEN'S  TEST  TYPES. 
CO. 

60  M. 


LXX. 

20  M. 


L. 

15  M. 


XL. 

12  M. 


XXX. 

9M. 


XX. 

6M. 


10  VISION  AND   AUDITION  —  WOODWARD. 

changes  or  irregular  apposition  of  the  flaps  after  a  cataract  ex- 
traction, or  in  dislocation  of  the  crystalline  lens."  Any  wound, 
or  other  solution  of  continuity,  of  the  cornea  may  cause  astig- 
matism. Myopia,  or  "short  sight,"  is  that  state  of  the  refrac- 
tion of  the  eye,  in  which,  in  the  great  majority  of  instances,  the 
antero-posterior  diameter  is  longer  than  in  emmetropia.  This 
is  axial  myopia.  The  most  comprehensive  definition  of  myopia 
is  that  state  of  refraction  in  which  the  retina  lies  beyond  the 
focus  of  the  dioptric  system.4 

The  acuteness  of  vision  of  any  eye  is  measured  by  testing 
the  reading  power  of  each  eye  separately.  Charts  of  test 
types  are  used,  and  that  devised  by  Snellen,  based  upon  the 
deduction  that  the  minimum  visual  angle  is  one  minute,  has 
been  generally  adopted  by  ophthalmologists.  The  chart  is 
hung  upon  the  wall  in  a  good  light  —  not  direct  sunlight  —  at 
20  feet,  or  6  metres  from  the  patient.  A  screen  is  then  placed 
before  one  eye,  and,  with  both  eyes  open,  the  patient  is  directed 
to  begin  at  the  top  and  read  as  many  letters  upon  the  chart  as 
he  can. 

If  he  is  able  to  distinguish  only  the  first  letter,  A,  of  the 
test  types  with  either  eye,  the  acuteness  of  vision  of  each  eye  is 

~~-,  or  —  lV  =  p^>  °rfiO/'     If  be  can  read  the  following 

two   letters,    but   none  below  that  line,   then  V  =  -^r,  or  TTTT- 

That  is  to  say,  the  patient  at  20  feet  can  read  only  those  letters 
of  the  test  types  which  he  should  be  able  to  read  at  200  feet 
and  100  feet  respectively,  if  his  vision  were  normal.  The 
numerator  of  the  fraction  always  denotes  the  distance  between 
the  patient  and  the  test  types,  and  the  denominator  denotes  the 
lowest  line  of  type  that  he  is  able  to  read  with  each  eye 
separately.  The  same  fraction  may  stand  for  the  acuteness  of 
vision  of  both  eyes;  but  frequently  the  vision  of  one  eye  is  more 
acute  than  that  of  the  other. 

90  fi 

When  V  —  —  —  ,  or  —  ,  it  is  normal  ;   that  is,   the  patient 
X.X.          6 

must  be  able  to  read  at  20  feet  letters  analogous  to  those  in  the 

20 

line  of  the  chart  used  in  the  test.     A  person  having  nor- 


1  Foster's  "Encyclop.  Med.  Die."          2  Landolt,  I.e.,  p.  118. 


ON  THE   ACUTENESS  OF  VISION.  H 

mal  vision  may  read  also  the  letters  in  the  lowest  line  and  even 
still  smaller  type;   but  vision  is  not  normal  unless  in  a  good 

light  one  can  read  at  20  feet  the  letters  in  the  — -  line  at  least 

XX 

When  vision  is  not  normal,  the  cause  for  it  may  be  found  in 
some  failure  of  transparency  of  the  refracting  media,  or  in 
some  morbid  state  of  the  cornea,  aqueous,  iris,  crystalline  lens, 
vitreous,  ciliary  bodies,  retina,  choroid,  or  optic  discs.  The 
ophthalmoscope  will  inform  an  experienced  person  whether  one, 
or  more,  of  those  structures  is  in  a  morbid  state.  Vision  is 
below  normal  also  when  the  retro-bulbar  portion  of  the  optic 
nerves,  the  chiasm,  the  optic  tracts,  and  the  cerebral  centres  from 
which  the  nerve  fibres  composing  the  optic  tracts  are  derived, 
are  diseased  or  injured.  The  ophthalmoscope  may  not  reveal 
anything  denoting  the  condition  of  those  deeply  seated  struc- 
tures until  some  weeks  or  months  have  passed ;  in  certain  cases 
no  morbid  changes  in  the  ophthalmoscopic  image  are  ever  ob- 
served. 

When  the  visual  apparatus  is  in  a  healthy  condition,  acute- 
ness  of  vision  depends  upon  the  refraction  of  the  eye.  Emme- 
tropic  eyes  have  normal  vision.  Hypermetropic  eyes  may 
have  normal  vision,  and  they  may  not.  In  order  that  an  hy- 
permetropic  eye  may  have  normal  vision,  a  contraction  of  the 
ciliary  muscle  must  take  place  to  increase  the  sphericity  of  the 
crystalline  lens  enough  to  compensate  for  the  shortness  of  the 
antero- posterior  diameter  of  the  eyeball,  by  advancing  the  focus 
of  the  dioptric  system  until  it  lies  in  the  retina.  So  long  as  the 
ciliary  muscle  is  able  to  accomplish  this  fact,  the  hypermetropic 
eye  will  have  normal  vision. 

Low  degrees  of  regular  hypermetropic  astigmatism  may  be 
overcome  by  an  analogous  process;  but,  in  general,  the  acute- 
ness  of  vision  in  astigmatic  eyes  is  below  normal.  Irivgular 
astigmatism  always  reduces  the  acuteness  of  vision  to  a  marked 
degree.  Myopic  eyes  never  have  normal  acuteness  of  vision  (20 
feet  test) . 

Recognition  of  things  by  sight  depends  not  only  upon  the 
size  of  the  object,  but  also,  to  a  certain  extent,  upon  the  observ- 
er's famHiarity  with  the  general  aspect  of  the  object,  and  upon 
the  brilliancy  of  the  object.  It  is  well  known  that  |>ersons 
whose  vision  is  imperfect  are  able  to  recognize  things  lying 


12  VISION   AND    AUDITION — WOODWARD. 

beyond  their  range  of  distinct  vision  by  virtue  of  their  familiarity 
with  the  general  characteristics  of  those  things.  A  woman  is 
thus  distinguished  from  a  man  by  her  dress.  And  a  near- 
sighted person  will  recognize  an  acquaintance  by  his  walk,  by 
some  peculiarity  of  dress,  or  by  some  other  mark  of  individuality, 
notwithstanding  that  the  person's  features  are  absolutely  indis- 
tinguishable to  the  observer  at  such  a  distance. 

Brilliant  objects,  such  as  stars,  flames,  polished  surfaces,  etc., 
are  visible  at  much  greater  distances  than  other  objects  having 
the  same  size  and  form. 

To  ascertain  whether  failure  in  acuteness  of  vision  be  due  to 
an  error  of  refraction  or  not,  ophthalmologists  employ  four 
methods : 

1.  Ophthalmoscopic     examination.      The     ophthalmoscope 
will  reveal  the  existence  of  morbid  changes  in  the  structures 
of  the  eyeball  which  take  part  in  the  visual  act.     It  may  be 
used   to   objectively  determine  the  refraction   of  the   dioptric 
system.      The  accommodation  (ciliary  muscle)  of  the  patient 
must  be  paralyzed,  and  the  accommodation  of  the  observer  re- 
laxed, to  make  this  method  of  observation  reliable ;  and,  even 
under  such  conditions,  the  error  will  amount  to  0.50  or  0.75  of 
a  diopter. 

2.  The  fundus-reflex  test,  or  retinoscopy.     This  is  an  objec- 
tive method  of  determining  the  state  of  the  refraction.     Unless 
the  patient's   accommodation  be  paralyzed,    the  results  of  this 
examination  are  not  to  be  relied  upon,  in  many  cases.     The 
error,  when  the  accommodation  is  paralyzed,  will  be  0.25  of  a 
diopter  at  least,  and  it  may  be  0.75  D. 

3.  Javal's  ophthalmometer  is  used  to  measure  astigmatism 
objectively.     It  gives   an  approximately  accurate  idea  of  the 
curvature  of  the  cornea,  from  which  is  derived  a  probable  diag- 
nosis of  the  amount  and  of  the  axis  of  the  astigmatism.     It  is, 
in  general,  the  more   useful  the  greater  the  astigmatic  error. 
But  the  ophthalmometer  does  not  inform  us  whether  the  astig- 
matism is  hypermetropic,  or  myopic,  or  mixed.     It  reveals  ir- 
regular corneal  astigmatism  with  great  certainty. 

4.  The  refraction  is  measured  also  by  the  subjective  method. 
The  patient  is  required  to  read  with  each  eye  separately  the 
chart  of  test  types  as  far  as  he  is  able.     Then  convex  (+)  spher- 
ical lenses  are  placed  before  the  eye  under  examination,  begin- 


ON  THE   ACUTENESS   OP   VISION.  13 

ning  with  a  weak  lens.  The  strongest  convex  lens  through 
which  the  eye  can  read  clearly  the  |£  line  of  types  is  the  meas- 
ure of  its  manifest  hypermetropia.  Anemmetropic  eye  will  re- 
ject -f  glasses.  When  hypermetropia  is  all  latent,  the  eye  may 
reject  glasses.  By  paralyzing  the  ciliary  muscle  with  atropine, 
the  total  hypermetropia  will  be  revealed  and  may  then  be  meas- 
ured. An  emmetropic  eye,  while  under  the  influence  of  atro- 
pine, should  pead  clearly  the  |£  line  of  types.  Should  the  pa- 
tient fail  to  read  the  normal  line  of  types  with  the  con  vex  spher- 
ical lenses,  convex  cylindrical  lenses  should  be  tried ;  and  the 
strongest  convex  cylinder  through  which  he  can  read  the  normal 
line  of  types  is  the  measure  of  his  manifest  hypermetropic  astig- 
matism. Should  neither  the  convex  spherical  nor  the  convex 
cylindrical  lenses  alone  give  him  the  proper  acuteness  of  vision, 
combinations  of  them  may  do  so;  and  the  strongest  combination 
of  such  lenses  is  the  measure  of  the  manifest  compound  hyi>er- 
metropic  astigmatism.  These  various  errors  may  be  absolutely 
measured  by  the  same  method,  while  the  patient's  accommoda- 
tion is  paralyzed  by  atropine. 

Should  the  patient  reject  convex  lenses  of  all  varieties  and 
strengths,  the  eye  may  be  tested  with  concave  (— )  lenses;  and 
the  weakest  concave  lens  with  which  the  normal  line  is  clearly 
read  is  the  measure  of  the  myopia.  Concave  cylinders  should 
be  tried,  and  the  weakest  of  them  that  gives  normal  vision  is  the 
measure  of  the  myopic  astigmatism.  Combinations  of  concave 
spherical  with  concave  cylindrical  lenses  may  be  required  to 
raise  vision  to  normal,  and  the  weakest  combination  is  the  meas- 
ure of  the  compound  myopic  astigmatism.  In  myopia  and  my- 
opic astigmatism,  the  accommodation  may  be  in  a  state  of 
spasm.  This  will  exaggerate  the  error  of  refraction.  To  obvi- 
ate this  source  of  error,  atropine  should  be  used  until  the  ciliary 
muscle  is  paralyzed. 

The  diagnosis  of  astigmatism  is  not  completed,  however, 
until  the  eye  can  see  the  test  dial  correctly  at  twenty  feet.  The 
test  dial  is  a  chart  made  like  a  clock-face  with  three  parallel 
black  lines  running  from  each  hour  toward  the  centre.  A  clear 
space  is  left  about  the  centre  to  avoid  confusing  the  patient. 
The  width  of  each  line  is  such  as  to  subtend  a  visual  angle  of 
one  minute. 

It  is  by  no  means  always  possible  to  raise  the  acuteness  of 


14 


VISION   AND   AUDITION — WOODWARD. 


vision  to  normal  with  glasses,  even  though  the  visual  apparatus 
be  perfectly  healthy.  Very  many  hypermetropic,  myopic,  and 
astigmatic  eyes  fall  into  this  category.  Nevertheless  a  combi- 
nation of  the  four  methods  of  examination  will  reveal  the  state 
of  the  refraction  of  any  eye.  If  the  error  of  refraction  be  con- 
siderable, and  the  acuteness  of  vision  be  not  raised  to  normal, 
or  if  it  be  not  materially  improved  by  correcting  lenses,  it  is 
highly  probable  that  the  dulness  of  sight  is  a  consequence  of  the 
error  of  refraction  and  nothing  else.  The  burden  of  proof  that 
it  is  due  to  something  else  should  always  rest  upon  those  who 
entertain  that  proposition. 

Having  measured  the  acuteness  of  vision  for  distant  objects, 
the  power  of  the  eye  to  see  objects  close  at  hand  must  be  tested. 

Jaeger  No.  1. 

A  Pol  being  caught  in  a  trap,  was  glad  to  compound  for  bu  neck  by  leaving  bia  tail  behind  him;  but  upon  coming  Abroad  into 
the  world,  he  began  to  be  BO  sensible  of  the  disgrace  such  a  defect  would  bring  upon  him,  that  he  almost  wished  he  had  died 
rather  than  come  away  without  it.  However,  resolving  to  make  the  best  of  a  had  matter,  he  called  a  meeting  of  the  rest  of  the 
Foxee,  and  proposed  that  all  should  follow  his  example.  "You  hare  no  notion,"  said  he,  "of  the  ease  and  comfort  with  which 
I  n<ar  more  about:  I  could  never  bare  believed  it  if  I  had  not  tried  it  myself  j  but  really  when  one  comes  to  reason  upon  it,  a 
tail  Is  such  an  ugly,  inconvenient,  unnecessary  appendage,  that  the  only  wonder  is  that,  as  Foxes,  we  could  have  put  up  with  it  so 
long.  1  propose,  therefore,  my  worthy  brethren,  that  you  all  profit  by  the  experience  that  I  am  most  willing  to  afford  you,  and 
tfr.t  all  Foxes  from  this  da;  forward  cut  off  their  tails."  Upon  this  on*  of  tbt  oldest  supped  forward,  and  said,  "I  rather  think, 

Jaeger  No.  2. 

07  friend,  that  you  would  Dot  have  advised  us  to  part  with  oar  tails,  if  there  were  an;  chance  of 
recovering  year  own."  A  Han  who  had  been  bitten  by  a  Dog  was  going  about  asking  who  could  cure 
him.  One  that  met  him  said,  "  Sir,  if  jou  would  be  cured,  take  a  bit  of  bread  and  dip  it  in  the  blood  of 
the  wound,  and  give  it  to  the  dog  that  bit  you."  The  man'  smiled,  and  said,  "If  I  were  to  follow  your 
advice,  I  should  be  bitten  by  all  the  dogs  in  the  city."  He  who  proclaims  himself  ready  to  buy  up  his 
enemies  will  never  want  a  supply  of  them.  A  certain  man  had  the  good  fortune  to  possess  a  Goose  that 
laid  him  a  Golden  Egg  every  day.  But  dissatisfied  with  so  slow  an  income,  and  thinking  to  seize  the 
whole  treasure  at  once,  he  killed  the  Goose,  and  cutting  her  open,  found  her— just  what  any  other  goose 

Snellen  D  =  0,5, 


The  Gallic  tribes  fell  off,  and  sued  for  peace.  Even 
the  Batavians  became  weary  of  the  hopeless  contest, 
while  fortune,  after  much  capricious  hovering  settled 
at  last  npon  the  Roman  side.  Bad  Civilis  been  suc- 
cessful, he  would  have  been  deified;  but  bis  misfortunes, 
at  last,  made  him  odious  in  spite  of  his  heroism.  Bat 


the  Bstavian  was  not  a  man  to  be  crashed,  nor  haft 
he  lived  so  long  in  the  Roman  service  to  be  oat- 
matched  in  politics  by  the  barbarous  Germans. 
He  was  not  to  be  sacrificed  as  a  peace-offering  to 
revengeful  Rome.  Watching  from  beyond  the  Rhine 
the  progress  of  defection  and  the  decay  of  national 


Snellen  D  =  0,6. 


enthusiasm,  he  determined  to  be  beforehand  with  those  who  were  now  his  enemies.  Ho 
accepted  the  offer  of  negotiation  from  Cerialis.  The  Roman  general  was  eager  to  grant  a> 
full  pardon,  and  to  re-enlist  so  brave  a  soldier  in  the  service  of  the  empire.  A  colloquy  was 
agreed  npon.  The  bridge  across  the  Nabalia  was  broken  asunder  in  the  middle,  and  Cerialis 
and  Civilis  met  upon  the  severed  sides.  The  placid  stream  Jiy  which  Roman  enterprise  had 
the  waters  of  the  Rhine  with  the  lake  of  Flevo,  flowed  between  the  imperial 


ON  THE   ACUTENESS  OF  VISION.  15 

Tliis  power  depends  upon  the  state  of  the  accommodation.  A 
normal,  emmet ropic  eye  should  be  able  to  read  fine  print,  Jae- 
ger No.  1  or  Snellen  1|,  as  near  as  8  inches,  or  21  centimeters, 
from  the  eye. 

The  error  of  refraction  being  corrected,  nearly  all  hyperme- 
tropic  and  astigmatic  eyes  (irregular  astigmatism  excepted) 
will  be  able  to  do  the  same.  Myopic  eyes,  in  which  the  error 
is  not  excessive,  will  be  able  to  read  as  well,  either  without  or 
with  correcting  lenses.  These  statements  will  hold  good  until 
the  patient  has  passed  his  fortieth  year.  All  eyes  then  begin 
to  experience  the  results  of  the  change  in  accommodation  power 
known  as  presbyopia,  or  "  old  sight. "  This  is  a  normal  physio- 
logical change,  which  makes  it  difficult,  or  impossible,  for  the 
patient  to  read  fine  type  or  to  distinguish  small  objects  at  8 
inches,  or  22  centimetres,  from  his  eye.  He  holds  his  work  far- 
ther from  his  eye,  and  places  the  lamp  between  his  eye  and  the 
book  or  paper.  But  sometimes  the  ciliary  muscle  is  strong 
enough  and  the  lens  is  elastic  enough  to  enable  the  patient  to 
overcome  the  effects  of  this  physiological  alteration  in  his  vis- 
ual apparatus,  even  until  he  is  forty-eight  or  fifty  j-ears  old. 
His  eye  is  presbyopic,  nevertheless.  Now  and  then  such  eyes 
suddenly  lose  their  power  to  read  newspaper  type  at  any  dis- 
tance without  the  aid  of  convex  lenses.  In  many  cases,  no  very 
definite  reason  can  be  given  for  this  sudden  failure  of  the 
accommodation . 

Presbyopia  develops  regularly  in  every  eye.  At  forty-five 
years  it  amounts  to  S-f  1  D. ;  at  fifty  years  it  is  S-f  2  D ;  at  fifty- 
five  years,  S+3  D ;  at  sixty  years,  S-f  4  D.  In  practice  it  is 
found  that  after  sixty  years  the  presbyopia  does  not  increase 
with  regularity. 

The  acuteness  of  vision  for  near  work,  therefore,  undergoes  a 
ph}rsiological  modification.  An  emmetrope,  for  example,  in 
order  to  see  small  print  as  well  at  fifty  years  of  age  as  he  did  at 
forty,  must  use  a  spherical  convex  lens  of  2  D.  His  presbyo- 
pia must  be  corrected.  The  same  is  true  of  those  whose  eyes 
are  hypermetropic  or  astigmatic.  The  amount  of  the  presbyo- 
pia must  be  added  to  the  patient's  distance  glasses  to  give  him 
the  correcting  glass  for  near  work.  Myopes  may  not  experience 
.iny  of  the  effects  of  presbyopia  until  Inter  in  life;  because  myo- 
pia compensates  for  equal  amounts  of  presbyopia.  A  myope, 


16  VISION  AND   AUDITION— WOODWARD. 

fifty  years  of  age,  wearing  a  spherical  —  2  D.  would  read  Jaeger 
No.  1  easily  at  22.  cm.  without  glasses.  But  at  fifty-five  years 
the  same  person  would  require  S+l  D.  to  enable  him  to  see  as 
well.1 

The  extrinsic  muscles  of  the  eyeball  play  an  important  role 
in  the  visual  act.  The  acuteness  of  binocular  vision  is  dimin- 
ished whenever  these  muscles  are  not  sufficiently  balanced  to 
adjust  both  eyes  properly  for  the  object  under  observation.  If 
the  image  of  the  object  do  not  fall  upon  corresponding  portions 
of  the  fundus  of  the  two  eyes,  the  object  will  not  be  seen  clearly 
(contours  blurred) ,  or  it  will  be  seen  double  (diplopia) .  This 
condition  is  often  more  distressing  to  the  patient  than  failure  of 
vision  due  to  an  error  of  refraction.  It  is  probable  that  the  nor- 
mal power  of  the  internal  recti  is  sufficient  to  overcome  the  effect 
of  from  30  to  40  prism  degrees ;  that  the  normal  power  of  the 
external  recti  is  about  8  prism  degrees ;  that  that  of  the  superior 
and  inferior  recti  ranges  from  1  to  4  prism  degrees. 

When  the  external  recti  a,re  relatively  weak  and  the  internal 
recti  are  strong,  there  is  a  tendency  of  the  visual  lines  to 
meet  before  they  should — esophoria;  when  the  interni  are 
weak  and  the  externi  relatively  stronger  than  they  should 
be,  there  is  a  tendency  to  divergence  of  the  visual  lines — 
exophoria.  When  a  superior  or  an  inferior  rectus  muscle  is 
relatively  weaker  than  its  antagonist,  there  is  developed  a  ten- 
dency of  one  visual  line  to  rise  above  the  other — hyperphoria, 
which  may  be  either  right  or  left,  according  to  the  case.  These 
conditions  are  grouped  under  the  term  heterophoria.  When  the 
deviations  are  more  marked ;  that  is,  when  there  is  an  obvious 
turning  of  the  eye,  we  have,  for  those  cases  in  which  the  eye 
turns  in,  the  term  esotropia  (internal  strabismus) ;  for  those  in 
which  the  eye  turns  out,  exotropia ;  for  those  in  which  the  eye 
turns  up,  hypertropia ;  or  in  which  it  turns  down,  hypotropia. 
These  conditions  are  designated  as  cases  of  heterotropia. 

To  measure  heterophoria,  prisms  are  used,  by  means  of  which 
lateral  or  vertical  diplopia  is  produced  at  will  by  the  observer. 
Having  developed  the  diplopia,  the  amount  of  deviation  of  the 
images  from  the  normal  position  is  measured  by  the  number  of 

1  For  those  who  cannot  read,  charts  and  for  near-testing  the  patient  may 
of  numbers,  or  charts  of  peculiar  be  required  to  designate  small  dots, 
figures,  are  used  for  the  20  feet  test ;  or  to  thread  needles,  etc. 


ON  THE   ACUTENE8S  OF   VISION.  17 

prism  degrees  required  to  restore  the  images  to  a  proper  relation, 
one  to  another.  Heterotropia  may  be  measured  in  prism  de- 
grees also  in  a  similar  manner  when  it  is  possible  to  develop 
diplopia.  It  is  not  always  possible  to  develop  diplopia  in  these 
cases.  When  the  heterotropia  is  due  to  recent  paralysis  of  one  of 
the  extrinsic  ocular  muscles,  diplopia  is  always  present,  if  the 
vision  of  each  eye  is  fairly  good.  The  patient  may  learn  to  sup- 
press the  false  image.  A  red  glass  placed  before  one  of  the  eyes 
will  enable  the  observer  to  distinguish  the  image  projected  upon 
that  eye,  so  that  the  deviation  of  the  lines  of  vision  may  be 
measured. 

The  subjective  symptoms  commonly  associated  with  errors 
of  refraction  and  heterophoria  are  indistinct  vision,  blurring  of 
vision,  pain  in  the  eyes,  pain  in  the  orbit  behind  the  eyea; 
frontal  and  temporal  headache,  which  may  be  more  marked  on 
one  side  than  the  other;  general  headache;  "sick"  headache; 
"sun"  headache;  "blind"  headache;  occipital  headache;  pain 
in  the  back  of  the  neck ;  confusion  of  mind ;  blind  spells ;  and 
vertigo.  Stevens  and  other  writers  have  claimed  that  chorea 
and  epilepsy  are  caused  by  errors  of  refraction  and  by  hetero- 
phoria. It  must  be  recollected  that,  at  the  time  of  testing  the 
patient's  eyes,  vision  may  be  normal,  and  the  patient  honestly 
unconscious  that  his  eyes  are  the  cause  of  his  symptoms.  Fre- 
quently it  may  be  impossible  to  state  positively  that  the  symp- 
toms are  due  to  eye-strain.  Then,  in  order  to  make  a  positive 
proof  of  the  matter,  the  ocular  errors  must  be  corrected,  and, 
if  they  have  caused  the  disturbances,  the  symptoms  will  disap- 
pear after  a  few  weeks  or  a  few  months. 

Hypermetropia,  and  astigmatism  not  due  to  lesions  of  the 
cornea,  are  congenital.  They  do  not  change  materially  during 
life.  Latent  hypermetropia  and  latent  astigmatism  may  become 
manifest  and  so  give  rise  to  the  idea  that  the  error  of  refraction 
has  increased.' 

Myopia  is  seldom  congenital,  but  generally  develops  in  early 
childhood.  The  development  of  it  is  favored  by  school  work, 
and  other  severe  usage  of  the  eyes  at  short  range,  by  the  diseases 
of  childhood,  and  by  anything  that  undermines  the  bodily  vigor. 

1  In  a  few  cases  that  have  come     tain,  that  an  astigmatic  error  has 
under  the  writer's  observation  it  has     actually  increased, 
seemed  highly  probable,  if  not  cer- 
III.-2 


18  VISION   AND   AUDITION — WOODWARD. 

All  cases  are  more  or  less  progressive ;  but  the  progress  of  the 
trouble  in  the  majority  of  cases  ceases  spontaneously,  or  may  be 
made  to  cease.  Cases  of  myopia  must  be  divided  into  two  cate- 
gories :  the  malignant  and  the  non-malignant.  Non-malignant 
myopia  of  low  degree  may  be  a  positive  advantage  to  one  whose 
business  calls  for  continuous  use  of  the  eyes  at  short  range. 
Malignant  myopia,  on  the  contrary,  is  a  condition  involving 
great  danger  of  ultimate  blindness.  The  eye  is  not  healthy; 
the  myopia  becomes  more  and  more  marked  until  it  is  excessive ; 
the  range  of  vision  becomes  progressively  smaller.  Injuries 
affect  such  eyes  much  more  seriously  than  others.  Even  slight 
contusions  may  accelerate  the  increase  of  the  myopia,  or  dislo- 
cate the  lens,  or  cause  hemorrhage  into  the  vitreous,  or  precipi- 
tate a  detachment  of  the  retina. 

The  muscle  of  accommodation  of  one,  or  of  both  eyes  may 
suffer  from  paresis  or  paralysis.  The  eye  will  then  be  adjusted 
for  its  far  point.  Both  eyes  will  not  work  in  harmony  and  the 
patient  may  be  greatly  annoyed  by  his  condition.  On  testing 
such  an  eye  it  will  be  found  that  the  power  to  adjust  the  eye  for 
objects  at  varying  distances  is  gone.  The  causes  of  this  condition 
are  as  follows :  Diphtheria,  typhoid  fever,  articular  rheumatism, 
syphilis,  diabetes,  parasitic  diseases,  poisoning  by  raw  sausages 
and  tainted  meat,  lesions  of  the  central  nervous  system  involv- 
ing the  nuclei  or  trunk  of  the  third  nerve,  and  vascular  disturb- 
ances in  the  same  region,  digestive  troubles,  fracture  of  the 
skull,  locomotor  ataxia,  anything  that  weakens  bodily  vigor, 
e.g.,  essential  ansemia,  and  anemia  developed  by  acute  diseases, 
lactation,  alcoholism,  venereal  excesses,  masturbation,  uterine 
lesions,  abundant  hemorrhages,  etc.,  herpes  zoster  ophthalmi- 
cus,  traumatisms  of  the  eye  or  orbital  region,  sympathetic  oph- 
thalmia, glaucoma,  and  neuralgia  of  the  dental  branches  of  the 
fifth  nerve,  atropine  and  other  mydriatics.1 

1  Landolt :  "  Refraction  and  Accommodation, "  translated  by  Culver, 
1886,  p.  551  et  seq. 


CHAPTER  II. 

SIMULATED    BLINDNESS. 

A  PERSON  may  claim  that  he  is  partially  or  totally  blind  in 
jne  or  in  both  eyes  in  consequence  of  some  injury.  If  ophthal- 
inoscopic  evidence  of  a  lesion  in  the  visual  apparatus  sufficient 
to  materially  weaken  or  totally  abolish  the  function  of  the  eye 
or  the  eyes  be  found,  the  patient's  statement  regarding  his 
ability  to  see  may  be  accepted.  But  when  no  ophthalmoscopic 
evidence  of  a  lesion  is  manifest,  doubt  of  the  truth  of  the  patient's 
statement  should  be  entertained. 

By  amblyopia  is  signified  partial  blindness,  where  there  are 
no  lesions  demonstrable  with  the  ophthalmoscope;  by  amauro- 
sis  is  signified  total  blindness  where  there  are  no  lesions  demon- 
strable with  the  ophthalmoscope.  In  this  connection,  then,  we 
have  to  deal  with  simulated  amblyopia  of  one,  or  of  both  eyes; 
and  simulated  amaurosis  of  one,  or  of  both  eyes. 

Monocular  amblyopia  or  amaurosis  is  simulated  most  fre- 
quently. The  problem  that  confronts  the  examiner  in  such  cases 
is  to  prove  that  the  malingerer  actually  uses  the  eye  which  he 
claims  is  amblyopic  or  amaurotic.  The  objective  evidence  bear- 
ing upon  the  question  is  as  follows :  The  pupil  of  a  healthy  eye 
contracts  in  response  to  the  stimulus  of  light ;  also  when  the  eye 
accommodates,  and  during  the  act  of  convergence  of  the  visual 
lines.  It  does  not  necessarily  follow,  however,  that  the  exis- 
tence of  these  reactions  is  proof  positive  that  the  eye  is  not  af- 
fected. The  converse  proposition,  however,  is  often  true.  The 
pupil  of  myopes  is  generally  large  (semi-dilated).  The  pupil  is 
dilated  when  the  light  is  faint>  during  and  after  great  muscular 
exertion,  and  in  real  amaurosis. l  Some  persons  can  dilate  or  con- 
tract their  pupils  at  will.  In  old  age,  in  hypermetropia,  in  near 
vision  and  in  strong  light,  the  pupil  is  contracted.  Observation 
of  the  tendency  to  fixation  of  the  eye  in  monocular  and  in  binoc- 
ular vision  will  afford  useful  evidence  regarding  the  function 
of  the  organ.  Place  a  screen  before  the  eye  in  question  and  in- 

1  Vide  p.  27. 
19 


20  VISION  AND   AUDITION— WOODWARD. 

struct  the  patient  to  look  at  an  object,  which  is  caused  to  move 
toward  and  recede  from  the  eye ;  if,  when  the  screen  is  removed, 
the  affected  eye  fixes  the  object,  it  is  probable  that  the  eye  is  a  use- 
ful one.  The  same  is  true  when  a  prism  of  8  or  10  degrees  base 
out  is  placed  before  the  eye.  If,  under  such  conditions,  the  eye 
turn  so  as  to  overcome  the  action  of  the  prism,  while  the  sound 
eye  fixes  a  given  object,  it  is  probable  that  the  eye  is  a  useful  one. 

One  may  cover  the  sound  eye  and  attempt  to  surprise  the 
patient  by  thrusting  a  finger  toward  the  eye  said  to  be  affected. 
Should  the  patient  wink  or  cringe,  the  eye  is  not  blind. 

The  examiner  may  seem  to  devote  his  whole  attention  to  the 
sound  eye,  determining  its  acuteness  of  vision,  its  refraction, 
and  its  range  of  accommodation.  The  patient's  attention  is 
thus  diverted  from  the  alleged  amaurotic  eye.  He  is  then  to 
read  fine  print ;  both  with  and  without  glasses.  Finally,  with- 
out exciting  his  suspicion,  a  strong  convex  glass  (6  D.)  is  set 
before  the  sound  eye,  while  the  type  is  held  at  the  usual  distance 
for  reading,  i.e.,  beyond  the  focus  of  the  convex  lens.  If  the 
patient  still  reads  the  type,  he  reads  with  the  eye  said  to  be 
affected. 

Among  the  tests  for  detecting  simulated  monocular  amblyo- 
pia  and  amaurosis  are  those  in  which  prisms  are  used  to  pro- 
duce double  vision.  If  a  prism  be  placed  before  one  eye  and  the 
patient  see  two  images,  for  example  of  a  candle,  he  must  have 
used  both  eyes.  The  experiment  may  be  modified  to  confuse  a 
person  acquainted  with  the  test.  Thus,  exclude  the  eye  in  ques- 
tion from  vision,  and  place  a  prism  over  the  sound  eye  so  that 
the  edge  shall  bisect  the  pupil.  This  will  cause  monocular  di- 
plopia.  Then,  without  attracting  the  patient's  attention,  remove 
the  screen  from  the  other  eye,  at  the  same  time  moving  the  prism 
so  as  to  cover  the  pupil  of  the  sound  eye  completely.  Should 
the  patient  still  see  double,  he  is  using  both  eyes. 

In  some  respects  the  stereoscope  is  one  of  the  most  useful 
agents  employed  in  detecting  simulated  blindness.  Prisms  are 
an  essential  part  of  the  construction  of  this  instrument.  The 
following  from  Kugel l  indicates  the  method  of  its  use : 

"  Vieusse  gives  the  following  method:  Two  wafers  of  dif- 
ferent color,  whose  distance  from  one  another  is  a  centimetre,  are 

1  "  Ueber  die  Diagnose  von  Simu-     opie, "  Wiener  med.  Wochenschrif t, 
lation  der  Amaurose  und  Ambly-      1889. 


SIMULATED  BLINDNESS  21 

brought  under  the  stereoscope.  With  this  small  distance  of  one 
from  the  other,  the  one  lying  on  the  right  hand  of  the  person 
examined  appears  on  the  left  side  and  the  other  appears  on  the 
right  side.  Suppose  there  were  a  red  wafer  on  the  right  and 
a  blue  wafer  on  the  left,  then  the  blue  wafer  will  appear  on  the 
right  side,  and  the  red  wafer  on  the  left  side.  If,  for  example,  we 
have  to  do  with  an  individual  who  pretends  left-sided  amauro- 
sis,  the  case  can  be  of  two  sorts:  either  the  person  admits  that 
he  sees  both  the  wafers ;  then  the  simulation  is  eo  ipso  proved ; 
or,  he  admits  that  he  sees  only  one  wafer.  In  the  latter  case  he 
would  naturally  confess  to  seeing  the  blue  wafer,  since  this  is  on 
that  side  which  corresponds  to  the  professedly  strong  eye,  viz., 
the  right  side,  and  he  betrays  himself  thereby,  so  to  speak, 
through  a  double  lie.  He  denies  the  existence  of  the  red  wafer 
which  he  must  see  with  the  professedly  strong-sided  eye,  but 
on  the  other  side  he  professes  to  see  the  blue  wafer  which  he 
can  see  only  with  the  professedly  amaurotic  eye. 

"  In  order  to  determine,  by  this  method,  even  the  degree  of 
the  sharpness  of  vision,  I  have  with  advantage  employed  two 
short  words,  as  for  example  herz-mein.  The  pretender  has 
either  read  mein-herz,  or  asserts  that  he  sees  only  one  of  these 
words,  the  very  one  indeed  which  he  could  have  seen  only  with 
the  professedly  bad  eye." 

Baudry1  gives  the  following:  "Our  test  is  designed  to  de- 
termine the  visual  acuteness  of  the  amblyopic  eye  or  the  one 
that  is  supposed  to  be  so.  We  accomplish  this  with  typo- 
graphical characters  disposed  as  will  be  stated.  Let  us  suppose 
that  upon  each  half  of  a  card  like  those  which  are  employed  for 
stereoscopic  tests  one  has  commenced  by  tracing  the  same  let- 
ters arranged  identically  in  the  same  way  and  separated  by  per- 
fectly equal  intervals  in  the  two  tests,  in  such  a  manner  that  the 
latter  shall  be  a  faithful  fac-simile  one  of  the  other  without  the 
least  difference  of  stereoscopic  parallels.  Let  us  imagine,  finally, 
that  one  suppresses  upon  each  portion  a  certain  number  of  letters 
or  entire  words  taken  by  chance,  or  a  combination  of  forms  of 
letters,  having  care  always  that  the  suppressions  made  upon 
each  of  the  lists  shall  not  be  reproduced  upon  the  other.  The 
place  of  the  suppressed  parts  should  be  left  blank.  One  may 

1  "Simulation  de  1'Amauroseet  de      yensde  la  devoiler. "  Bull,  scient.  du 
J'Amblyopie,    des   principaux  mo-      Department  duNord,  New.  8,9.  1883. 


22  VISION   AND   AUDITION— WOODWARD. 

prepare  in  the  same  way  ten  cards  of  which  the  characters 
shall  have  progressively  increasing  dimensions  calculated 
in  a  manner  to  represent  ten  numbers  of  the  typographical 
decimal  scale,  so  that  they  may  be  made  to  serve  as  a  measure  of 
the  acuteness  of  vision  in  tenths.  Several  numbers  may  be 
grouped  on  the  same  card.  These  cards  being  placed  in 
turn  in  the  stereoscope,  the  simulator  is  invited  to  read  the 
words  or  to  pick  out  the  letters  which  he  sees,  commencing 
with  the  last  number — that  corresponds  to  V=0.1.  When 
he  can  read  only  the  characters  traced  upon  one  of  the  halves 
of  the  card,  the  test  will  be  ended,  and  the  number  of  the 
last  character  which  he  shall  have  been  able  to  read  at  one  time 
upon  the  two  halves  of  the  card  will  measure  the  visual  acuteness 
of  the  amblyopic  eye.  ...  It  is  convenient  to  have,  moreover, 
a  card  both  halves  of  which  are  perfectly  identical  and  to  make 
that  the  first  test,  in  order  that  the  person  submitted  to  this  mode 
of  examination  shall  not  suspect  the  trick  which  is  used  for  the 
purpose  of  unmasking  the  fraud." 

Another  series  of  tests  are  based  upon  the  principle  of  sup- 
pression of  color  by  colored  glasses.  Kugel,1  in  his  exhaustive 
article,  writes  as  follows :  "  Snellen  *  gives  the  following  very 
practical  method.  Red  and  green  letters  are  viewed  bmocularly 
while  the  strong  eye  is  furnished  either  with  a  red  or  with  a 
green  glass.  As  is  well  known,  translucent 3  green  letters  are 
seen  indistinctly  through  a  red  glass,  while  translucent 3  red 
letters  are  seen  indistinctly  through  a  green  glass.  If,  now,  in 
our  case,  both  green  and  red  letters  are  seen  plainly,  the  person 
examined  is  caught. 

"  Let  us  take  the  case  of  left-sided  amaurosis :  then  holding 
a  red  glass  before  the  right  eye,  only  the  red  letters  are  recog- 
nized. The  reverse  must  be  the  case  if  a  green  glass  be  held 
before  this  eye.  If  both  green  and  red  letters  are  seen  at  the 
same  time — a  thing  that  can  happen  only  by  the  help  of  the 
professedly  amaurotic  or  amblyopic  eye — the  pretender  is  un- 
masked." 

Bravais4  gives  the  following  test:  "For  cases  where  the 
prism  test  has  failed,  or  the  observer  does  not  possess  the  double 
prism  of  Monoyer,  and  does  not  possess  the  scale  of  Snellen,  or 
the  tables  of  Stilling,  the  author  suggests  the  following:  Writ- 

1  Loc.  tit.  4  Bulletin  et  Memoires  de  la  Soc. 

2Zehender's  Klin.  Monatsch.  fur      Fran^aise  d'Ophthalmologie,  1883- 
Augenheilkunde,  1877.  84. 

3  Woodward. 


SIMULATED   BLINDNESS.  23 

ing  with  a  red  pencil  disappears  when  viewed  through  a  red 
glass.  Write  a  word  in  two  colors,  alternately  red  and  blue  let- 
ters, e.g.,  the  word  noir.  If  the  o  and  r  are  in  red,  the  eye 
covered  by  a  red  glass  will  see  only  ni.  If  the  patient  read  the 
word  noir  the  eye  covered  by  the  dark  glass  is  not  blind.  One 
may  write  two  isolated  words,  one  to  be  written  in  red,  the 
other  in  blue.  Or  an  entire  phrase  may  be  written  in  which 
certain  words  are  in  red,  e.g.,  Je  ne  vois  pas  bien  clair;  the 
words  ne,  pas  and  clair  in  red. 

"  One  may  have  cards  half  blue  and  half  red.  It  suffices  to 
write  with  a  black  pencil  upon  the  two  colors.  With  the  col- 
ored glasses  the  writing  upon  the  blue  ground  is  not  read  through 
the  red  glass  and  the  writing  upon  the  red  ground  is  not  read 
through  the  blue  glass;  as  with  the  scales  of  Snellen,  each  eye 
sees  only  certain  characters.  With  this  card  one  can  varj-  the 
tests ;  write  words  of  different  or  of  the  same  size,  place  them 
one  above  the  other,  or  one  to  the  right,  the  other  to  the  left." 

Michaud1  gives  the  following:  "It  is  known  that  marks 
with  the  red  pencil  traced  upon  a  piece  of  white  paper  are  not 
visible  through  a  red  glass.  Therefore  in  the  case  of  amaurosis 
or  monocular  amblyopia  one  places  a  red  glass  before  the  healthy 
eye.  The  patient  ought  not  to  see  any  of  the  characters.  If 
the  red  characters  are  seen  it  will  be  by  the  alleged  amaurotic 
eye.  The  patient,  however,  may  be  posted  respecting  the  test 
and  declare  that  he  sees  nothing.  To  eliminate  as  far  as  pos- 
sible this  chance  of  error  we  have  recourse  to  the  following 
artifice.  It  is  sufficient  to  remove  from  letters  of  simple  form 
one  or  two  parts  to  change  at  once  the  aspect  and  value.  For 
example,  from  the  letter  E  it  is  easy  to  make  I,  F,  or  L.  If  then 
we  trace  upon  paper  an  E  of  which  the  horizontal  lines  are  red, 
and  if  we  cause  this  letter  to  be  seen  with  a  red  glass,  the  pa- 
tient will  not  see  an  E  but  an  I.  Several  letters  thus  modified 
in  a  word  may  compose  a  new  word,  and  if  one  may  admit  that 
a  badly  seen  E  may  be  confounded  with  I  or  L,  it  is  impossible 
to  pretend  that  the  word  TETE  could  be  taken  for  the  word 
K1LLE.  In  the  same  way  the  word  MEOTANE,  having  no 
sense,  could  become  VICINAL. 

"  Now,  in  reading  the  reader  does  not  habitually  look  at  each 
letter  forming  a  word.  It  is  the  general  appearance  of  the  writ- 
1  Archiv.  de  Medecine  et  de  Pharmacie  Militaires.  18B8. 


24  VISION  AND   AUDITION — WOODWARD. 

ing  which  fixes  in  his  mind  the  thought  corresponding  to  the 
word.  By  suppressing  such  and  such  a  word  representing  an 
idea  a  change  may  be  made  to  another  word  representing  another 
idea.  Thus  let  us  present  to  the  simulator  the  word  EPONGE 
made  in  red  and  black.  After  having  put  a  red  glass  before 
the  good  eye,  the  alleged  amaurotic  eye  which  is  uncovered  will 
see  the  word  EPONGE.  The  idea  corresponding  to  this  word 
is  fixed  in  the  mind  of  the  patient,  and  it  will  be  difficult  for 
him  to  substitute  for  it  the  idea  LION  by  the  mental  sub- 
traction of  that  which  is  marked  in  red.  The  simulator,  urged 
to  read  quickly  in  a  loud  voice  without  time  for  reflection,  will 
surely  read  EPONGE.  If  the  uncovered  eye  is  really  amauro- 
tic, the  red  glass  does  its  work  of  eff acement  for  the  healthy  eye, 
all  that  traced  in  red  disappears,  and  the  patient  reads  the  word 
LION  as  quickly  as  he  reads  EPONGE  without  the  interposi- 
tion of  the  red  glass. 

"  To  render  more  difficult  for  the  simulator  the  mental  sub- 
traction of  the  red,  one  may  employ  other  colors  in  tracing  the 
parts  of  the  letters  so  as  to  make  them  polychromatic.  Yellow 
should  be  avoided,  as  it  is  difficult  to  see  it  at  a  certain  distance, 
and  the  perception  of  it  is  annihilated  by  the  red  glass. 

"  Finally,  if  one  wishes  to  disturb  still  more  the  simulator,  one 
may,  while  placing  the  red  glass  before  the  good  eye,  place  a 
glass  strongly  tinted  in  green  before  the  suspected  eye.  If  bi- 
nocular vision  is  preserved,  the  word  will  be  read  in  its  entirety. 

"  It  is  not  sufficient  for  the  military  surgeon  to  be  able  to 
affirm  that  an  eye  pretended  amaurotic  or  strongly  amblyopic 
is  not  so ;  it  is  necessary  that  he  may  be  able  to  say  whether 
the  acuteness  of  vision  of  that  eye  is  superior  or  inferior  to  i  for 
the  right  eye,  and  -^  for  the  left  eye.  Nothing  is  easier  than  to 
give  to  the  characters  in  color  dimensions  clearly  defined  and 
fit  to  serve  for  the  determination  of  the  acuteness  of  vision. 
We  make  use  of  a  red  glass,  a  green  glass,  and  small  tablets. 
Our  red  glass  is  rectangular  in  shape,  10X5  cm.  We  recom- 
mend a  glass  of  an  intense  red  and  of  demi-double  quality  as 
we  find  it  at  all  glaziers'.  Same  dimensions  and  recommenda- 
tions for  the  green  glass.  Our  tablets  have  the  dimensions  of 
loto  cards,  which  renders  them  easy  to  carry.  The  characters 
which  we  have  adopted  are  those  of  the  type  of  the  scales  of 
Snellen ;  they  have  among  other  advantages  that  of  being  easy 


SIMULATED   BLINDNESS. 


25 


to  trace  with  brush  and  water-color  upon  paper  ruled  in  milli- 
metres, i.e.,  architect's  paper.  Take  the  paper  of  which  the 
ruling  is  brownish-red  in  preference  to  that  of  which  the  ruling 
is  in  blue.  Avoid  tracing  in  pencil  the  contour  of  the  letters, 
above  all  in  the  parts  which  ought  to  be  tinted  red.  Do  not 
make  use  of  carmine,  but  of  vermilion  or  cinnabar. 

"  We  confine  ourselves  to  characters  of  2,  4,  and  5  mm.  in 
size,  which  are  visible  to  the  normal  eye  at  G.CG  m.,  13.33  m., 
and  16.66  m. ;  and  consequently  at  1.66  m.,  3.33  m.,  and  4. 1C 
m.  by  an  eye  of  which  the  vision  is  reduced  to  i,  and  at  0.55 
m.,  1.11  m.,  and  1.38  m.  by  an  eye  of  which  the  vision  is  re- 
duced to  -jV 

"  For  the  illiterate  we  substitute  for  letters,  points,  marks, 
crosses,  which  may  become  themselves  points,  and  horizontal 
or  vertical  marks ;  figures  of  playing  cards,  etc. 

"  We  advise  placing  the  tablets  well  in  front  of  the  light  to 
avoid  the  chances  of  error  which  might  come  from  the  reflec- 
tions and  dulness  given  to  the  characters  by  the  colored  glasses 
employed.  As  an  example  of  the  results  to  which  we  may  come 
by  the  use  of  glasses  and  colored  characters  we  consider  it  of 
some  interest  to  give  the  following  observation :  It  was  concern- 
ing a  young  soldier  of  our  regiment  who  for  three  weeks  declared 
to  his  immediate  superiors  that  he  did  not  see  with  his  right 
eye.  This  man,  endowed  with  a  subtle  intelligence,  had  taken 
care  to  prepare  the  way  by  saying  in  his  company  that  he  had 
dissimulated  his  infirmity  at  the  conseil  de  revision,  and  since 
his  enlistment,  in  order  not  to  be  exempted  or  invalidated. 
He  wished  to  avoid  marriage,  and,  moreover,  he  desired  to  satisfy 
his  military  obligations.  But  he  had  not  counted  on  target 
practice,  and  in  fact,  to  his  great  regret,  he  could  not  dissemble 
any  longer. 

"  This  good  apostle,  to  whom  nothing  was  wanting,  not  even 
a  contusion  of  the  superciliary  arch  from  the  kick  of  a  horse, 
\vas  submitted  to  an  examination.  We  proceeded  to  our  exam- 
ination with  the  aid  of  M.  Maupetit,  surgeon-major. 

"  Nothing  was  found  with  the  ophthalmoscope— the  fundus 
was  normal. 

"  Our  man  could  read  well  with  the  left  eye,  but  with  the 
right  eye  he  did  not  distinguish  the  A  from  Z,  whatever  the 
size  of  the  letters. 


26  VISION   AND   AUDITION — WOODWARD. 

"  We  place  a  red  glass  before  his  left  eye,  leaving  the  other 
uncovered,  and  the  reading  of  the  black  characters  is  quite  easy. 
Nothing  surprising  thus  far.  But  behold,  when  we  substitute 
colored  characters  for  black  characters,  the  vision  is  declared 
abolished  for  both  eyes !  The  presantation  of  colored  letters  had 
aroused  the  suspicion  of  our  man,  his  strange  reply  aroused  ours. 
The  idea  occurred  to  us  to  let  him  understand  that  this  was  not 
really  extraordinary  and  that  it  could  be  dependent  upon  trouble 
with  the  sight  of  the  right  eye  (the  eye  said  to  be  amaurotic) . 
We  cover  that  eye  with  the  palm  of  the  hand,  and  the  left  eye 
recovers  its  function!  The  colored  characters  are  read  through 
the  red  glass !  We  substitute  a  green  glass  for  the  palm  of  the 
hand  placed  before  the  right  eye,  at  the  same  time  a  red  glass 
is  placed  before  the  left  eye;  and  we  present  another  table. 
This  table  is  read  in  detail  as  if  nothing  had  been  traced  upon 
it  in  red.  The  fraud  was  thenceforth  manifest. 

"  A  final  test  showed  us  to  what  degree  of  skill  our  simulator 
pretended.  We  place  a  red  glass  before  the  eye  declared  good, 
we  leave  uncovered  the  eye  declared  amaurotic,  and  we  present 
some  lines  of  writing  of  a  yellow  color.  The  man  sees  nothing 
and  cannot  read.  Arguing  then  as  before  that  the  vision  may 
be  affected  by  the  trouble  in  the  right  eye,  we  cover  the  right 
eye  and  the  reading  goes  freely.  That  was  an  irreparable  dis- 
aster for  the  pretended  sincerity  of  the  simulator  in  question ; 
for  with  the  right  eye  covered,  and  the  left  eye  concealed  behind 
a  red  glass,  he  ought  to  see  absolutely  nothing  (we  have  said 
above  that  red  glasses  prevent  the  perception  of  clear  yellow). 
How  then  could  he  read?  He  did  not  read,  he  recited  from 
memory  what  he  had  had  time  to  learn  before  we  .had  closed 
the  right  eye.  Moreover,  all  that  had  been  read  had  been  read 
under  conditions  which  enabled  us  to  declare  that  his  vision  was 
normal. " 

Many  other  tests  for  the  detection  of  simulated  blindness 
have  been  devised.  The  reader  is  referred  for  a  description  of 
them  to  the  writings  of  Kugel,1  Baudry,2  Bravais,3  and  Nieden.4 

1  "  Ueber  die  Diagnose  von  Simu-  lateral  par  les   Verres   colorees  de 
lation    der  Amaurose  und  Ambly-  Snellen,"  Bull,  et  Mem.  de  la  Soc. 
opie,"  Wiener  med.  Wochen.,  1889.  Frang.  d'Ophthal.,  1883-84. 

2  "Simulation  de  1' Amaurose    et  4" Ueber     die     Simulation     von 
de  1'Amblyopie,"  Paris,  1889.  Augenleiden   und   die  Mittel    ihrer 

3  "Simulation  de  1' Amaurose  uni-  Entdeckung, "  Wiesbaden,  1893. 


SIMULATED   BLINDNESS.  27 

Congenital  amaurosis  and  congenital  amblyopia  are  not  un- 
common. And  amnurosis  and  amblyopia  ex  anopsia  are  not 
uncommon.  The  anatomical  structure  and  the  physiological 
function  of  such  eyes  are  normal  so  far  as  we  can  discern,  ex- 
cepting that  the  vision  is  very  much  reduced.  Strabismus, 
convergent  or  divergent,  is  often  associated  with  such  an  amau- 
rosis  or  amblyopia.  A  difference  in  the  refraction  of  the 
eyes  is,  however,  much  mure  regularly  found.  As  a  rule, 
the  refraction  is  hypermetropic,  or  an  astigmatism  of  high 
degree  is  found,  or  a  combination  of  the  two  exists.  The  dif- 
ference in  the  refraction  of  the  two  eyes  is  such  that  the  patient 
will  use  the  one  that  gives  him  least  strain  (smaller  error  of  re- 
fraction). Inasmuch  as  the  condition  is  one  of  long-standing 
— from  birth  or  early  childhood — the  patient  has  never  enjoyed 
perfect  binocular  vision.  Experience  has  taught  him  to  see 
everything  with  one  eye.  But  a  person  who  has  enjoyed  clear 
binocular  vision  is  very  much  disturbed  for  some  weeks  or 
months  after  losing  one  of  his  eyes.  Appreciation  of  perspec- 
tive is  practically  suspended  for  some  time,  and  obliteration  of 
so  large  a  section  of  the  field  of  binocular  vision  causes  at  first  an 
awkwardness  and  a  hesitation  in  the  patient's  movements,  that 
is  not  observed  in  one  whose  eye  has  been  amaurotic  or  am- 
blyopic  from  birth  or  early  childhood. 

Monocular  amaurosis  or  amblyopia  may  be  innocently 
claimed  by  children,  or  even  by  older  patients.  Association 
with  one  who  has  some  marked  ocular  abnormality  may  sug- 
gest to  a  child  the  existence  of  some  trouble  with  one  of  its  own 
eyes.  Or,  the  statement  that  one  of  its  eyes  is  blind  will  some- 
times lead  a  child  to  insist  positively  and  persistently  that  it  is 
so.  There  is  no  difficulty  in  proving  the  truth  in  these  CMOS, 
On  the  part  of  the  patient  there  is  no  desire  to  deceive,  and  when 
it  is  proven  to  him  that  he  sees  with  the  eye  supposed  to  be  blind, 
the  trouble  is  at  an  end.  Why  older  subjects  should  exigence 
this  sort  of  amblyopia  and  amaurosis,  it  would  be  difficult  to 
explain.  I  have  never  observed  it  in  a  patient  more  than  twenty 
years  of  age. 

True  amblyopia  and  amaurosis  may  be  due  to  traumatism, 
lightning  stroke,  local  or  general  hemorrhages,  toxic  substances 
in  the  blood,  uremia,  diabetes,  hysteria,  migraine,  reflex  action, 
and  lesions  in  the  brain  and  spinal  cord. 


28     .  VISION  AND   AUDITION— WOODWARD. 

Simulated  amaurosis  of  both  eyes  will  be  detected  only  by 
watching  the  patient  and  by  surprising  him  into  some  action 
that  will  reveal  the  fraud.  General  ansesthesia  might  be  tried. 
While  recovering  from  the  anesthetic,  the  patient  would  be  off 
his  guard  and  might  then  be  entrapped. 

Simulated  amblyopia  of  both  eyes  might  be  detected  by  ob- 
serving the  variations  in  the  vision  from  time  to  time,  and  al- 
ways under  similar  conditions  of  light,  etc.  If  the  acuteness  of 
vision  do  not  vary,  and  if  it  be  not  possible  to  detect  any  evi- 
dence of  simulation  by  watching  the  patient  or  by  surprises, 
true  amblyopia  may  exist. 

AFFECTIONS  OF  THE  EYE  INTENTIONALLY  PRODUCED. 

Such  ocular  disturbances  are  especially  common  in  those 
countries  in  which  military  service  is  compulsory.  Conjunc- 
tivitis, keratitis,  cataract  and  mydriasis  are  the  affections  com- 
monly observed.  In  general,  the  right  eye  only  is  attacked. 
A  variety  of  things  have  been  introduced  into  the  eye  to  pro- 
duce conjunctivitis,  e.g.,  cigar  ashes,  tobacco,  snuff,  the  seed 
of  various  kinds  of  grain,  pepper,  spirit  of  wine,  brandy,  soap, 
common  salt,  blue  vitriol,  lunar  caustic,  plaster,  cantharides, 
pus  from  purulent  ophthalmia,  pus  from  a  suppurating  lachry- 
mal sac,  etc.  A  great  variety  of  foreign  bodies  have  been  in- 
serted into  the  eye  for  similar  purposes.  Inflammation  of  the 
cornea  sometimes  complicates  such  attacks  of  conjunctivitis, 
and  patients  have  occasionally  resorted  to  rubbing  the  cornea 
with  lunar  caustic  in  order  to  inflame  its  tissues.  Cataract 
has  been  intentionally  produced  by  thrusting  a  needle  or  a  knife 
blade  through  the  cornea  into  the  crystalline  lens. 

Foreign  bodies  in  the  conjunctiva  may  be  buried  in  granu- 
lation tissue  and  escape  detection.  When  they  lie  in  the  superior 
fornix,  they  are  not  easily  found.  They  may  lodge  there 
for  a  long  time  without  exciting  more  than  a  slight  catarrh. 

Artificially  induced  conjunctivitis  is  most  intense,  as  a  gen- 
eral rule,  over  the  lower  eyelid  and  lower  portion  of  the  bulbar 
conjunctiva.  Croupous  conjunctivitis  is  excited  by  caustic  sub- 
stances. An  eroded  spot  will  be  found  in  the  palpebral  con- 
junctiva and  a  corresponding  erosion  on  the  opposing  bulbar 
conjunct! val  surface.  The  course  run  by  artificial  conjunctivi- 


AFFECTIONS  OF  THE  EYE  INTENTIONALLY  PRODUCED.   20 

tis  differs  from  that  of  other  varieties  in  that  it  is  especially 
obstinate  in  yielding  to  treatment.  After  having  brought  about 
a  considerable  improvement  in  the  eye's  condition,  at  the  next 
visit  one  may  find  that  the  disease  has  broken  out  afresh.  More 
of  the  exciting  cause  had  been  introduced  into  the  eye.  In 
order  to  cure  such  cases  and  unmask  the  malingerer,  absolute 
control  over  the  patient  is  a  necessity.  When  it  is  no  longer 
possible  for  him  to  keep  up  the  irritation,  the  inflammation 
may  be  caused  to  subside. 

Solutions  of  atropine  and  ointment  of  belladonna  are  the  prep- 
arations employed  to  cause  mydriasis.  The  full  effect  of  these 
preparations  is  maximum  dilatation  of  the  pupil  and  complete 
paralysis  of  the  muscle  of  accommodation.  From  one  to  two 
weeks  elapse  after  discontinuing  the  applications  before  the 
effects  entirely  disappear. 

The  differential  diagnosis  of  mydriasis  induced  by  a  drug, 
from  that  due  to  trauma,  glaucoma,  or  real  amaurosis  is  estab- 
lished by  virtue  of  the  following :  The  pupil  is  more  widely 
dilated;  ruptures  of  the  sphincter  of  the  iris,  which  are  present 
in  cases  of  marked  traumatic  dilatation,  are  wanting;  ophthal- 
moscopic  evidence  of  glaucoma  does  not  exist;  the  accommo- 
dation is  paralyzed  either  partially  or  completely.  Moreover, 
illumination  of  the  sound  eye  causes  consensual  contraction 
of  the  pupil  in  an  amaurotic  eye ;  on  the  contrary,  however, 
illumination  of  an  amaurotic  eye  does  not  cause  consensual 
contraction  of  the  pupil  of  the  sound  eye ;  and  illumination  of 
an  amblyopic  eye  causes  slow  and  weak  contraction  of  the  pupil 
of  its  fellow.  Slight  inequality  of  the  pupils  without  paralysis 
of  the  accommodation  may  be  due  to  pathological  changes  in 
the  brain  or  spinal  cord,  or  to  a  difference  in  the  refraction  of 
the  eyes. ' 

1  Nieden:  "Ueber  die  Simulation  von  Augenleiden, "  etc.,  1893,  p.  345. 


CHAPTER  III. 

INJURIES    OF   THE    ORBIT. 

CONTUSIONS  OF  THE  MARGINS  OF  THE  ORBIT. 

CONTUSIONS  of  the  margins  of  the  orbit  may  excite  periosti- 
tis, caries  or  necrosis  of  the  bones  at  the  site  of  the  injury  in 
scrofulous  and  badly  nourished  persons,  especially  children, 
whether  extravasation  have  occurred  or  not.  Such  injuries  are 
among  the  most  frequent  causes  of  those  diseases  in  that  class 
of  patients.  '  The  inflammation  of  the  periosteum  may  termi- 
nate in  resolution  ;  but,  as  a  rule,  suppuration  with  the  forma- 
tion of  an  abscess  takes  place.  Death  of  the  bony  structure 
may  follow.  The  process  may  run  an  acute  or  a  chronic  course. 
It  may  be  circumscribed,  or  it  may  extend  to  the  adjacent  orbi- 
tal walls. 

Especially  when  the  inflammation  runs  a  chronic  course,  the 
cicatricial  tissue  resulting  therefrom  will  cause  ectropium,  or 
lagophthalmus,  or  it  may  restrict  the  movements  of  the  eyeball. 
This  may  be  the  end  of  an  acute  attack  as  well.  Periostitis, 
with  or  without  caries  or  necrosis,  may  be  complicated  by  a 
severe  attack  of  orbital  cellulitis  resulting  in  the  formation  of  an 
abscess  in  the  orbital  cellular  tissue.  The  consequence  of  this 
may  be  inflammation  and  atrophy  of  the  optic  nerve,  and  con- 
sequent partial  or  complete  blindness;  or  the  patient  may  die 
from  extension  of  the  morbid  process  to  the  brain  or  its  mem- 
branes. 

When  the  inflammatory  process  involves  the  roof  of  the 
orbit,  meningitis,  or  abscess  in  the  frontal  lobes  of  the  brain, 
may  set  in  and  terminate  life. 

Contusions  of  the  margins  of  the  orbit  may  be  productive  of 
a  lesion  having  clean-cut  edges  and  resembling  very  closely  an 
incised  wound.  Its  usual  site  is  near  the  superior  margin  of 


"  Graefe-Saemisch  Handbuch  d.  ges.  Augenheilkunde,  "  vi., 
pp.  530,  581. 

30 


INDIRECT   FRACTURE   OP   THE  ROOF  OF  THE  ORBIT.         31 

the  orbit,  but  it  has  been  observed  over  the  inferior  margin. 
The  wound  extends  to  the  bone,  the  sharp  edge  of  which  severs 
the  soft  parts  as  they  are  driven  upon  it  by  the  contusing  force. 
For  this  reason,  the  superficial  wound  is  less  extensive  than 
the  subcutaneous  wound.  Beneath  the  integument,  the  soft 
parts  are  lacerated  and  separated  to  a  greater  or  less  extent 
from  the  subjacent  bone.  Such  lesions  are  apt  to  suppurate.' 

FRACTURE  OF  THE  MARGINS  OF  THE  ORBIT. 

Contusions  may  result  in  fracture  of  the  margins  of  the  orbit 
on  which  they  impinge.  The  force  of  the  blow  is  generally 
sufficient  to  produce  a  compound  fracture,  but  the  fracture  may 
be  a  simple  one.  Owing  to  its  more  exposed  situation,  the  supe- 
rior margin  is  most  frequently  affected. 

An  excessive  force  may  fracture  or  dislocate  the  malar  bone. 
This  will  be  evident  from  the  deformity.  Moreover,  if  anaes- 
thesia involving  the  area  supplied  by  the  infra-orbital  nerve  be 
noted,  it  is  probable  that  the  inferior  margin  of  the  orbit  has 
been  fractured. 

Uncomplicated  fractures  of  the  orbital  margins,  as  a  rule, 
lead  to  deformity  only.  Berlin  cites  a  case  of  fracture  of  the 
infra-orbital  margin  from  a  stone  bruise  which  terminated 
fatally  by  tetanus.2  A  compound  fracture  may  inflame,  suppu- 
rate, and  endanger  the  patient's  life  as  well  as  his  eye. 

When  a  compound  fracture  of  the  orbital  margin  is  compli- 
cated by  fissure  of  the  roof  of  the  orbit,  the  gravity  of  the  in- 
jury is  intensified.  Meningitis,  or  abscess  of  the  brain,  may 
develop,  and  carry  off  the  patient.  Such  fractures  of  the  vault 
of  the  orbit  are  less  dangerous  than  direct  fractures  in  which 
the  orbital  margin  is  not  involved. 

INDIRECT  FRACTURE  OF  THE  ROOF  OF  THE  ORBIT. 

Injuries  productive  of  fracture  of  the  base  of  the  skull  fre- 
quently cause  fracture  of  the  roof  of  the  orbit.  The  fracture  in 
such  cases  is  one  in  continuity.  According  to  Berlin,'  Prescott- 
Hewitt's  statistics  from  St.  George's  Hospital  give  23  cases  of 
fracture  of  the  roof  of  the  orbit  in  G8  fractures  of  the  base  of 

1  For  medico-legal  case,  see  Ber-         *  Loc.  fit.,  vi..  p.  584. 
lin,  I.e.,  p.  582.  3  IMC.  ctf.,  p.  004 


32  VISION   AND   AUDITION — WOODWARD. 

the  skull.  Von  Holder '  found  in  124  cases  of  fracture  of  the 
base  of  the  skull,  that  in  79  the  roof  of  the  orbit  was  also  frac- 
tured. These  lesions  belong  especially  to  the  domain  of  general 
surgery.  When,  as  sometimes  happens,  the  victim  of  such  a 
casualty  survives,  coincident  and  consecutive  alterations  in  the 
function  of  his  visual  apparatus  may  become  a  subject  for  med- 
ico-legal investigation. 

Immediately  on  recovering  consciousness,  the  patient  may 
complain  of  blindness  of  one  or  of  both  eyes.  Failure  of  vision 
may  be  owing  to  lesion  of  both  optic  nerves  or  of  the  chiasm, 
by  fragments  of  bone.  Hemorrhage  at  the  base  of  the  brain 
may  impair  the  function  of  the  optic  nerves,  or  of  the  optic 
tracts.  Blood  may  be  extravasated  into  the  sheaths  of  the  optic 
nerves  and  cause  blindness.  When  the  optic  nerves,  the  chiasm, 
or  the  optic  tracts  are  lacerated  by  spiculae  of  bone,  the  resulting 
disturbance  of  function  will  be  permanent.  When  hemorrhage 
interferes  with  the  conductivity  of  those  structures,  the  loss  of 
function  may  be  transient.  The  differential  diagnosis  between 
these  sets  of  cases  may  be  established  only  by  the  conditions 
observed  after  some  weeks  have  passed.  Restoration  of  sight 
would  imply  that  the  conducting  apparatus  had  not  been  torn 
by  fragments  of  bone. 

Failure  of  vision  may  supervene  not  as  an  immediate  conse- 
quence of  the  traumatism,  but  as  a  result  of  consecutive  inflam- 
mation of  the  membranes  of  the  brain,  or  of  the  brain  tissue  itself. 

Indirect  violence  may  fracture  the  roof  of  the  orbit  alone. 
Berlin2  collected  27  cases  of  this  description.  In  1890,  Roller 
reported  2  cases,3  and,  in  1893,  Callan4  reported  8  cases  of  the 
same  nature.  Similar  cases  have  come  under  the  writer's  ob- 
servation. The  clinical  picture  of  such  accidents  is  a  clear  one. 
The  patient  receives  a  blow  from  a  club,  a  stone,  or  the  fist,  in 
the  orbital  region,  or  he  falls  from  a  height  (15  to  30  feet)  or  is 
thrown  from  a  carriage  or  other  rapidly  moving  vehicle  (tobog- 
gan) and  receives  a  contusion  near  the  eye,  or  his  head  may  be 
compressed  under  a  wagon-wheel  or  a  horse's  hoof.  One  of 
Callan's  patients  fell  down  three  steps  of  a  stairway,  struck  the 
edge  of  an  open  door,  and  was  wounded  above  his  left  eye. 

1  "  Graef e-Saemisch  Handbuch  d.          *  N.  Y.  Med.  Jour. ,  April  12th,  1890. 
ges.  Augenheilkunde, "  vi. ,  p.  604.  4  N.  Y.  Eye  and  Ear  Infirmary 

2  Loc.  Git.  Reports,  vol.  i.,  p.  1,  1893. 


INDIRECT   FRACTURE   OF   THE   ROOF   OF    THE   ORBIT.          33 

Symptoms  of  concussion  of  the  brain  are  more  or  less  marked. 
The  patient  may  fall  to  the  ground  unconscious  and  remain  in 
that  state  for  many  hours.  Two  or  three  days  may  pass  before 
memory  is  restored.  Or,  the  patient  may  not  become  uncon- 
scious, but  complain  of  dizziness  and  faintness.  Bleeding  at 
the  nose  and  vomiting  of  blood  are  common  symptoms.  On 
recovering  consciousness,  the  patient  may  call  attention  to  blind- 
ness on  the  injured  side.  Or,  as  happened  in  Callan's  second 
case,  the  patient,  whose  consciousness  is  not  suspended  by  the 
injury,  may  assert  positively  that  blindness  immediately  fol- 
lowed the  blow.  The  eyelids  on  the  injured  side  will  l>e  discol- 
ored and  oedematous.  Subconjunctival  extravasation  and  even 
exophthalmus  may  be  present.  Deviation  of  the  eye  inward, 
or  more  frequently  outward,  or  even  ophthalmoplegia  may  be 
found. 

Ophthalmoscopic  examination  will  give  a  negative  result 
immediately  after  the  injury.  Nothing  will  be  found  in  tho 
eye  to  account  for  the  blindness,  excepting  in  cases  where  there 
has  been  a  contusion,  or  other  direct  injury  of  the  eyeball. 
Vieusse  reported  the  occurrence  of  complete  optic  atrophy 
twenty-four  hours  after  the  injury,  but  Berlin  '  regarded  it  as  an 
example  of  ischaemia  of  the  optic  nerve  and  retina.  Callan " 
observed  atrophy  of  the  optic  nerve  one  week  after  the  injury. 
The  appearance  of  the  change  may  be  delayed  until  the  fifth 
week.' 

In  all  of  Callan's  cases,  atrophy  of  the  optic  nerve  on  the 
injured  side  was  observed.  Berlin  refers  to  the  fact  that  among 
27  cases,  in  which  visible  traces  of  injury  to  the  forehead  and 
orbital  margin  of  the  right  side  were  found,  only  one  showed 
blindness  of  the  opposite  (left)  eye. 

Only  one  case  of  one-sided  amaurosis  in  Berlin's  statistics  re- 
covered, and  two  improved.  In  10  cases,  the  vision  of  lx>th  eyes 
was  affected;  in  some  amblyopia,  in  others  amaurosis.  Five 
recovered,  or  improved.  In  1  case,  one  eye  remained  blind, 
in  2  cases,  both  eyes  remained  blind,  in  the  remaining  cases  the 
result  was  not  known.  Recovery  was  not  noted  in  the  other 
cases  referred  to. 

The  lesions  in  the  class  of  injuries  under  consideration  nre 
believed  to  be  fracture  of  the  roof  of  the  orbit  involving  the 
1  Loc.  cit.  *  Loc.  cit.  »  Berlin.  I.e. 

III.—  * 


34  VISION    AND   AUDITION — WOODWARD. 

optic  foramen,  laceration  of  the  optic  nerve,  and  hemorrhage  into 
its  sheath.  Direct  proof  that  it  is  so,  is,  obviously,  not  obtain- 
able; for  the  injury  is  seldom,  if  ever,  fatal. 

DIRECT  FRACTURE  OF  THE  ROOF  OF  THE  ORBIT,  NOT 
INVOLVING  THE  MARGIN. 

These  fractures  are  compound.  They  are  caused  by  direct 
violence,  e.g.,  thrusts  of  pointed  instruments  into  the  orbit  (hay- 
fork, rapier,  foil,  sword,  umbrella,  walking-stick,  knife,  pointed 
sticks,  etc.)  or  falls  upon  similar  things  (pencil- holders,  etc.),  or 
gunshot  wounds, — even  the  missile  from  a  blow-gun  has  frac- 
tured the  roof  of  the  orbit.  Owing  to  the  fragile  nature  of  the 
bone  in  this  region,  a  pointed  weapon  driven  with  moderate 
force  into  the  orbit  in  an  upward  and  backward  direction  will 
cause  a  fracture.  The  extreme  gravity  of  the  lesion  depends 
upon  three  things:  the  violence  inflicted  upon  the  brain;  the 
occurrence  of  intracranial  hemorrhage;  and  the  development 
of  abscess  of  the  brain  or  of  meningitis. 

Berlin1  collected  52  examples  of  this  lesion:  41,  or  79 
per  cent,  died ;  of  these,  34  per  cent  died  from  the  immediate 
effects  of  the  injury;  11,  or  21  per  cent,  recovered  more  or  less 
completely — ;t  had  hemiplegia,  1  suffered  from  headache,  and  1 
was  weak-minded. 

Callan  reports  one  case  of  direct  fracture  of  the  roof  of  the 
orbit  following  the  thrust  of  a  foil  between  the  nose  and  the  eye- 
ball. His  patient  recovered  with  atrophy  of  the  optic  nerve 
and  divergent  strabismus. 

The  upper  eyelid,  especially  near  the  inner  angle  of  the  eye, 
is  commonly  punctured.  Occasionally  the  weapon  enters  be- 
tween the  open  eyelids  and  passes  through  the  conjunctiva  into 
the  orbit.  When  this  happens  the  existence  of  a  wound  may 
be  overlooked.  The  eyeball  is  seldom  injured.  Having  trans- 
fixed the  integument  of  the  eyelid  and  the  conjunctiva,  the 
weapon  passes  through  the  orbital  cellular  tissue,  reaches  the 
bone,  fractures  it,  and  may  then  lacerate  the  substance  of  the 
brain  and  even  rupture  one  of  the  large  blood-vessels.  Frag- 
ments of  bone  may  be  driven  into  the  brain,  and  a  foreign  body 
(e.g.,  the  ferule  of  an  umbrella)  may  be  lodged  in  the  brain  or 

1  Loc.  cit. ,  p.  603. 


DIRECT   FRACTURE   OP   THE   ROOF  OF  THE   ORBIT.  35 

in  the  fracture  when  the  weapon  is  withdrawn,  thus  projecting 
into  both  the  orbit  and  the  cranial  cavity.  The  course  of  the 
wound  is  not  easy  to  follow  through  the  soft  parts.  For,  as 
the  blow  is  delivered,  the  eyeball  rolls  upward  and  is  pushed 
before  the  weapon.  When  the  weapon  is  withdrawn  the  globe 
resumes  its  usual  position,  and  thus  the  tract  of  the  wound  may 
be  so  distorted  that  a  probe  could  not  be  made  to  follow  it. 
Moreover,  probing  of  such  wounds  must  be  done  with  caution 
lest  further  injury  to  the  cerebral  tissue  be  inflicted. 

Hemorrhage  from  the  wound  and  into  the  orbit,  prolapse 
of  orbital  fat,  and  the  appearance  of  cerebral  tissue  in  the  dis- 
charges, are  indications  respecting  the  depth  to  which  the  weap- 
on may  have  penetrated.  Among  the  cerebral  symptoms,  sudden 
loss  of  consciousness  is  noted  in  a  large  number  of  cases.  The 
patient  may  die  unconscious.  After  recovering  consciousness, 
the  patient's  symptoms  range  from  headache,  vertigo,  weakness 
of  intellect,  and  prostration,  to  paralysis,  unconsciousness,  and 
coma,  ending  in  death.  The  symptoms  are  those  of  intra-cra- 
nial  hemorrhage,  of  injury  to  the  brain  substance,  of  cerebral 
abscess,  or  of  meningitis. 

Not  all  persons  injured  in  this  way  suffer  from  cerebral 
symptoms  immediately  after  the  injury.  A  certain  number  do 
not  have  cerebral  symptoms.  According  to  Berlin,1  the  num- 
ber of  such  cases  is  relatively  large;  he  refers  to  14.  Both  phy- 
sician and  patient  may  be  disposed  to  consider  the  injury  a 
trivial  one,  owing  to  the  apparently  insignificant  wound  and 
the  general  condition  of  the  patient;  while,  later  on,  stu]>or, 
vertigo,  convulsions,  unconsciousness,  sopor,  and  a  febrile  move- 
ment may  develop  and  kill  the  patient,  or  he  may  die  suddenly. 
The  following  cases  illustrating  various  phases  of  this  class  of 
injuries  are  cited  by  Mackenzie.' 

"  CASE  14. — Ruyscli  relates  the  case  of  a  man  who  was  wounded  in 
the  left  orbit  with  the  end  of  a  stick,  not  particularly  sharp.  The  injury 
appeared  of  little  importance,  yet  the  patient  died  soon  after  receiving 
the  wound.  The  magistrates  appointed  Ruysch  to  examine  the  body, 
in  order  to  discover  the  cause  of  sudden  death.  Externally,  he  observed 
a  slight  degree  of  ecchymosis  at  the  upper  part  of  the  eye,  but  on  re- 
moving the  calvaria,  he  found  that  the  wound  had  penetrated  to  a  con- 
siderable depth  into  the  brain. 

1  Loc.crt.,p.602.  Mackenzie  :  "  Dis-         •  Loc.  rit.,  p.  53  et  txq. 
eases  of  Eye,"  Phil.,  1855,  p.  60. 


36  VISION   AND    AUDITION — WOODWARD. 

"  CASE  15. — Peter  Borel  mentions  a  still  more  remarkable  case  of  a 
man  who  was  wounded  with  a  sword  in  the  left  orbit.  Thinking  the 
wound  had  not  penetrated  deep,  he  merely  covered  it  with  plaster,  after 
which  he  walked  two  leagues,  and  ate  and  drank  heartily  with  his  com- 
panions, exactly  as  if  he  had  been  well,  being  affected  with  no  pain. 
Next  morning  he  was  found  dead.  The  skull  was  opened,  when  the 
wound  was  found  to  have  penetrated  the  cerebellum. 

"CASE  16. — A  man  was  brought  into  the  London  Hospital,  April 
12th,  1832,  with  a  lacerated  wound  of  the  right  upper  eyelid.  He  stated 
that,  while  working  on  board  ship  discharging  coals,  a  hook  used  for 
raising  the  coals  caught  him  by  the  eye,  so  that  he  was  elevated  to  the 
height  of  several  feet.  His  companions,  observing  what  had  happened, 
suddenly  let  go  the  rope,  so  that  the  poor  fellow  fell  heavily  on  the 
deck.  He  immediately  withdrew  the  hook  himself.  On  his  admission 
to  the  hospital,  he  did  not  appear  to  be  suffering  from  any  serious 
injury.  The  eyeball  was  uninjured,  and  no  fracture  could  be  detected; 
his  respiration  was  natural;  his  pulse  76,  full,  but  not  more  than 
might  have  been  expected  in  a  robust  man;  pupils  obedient  to  the  light; 
no  pain  in  the  head.  .  .  .  He  passed  a  quiet  night.  .  .  .  The  next  morn- 
ing he  had  very  little  pain  in  the  head.  .  .  .  Symptoms  of  compression 
of  the  brain  came  on  very  suddenly  in  the  evening.  His  breathing 
became  stertorous;  his  pupils  contracted  and  insensible  to  the  stimu- 
lus of  light;  pulse  52,  and  laboring;  he  could  not  be  roused  by  any 
noise.  At  this  time  a  quantity  of  blood,  mixed  apparently  with  cere- 
bral substance,  to  the  amount  of  about  two  ounces,  escaped  from  the 
wound.  .  .  .  He  lingered  in  this  state  until  two  o'clock  the  next  morn- 
ing, when  he  died. 

"  The  orbitary  plate  of  the  frontal  bone  was  found  to  be  completely 
smashed,  and  a  considerable  portion  of  the  anterior  lobe  of  the  right 
hemisphere  of  the  brain  wanting,  it  having  escaped  through  the  wound. 

"CASE  17. — A  countryman,  about  55  years  of  age,  was  asked  by 
one  who  met  him  to  step  out  of  the  way;  but  as  he  was  carrying  a 
heavy  burden  at  the  time  he  could  not  do  so,  and  therefore  refused. 
The  other,  provoked  at  this,  struck  the  countryman  violently  over  the 
shoulders  with  a  whip,  and  when  the  whip  broke  thrust  the  sharp 
end  of  the  broken  shaft  of  the  whip  in  the  countryman's  face.  Not  appre- 
hending any  dangerous  effects  from  the  blows  which  he  had  received, 
the  countryman,  with  his  burden  on  his  back,  trudged  along  after  his 
cart,  which  was  loaded  with  wood,  for  nearly  a  quarter  of  a  mile,  till 
he  arrived  at  the  wood-market,  when  he  instantly  dropped  down  dead. 

"  Schmid  was  appointed  to  inspect  the  body.  On  examining  the 
head  externally  he  found  that  the  sharp  end  of  the  stick  had  penetrated 
at  the  inner  can  thus  of  the  right  eye.  He  endeavored  to  ascertain 
with  the  probe  whether  the  wound  had  reached  the  brain;  but  he  could 
not  on  account  of  the  narrowness  of  the  wound.  Having  opened  the 


DIRECT  FRACTURE   OP  THE   ROOF  OF  THE  ORBIT. 

cranium,  the  brain  and  its  membranes  at  first  view  appeared  sound; 
but,  on  raising  the  anterior  part  of  the  cerebrum,  the  nasal  extremity 
of  the  falx  was  observed  to  be  injured,  and  it  was  found  that  the  wound 
had  penetrated  into  the  third  ventricle,  in  which  lay  a  considerable 
quantity  of  clotted  blood. 

"CASE  18. — A  man,  standing  at  the  head  of  a  horse  which  had  fall- 
en in  the  street,  was  suddenly  struck  in  the  face,  ujx>n  the  animal 
raising  itself  unexpectedly.  The  blow  was  so  violent  that  he  was 
thrown  down  by  it,  but  not  stunned.  He  was  of  the  opinion  that  it 
was  not  the  head  of  the  horse,  but  some  part  of  the  harness,  that  had 
struck  him.  There  was  a  bleeding  wound  between  the  left  eye  and  the 
nose,  about  an  inch  long,  dividing  the  lachrymal  canal  and  the  |»1- 
pebral  tendon.  A  probe  was  introduced  to  the  depth  of  three-quarters 
of  an  inch  into  the  wound,  in  the  direction  of  the  inner  wall  of  the 
orbit,  but  without  the  bone  being  felt.  The  left  eye  was  uninjured.  The 
right  eye,  without  any  perceptible  in  jury,  had  entirely  lost  the  power  of 
vision.  Its  pupil  was  dilated  to  the  utmost;  and,  although  its  common 
sensibility,  as  well  as  its  different  motions,  was  perfect,  a  lighted 
candle  held  close  before  it  caused  no  contraction  of  the  pupil,  nor  any 
sensation  of  light.  The  patient  answered  questions  promptly  and 
clearly,  and  evinced  no  symptoms  of  injury  extending  to  the  brain,  ex- 
cept that  he  complained  of  a  little  headache.  The  bones  of  the  nose  were 
examined,  butnocrepituscouklbe  felt;  neither  was  there  any  ecchymo- 
sis  to  indicate  injury  on  the  right  side.  Delirium,  however,  and  stupor 
supervened  on  the  following  day.  ...  In  the  evening  convulsions 
came  on;  the  left  arm  and  leg  were  stiff  and  contracted,  while  the  right 
extremities  were  in  constant  motion.  The  pupil  of  the  right  eye  was 
now  found  to  be  contracted.  .  .  .  The  left  side  and  extremities  sub- 
sequently became  paralytic,  while  the  right  was  tranquil.  He  died 
convulsed  on  the  fifth  day  after  the  accident. 

"On  dissection,  the  brain  and  its  membranes  were  found  loaded 
with  vessels,  and  there  was  a  copious  deposit  of  lymph  between  the 
arachnoid  and  the  pia  mater,  over  both  hemispheres.  A  large  accumu- 
lation of  serum,  with  purulent  matter  diffused  in  it,  was  present  in  both 
lateral  ventricles.  The  whole  lower  surface  of  the  anterior  lobes  was 
adherent  to  the  dura  mater,  by  means  of  coagulable  lymph.  The  optic 
nerves  being  exposed,  the  right  was  seen  to  be  torn  completely  through 
or  its  ends  joined  only  by  delicate  membrane  close  to  the  foramen  opti- 
cum.  The  base  of  the  brain,  from  the  medulla  oblongata  to  the  chiasma, 
was  thickly  covered  with  a  layer  of  lymph,  which  obscured  the  rootaof 
the  nerves.  In  the  posterior  part  of  the  right  anterior  lolx»,  close  to  the 
injured  part  of  the  optic  nerve,  and  approaching  to  the  anU-rior  eornu 
of  the  lateral  ventricle,  the  brain  was  bruised,  softened,  andecchymosed. 
The  cause  of  the  laceration  of  the  brain  and  tearing  across  of  the  optic 
nerve  was  found  to  be  a  fracture  of  the  cerebral  plate  of  the  ethmoid 


38  VISION   AND    AUDITION — WOODWARD. 

bone,  with  part  of  the  sphenoid  forming  the  roof  of  the  foramen  opti- 
cum.  The  fractured  fragment  of  bone  was  found  loosely  attached  by 
dura  mater  to  the  forepart  of  the  sella  turcica,  above  the  right  cavernous 
sinus.  On  introducing  a  probe  into  the  external  wound,  it  could  be 
made  to  pass,  by  a  slight  degree  of  management,  into  the  crushed  part 
of  the  ethmoid,  and  to  appear  within  the  skull.  .  .  . 

"  CASE  21. — A  soldier  was  brought  to  the  hospital  at  Brest,  at  eleven 
o'clock  in  the  evening,  having  been  wounded  with  a  pitchfork  at  the 
middle  of  the  left  upper  eyelid.  The  wound  was  oblique,  about  three 
lines  in  length,  and  appeared  to  implicate  only  the  skin  and  orbicu- 
laris  palpebrarum;  there  was  very  little  blood  discharged;  the  eyelid  was 
distended  and  the  conjunctiva  inflamed.  The  apparent  simplicity  of 
the  wound,  the  goodness  of  the  pulse,  and  the  free  exercise  of  all  func- 
tions, led  to  a  favorable  prognosis;  the  patient  asserted  that  he  had 
experienced  nothing  particular  at  the  moment  of  the  injury,  and  had 
scarcely  been  stupefied  by  it.  ...  The  patient  rested  during  the  night; 
next  day  he  was  quite  lively,  walking  about  the  wards,  complaining 
only  of  slight  pain  in  the  wound,  and  even  eating  with  appetite.  The 
same  day,  at  seven  in  the  evening,  he  was  seized  with  convulsions, 
which  were  supposed  by  his  attendants  to  be  epileptic.  The  day  after, 
he  was  kept  from  food,  and  bled  at  the  arm;  the  convulsions  returned, 
and  he  was  bled  at  the  foot.  Vomiting,  uneasiness,  agitation,  and 
delirium  came  on;  the  pulse  became  smaller  and  contracted;  cold 
sweats  succeeded,  and  the  patient  died  at  two  o'clock  next  morning. 

"On  dissection,  the  eyelids  were  found  cedematous,  and  the  wound 
had  already  closed.  On  cutting  through  the  upper  eyelid  and  orbicu- 
laris  palpebrarum,  a  circumscribed  collection  of  pus  was  found  in  the 
orbit  between  its  roof  and  the  levator  palpebrse  superioris.  This  col- 
lection of  pus  communicated  with  the  cranium  through  the  orbitary 
plate  of  the  frontal  bone,  which  had  been  penetrated  by  one  of  the 
prongs  of  the  fork.  After  removing  the  eyeball,  the  inferior  wall  of 
the  orbit  was  found  fractured,  and  depressed  almost  completely  into 
the  maxillary  sinus.  This  fracture  is  compared  by  M.  Massot,  the 
narrator  of  the  case,  to  the  depression  which  might  be  produced  on  the 
surface  of  an  egg,  by  pressing  it  inward  with  the  thumb.  On  remov- 
ing the  calvaria,  the  dura  mater  appeared  in  a  morbid  state  at  that 
place,  the  anterior  fossae  of  the  base  of  the  cranium  were  covered  with 
pus,  the  anterior  lobes  of  the  cerebrum  were  in  a  state  of  suppuration,  and 
the  rest  of  the  brain  healthy.  M.  Massot  thinks  it  probable  that,  when 
the  fork  was  pushed  through  the  orbit  into  the  cranium,  the  eyeball 
being  fixed  and  violently  pressed  between  the  fork  and  the  floor  of  the 
orbit,  the  thin  plate  of  the  superior  maxillary  bone  could  not  resist  this 
pressure,  but  sank  by  continued  action  of  the  fork  upon  the  eyeball. 

"CASE  31. — A  lieutenant  in  a  Highland  regiment,  running  on  a 
dark  night  to  escape  a  shower  of  rain,  came  in  contact  with  an  irritable 


DIRECT   FRACTURE   OF   THE   ROOF   OF   THE  ORBIT.  30 

old  man,  who  made  a  thrust  at  him  with  an  umbrella,  the  point  of 
which  struck  him  immediately  beneath  the  left  eyebrow.  The  wound 
was  attended  with  so  little  pain  or  shock  to  the  system,  that  the  gentle 
man  walked  a  distance  of  at  least  half  a  mile,  to  Sir  Philip  Crampton's 
house;  and  having  mentioned  the  occurrence  as  one  to  which,  how- 
ever, he  attached  no  importance,  begged  Sir  P.  to  look  at  the  wound 
on  the  eyelid,  which  still  continued  to  bleed  slightly.  Sir  P.  found  a 
wound  of  about  three-fourths  of  an  inch  in  length  in  the  upper  eye- 
lid, exactly  in  the  seat  of  the  fold  formed  in  this  part  by  the  action  of 
opening  the  eye,  on  looking  up.  When  the  eyeball  was  so  turned, 
there  was  no  appearance  of  wound;  but  when  the  eyelid  was  drawn 
downward,  the  wound  gaped  and  showed  the  conjunctiva,  which 
still  completely  covered  the  upper  portion  of  the  ball  of  the  eye. 
Vision  was  quite  unimpaired.  The  wound  having  been  united  by  two 
points  of  suture,  the  patient  took  his  leave  and  walked  home.  Sir  P. 
called  on  him  next  morning,  and  found  him  at  breakfast,  making  no 
complaint,  but  of  some  stiffness  in  the  eyelid.  Next  morning  at  seven 
o'clock,  Sir  P.  was  called  to  him  in  a  hurry,  and  found  him  in  so  strong 
convulsions  that  it  was  with  difficulty  two  persons,  were  able  to  keep 
him  from  working  himself  out  of  bed.  The  convulsions  continued, 
with  short  intervals  of  coma,  till  eight  or  nine  o'clock  in  the  evening, 
when  he  expired. 

"At  the  post-mortem  examination  it  was  found  that  the  brass  fer- 
rule of  the  umbrella,  nearly  two  inches  long,  had  penetrated  the  orbi- 
tal plate  of  the  frontal  bone,  and  was  lodged  in  the  substance  of  the 
left  hemisphere  of  the  brain;  it  was  imbedded  in  a  thin  coagulum  of 
blood,  which  extended  into  the  left  lateral  ventricle;  both  ventricles 
contained  a  small  quantity  of  bloody  serosity. 

"CASE  25.— A  laborer  thrust  a  long  lath,  with  great  violence,  into 
the  inner  canthus  of  the  left  eye  of  another  laborer.  It  broke  off  quite 
short,  so  that  a  piece  nearly  two  inches  and  a  half  long,  half  an  inch 
wide,  and  above  a  quarter  of  an  inch  thick,  remained  in  his  head,  and 
was  so  deeply  buried  that  it  could  scarcely  be  seen  or  laid  hold  of. 

"He  rode  with  the  piece  of  lath  in  him  above  a  mile,  to  Barnet,  where 
Mr.  Morse  extracted  it  with  difficulty,  it  sticking  so  hard  that  others 
had  been  baffled  in  attempting  to  remove  it.  The  man  continued  dan- 
gerously ill  for  a  long  time;  at  last  he  recovered  entirely,  with  the 
sight  of  the  eye  and  the  use  of  its  muscles;  but,  even  after  he  seemed 
well,  upon  leaning  forward  he  felt  great  pain  in  his  head. 

"CASE  26.— Percy  had  under  his  care  a  fencing  master,  who  in  an 
assault  received  so  furious  a  thrust  from  a  foil  on  the  right  eye,  that 
the  weapon  penetrated  nearly  half  a  foot  into  the  head,  and  broke 
short.  The  man  fell  down  in  a  state  of  insensibility,  and  very  soon 
the  supervening  swell  ing  was  so  great  as  to  conceal  the  foreign  body. 
In  order  to  lay  hold  of  it,  Percy  opened  and  evacuated  the  contents  of 


40  VISION   AND   AUDITION — WOODWARD. 

the  eyeball.  His  forceps  not  being1  strong  enough,  he  sent  to  a  clock- 
maker  in  the  neighborhood,  and  borrowed  from  him  a  pair  of  screw 
pincers,  with  which  he  laid  hold  of  the  broken  end  of  the  foil,  and 
thus  succeeded  in  extracting  it.  The  fencing-master  died  some  weeks 
after,  more  from  the  consequence  of  intemperance  than  of  the  injury. 

"CASE  33. — Mr.  White  relates  the  case  of  a  person,  to  whom  it  hap- 
pened that,  as  he  sat  in  company,  the  small  end  of  a  tobacco-pipe  was 
thrust  through  the  middle  of  the  lower  eyelid.  It  passed  between  the 
globe  of  the  eye  and  the  inferior  and  external  circumference  of  the 
orbit,  and  was  forced  through  that  portion  of  the  os  maxillare  which  con- 
stitutes the  lower  and  internal  part  of  the  orbit.  The  pipe  was  broken 
in  the  wound,  and  the  part  broken  off,  which,  from  the  examination 
of  the  remainder,  appeared  to  be  above  three  inches,  was  quite  out 
of  sight  or  feeling,  nor  could  the  patient  give  any  account  of  what  had 
become  of  it.  The  eye  was  dislocated  upward,  pressing  the  upper  eyelid 
against  the  superior  part  of  the  orbit;  the  pupil  pointed  perpendicularly 
upward,  the  depressor  oculi  was  upon  the  full  stretch,  and  the  patient 
could  see  none  with  that  eye.  Mr.  White  applied  one  thumb  above 
and  the  other  below  the  eye.  and  after  a  few  attempts  at  reduction  it 
suddenly  slipped  into  its  socket.  The  man  instantly  recovered  perfect 
sight,  and  suffered  no  other  inconvenience  than  that  of  a  constant 
smell  of  tobacco-smoke  in  his  nose,  for  a  long  time  after,  for,  as  he  in- 
formed Mr.  White,  the  pipe  had  just  been  used  before  the  accident. 
About  two  years  afterward  he  called  upon  Mr.  White,  to  acquaint  him 
that  he  had,  that  morning,  in  a  fit  of  coughing,  thrown  out  of  his 
throat  a  piece  of  tobacco-pipe,  measuring  two  inches,  which  was  dis- 
charged with  such  violence  as  to  be  thrown  seven  yards  from  the  place 
where  he  stood.  In  about  six  weeks  he  threw  out  another  piece,  meas- 
uring an  inch,  in  the  same  manner,  and  never  afterward  felt  the  least 
inconvenience. 

"CASE  34. — A  boy  of  14  years  of  age  was  struck  by  an  arrow,  while 
amusing  himself  in  his  playground.  It  stuck  fast  in  the  orbit;  but  the 
boy  pulled  it  out,  and  threw  it  on  the  ground.  A  surgeon  arrived,  to 
whom  the  playfellows  of  the  boy  who  was  wounded  showed  the  arrow, 
deprived  of  its  iron  point.  With  a  probe  the  surgeon  attempted  to 
examine  the  wound;  but,  on  the  boy  fainting,  he  desisted,  so  that  the 
iron  point  was  left  in  the  orbit.  The  external  wound  healed,  and  the 
boy  recovered;  the  eye  remained  clear  and  movable,  but  deprived  of 
sight.  This  happened  in  the  beginning  of  August,  1594,  and  nothing 
more  was  heard  of  the  iron  point  till  October,  1624;  when,  after  an 
attack  of  fever  and  catarrh,  with  a  great  deal  of  sneezing  it  descended 
into  the  left  nostril,  whence,  taking  the  way  of  the  fauces,  it  came  into 
the  mouth  and  was  discharged.  During  the  whole  thirty  years  and 
three  months  that  it  had  remained  in  the  head,  it  had  not  been  produc- 
tive of  any  pain. 


FRACTURE   OF   THE  INNER   WALL  OF  THE  ORBIT.  41 

"CASE  22.— The  son  of  General  E.,  a  student  at  the  Polytechnic 
School  in  Paris,  received,  in  fencing,  the  end  of  the  foil  through  the 
roof  of  the  orbit,  and  became  hemiplegic  on  the  opposite  side  of  the  body. 
The  eye  was  saved. 

"CASE  23. — Thomas  Hale,  aged  35,  was  assisting  in  hay-making. 
A  scaffolding  had  been  erected  at  the  side  of  the  hayrick;  and  while 
his  companion,  a  man  named  Joslyn,  was  in  the  act  of  throwing  some 
hay  upon  it,  the  pitchfork  missed  the  hay,  and  struck  Hale  in  the  right 
eyebrow.  Instead  of  drawing  the  pitchfork  out,  Joslyn,  under  the  im- 
pression that  he  had  caught  the  hay,  thrust  it  farther  in,  the  one  prong 
entering  Hale's  orbit,  while  the  other  glanced  over  the  outside  of  his 
head. 

"When  the  prong  was  withdrawn,  which  was  accomplished  with 
difficulty,  Hale  turned  to  leave  the  field,  having  the  impression  that 
his  eye  had  been  driven  out  of  his  head;  but  he  had  not  proceeded  more 
than  five  or  six  yards  before  he  fell,  his  left  side  crippling  under  him. 
In  other  respects  he  recovered,  but  the  palsy  continued,  the  fingers  of 
the  left  hand  being  contracted,  and  the  left  foot  swinging  about, 
although  he  became  able,  in  the  course  of  some  months,  to  walk  at  the 
rate  of  a  mile  in  thirty  minutes.  Dr.  Roe,  who  published  the  case, 
had  given  a  trial  to  strychnia  internally,  and  to  electro-magnetism, 
without  any  very  striking  improvement.  Hale  continued  to  taste, 
smell,  and  see  as  well  as  ever." 

FRACTURE  OF  THE  INNER    WALL  OF  THE  ORBIT. 

These  fractures  may  be  either  direct  or  indirect.  When  di- 
rect they  are  due  to  gunshot  wounds,  blows  from  umbrella  han- 
dles, etc.,  falls  upon  iron  hooks,  etc.,  injury  by  the  calks  of 
horseshoes,  etc.  Indirect  fractures  may  be  due  to  falls,  blow 
of  fist,  etc.  Direct  fractures  are  compound,  and  may  be  recog- 
nized, as  a  rule,  without  much  difficulty.  The  diagnosis  of  indi- 
rect fracture  is  indicated  by  hemorrhage  from  the  nose  and  em- 
physema of  the  orbit.  Emphysema  of  the  orbit  is  a  crepitating 
swelling  produced  by  the  entrance  of  air  into  the  ureolar  tissue 
through  the  fracture,  when  the  patient  blows  his  nose  or  sneews. 
It  may  occur  in  fracture  of  the  roof  of  the  orbit,  the  air  enter- 
ing the  areolar  tissue  by  way  of  the  frontal  sinus.  This  is  un- 
common. It  may  occur  also  in  fracture  of  the  floor  of  the  orbit ; 
tben  the  antrum  is  the  avenue  by  which  the  air  readies  the  site 
of  the  lesion.  Emphysema  of  the  orbit  is,  however,  generally 
due  to  fracture  of  the  inner  wall.  These  lesions  may  be  com- 
plicated by  fracture  of  the  roof  of  the  orbit.  Ordinarily  they 


42  VISION   AND    AUDITION — WOODWARD. 

do  not  threaten  the  patient's  life.     Deformity  may  result  from 
them. 

FRACTURE  OF  THE    FLOOR  OF  THE   ORBIT. 

They  may  be  gunshot  fractures,  or  they  may  be  due  to  heavy 
blows  upon  the  face,  or  they  may  be  caused  by  a  force  pushing 
the  eyeball  through  the  bone. 

FRACTURE  OF  THE  EXTERNAL   WALL  OF  THE  ORBIT. 

Considerable  violence  is  necessary  to  cause  these  fractures. 
They  are  usually  compound  fractures  and  occur  most  commonly 
in  gunshot  wounds.  Extensive  fractures  of  this  wall  may  open 
the  cranial  cavity,  and  endanger  life.  Fissures  extending  along 
the  base  of  the  skull  may  occur  as  a  complication.  Some  de- 
formity of  the  face  remains. 

WOUNDS    OF    THE  SOFT    PARTS    OF    THE  ORBIT,   NOT    IN- 
CLUDING INJURIES  TO  THE  EYEBALL. 

Sword-thrusts,  thrusts  of  pointed  sticks,  canes,  umbrella 
handles,  knife  blades,  etc.,  or  missiles  like  fragments  of  iron, 
copper,  or  stone,  bird-shot,  bullets,  etc.,  sometimes  wound  the 
soft  parts  in  the  orbital  cavity  without  injuring  the  eyeball. 
The  anatomical  structures  involved  in  these  traumatisms  are 
the  cellular  tissue,  the  blood-vessels,  the  ocular  muscles,  the 
nerves  supplying  those  muscles,  the  branches  of  the  fifth  nerve 
supplying  sensation  to  the  cornea,  and  the  optic  nerve.  In  cer- 
tain cases,  fracture  of  one  of  the  walls  of  the  orbit  exists  as  a 
complication:  when  thereof  of  the  orbit  is  involved,  the  gravity 
of  the  injury  is  greatly  magnified.  A  weapon  or  a  missile  per- 
forates the  eyelid,  the  conjunctiva,  and  the  septum  orbitce 
before  it  wounds  the  soft  parts  of  the  orbit.  The  blow  may 
fall,  however,  when  the  eye  is  open,  and  then  the  eyelids  may 
escape  injury.  In  general,  the  blow  is  delivered  'point-blank, 
or  nearly  so,  and  the  weapon  commonly  enters  the  orbit  to  the 
nasal  side  of  the  eyeball. 

Merkel  found  the  depth  of  the  orbit  to  be  in  men  43  mm.,  in 
women  40.5  mm.  These  figures  are  approximately  correct  for 
adults.  Children's  orbits  are  much  shallower;  according  to 
Lushka,  in  one  instance  the  measurement  was  26  to  27  mm. 


WOUNDS   OF   THE   SOFT    PARTS  OF  THE   ORBIT.  43 

After  one  of  these  injuries,  a  foreign  body  may  or  may  not 
remain  lodged  in  the  orbit.  Certain  effects  are  observed  to  fol- 
low traumatisms  of  the  soft  parts  of  the  or  bit  irrespective  of  the 
lodgment  of  a  foreign  body  therein.  Thus,  laceration  of  the  blood- 
vessels is  an  accompaniment  of  every  wound.  The  hemorrhage 
is  intra-orbital ;  its  volume  depending  upon  the  number  and  the 
size  of  the  vessels  injured  (especially  arteries) .  The  bulk  of  the 
extravasation  accumulates  in  the  orbit  and  only  a  relatively 
small  portion  escapes  by  the  wound,  which  is  usually  of  restricted 
calibre.  Accumulation  of  blood  in  the  orbit  displaces  the  eye- 
ball forward  (exophthalmus)  toward  the  point  of  least  resistance, 
and  possibly  in  a  vertical  or  a  lateral  direction,  according  to 
the  position  of  the  principal  bleeding  point.  Exophthalmus 
may  be  so  marked  that  the  eyelids  cannot  close  over  the  cornea. 
This  state  may  excite  inflammation  and  ulceration  of  the  cornea 
and  terminate  in  destruction  of  the  eye. '  Vision,  in  average 
cases,  may  not  be  affected  or  it  may  be  very  much  impaired, 
presumably  by  virtue  of  pressure  upon  the  optic  nerve  by  the 
extravasation,  or  by  virtue  of  the  tension  of  the  optic  nerve  due 
to  the  altered  position  of  the  eyeball,  or  perhaps  by  both  condi- 
tions working  together.  In  nearly  all  cases,  no  ophthalmoscopic 
explanation  of  the  amblyopia  or  amaurosis  will  be  found.  Un- 
less the  acuteness  of  vision  is  very  much  reduced,  the  patient 
will  complain  of  diplopia. 

Resorption  of  the  extravasated  blood,  return  of  the  globe  to 
its  normal  position,  and  restoration  of  function  may,  in  gene- 
ral, be  prognosticated.  Still,  recovery  may  not  be  complete. 
Amaurosis  or  amblyopia  may  become  permanent,  if  the  resorp- 
tion  take  place  slowly ;  or  the  eyeball  may  become  phthisical  by 
virtue  of  an  excessive  exophthalmus,  as  in  Berlin's  cases. 

The  ocular  muscles  may  be  injured.  According  to  Berlin,1 
the  ocular  muscles,  as  regards  frequency  of  the  occurrence,  are 
injured  in  the  order  in  which  they  are  named  as  follows:  rectus 
interims,  rectus  inferior,  levator  palpebrw  superioris,  rec- 
tus superior,  rectus  externus,  obliquus  superior,  obliquus  in- 
ferior. The  levator  palpebne  superioris,  as  its  name  signifies, 
simply  elevates  the  upper  eyelid,  and  does  not  affect  the  move- 
ments of  the  eyeball.  Division  of  its  fibres  gives  rise  to  trau- 
matic ptosis.  Partial  or  complete  division  of  one,  or  of  any 
1  Berlin,  I.e.,  p.  576.  '  Loc.  tit. 


44  VISION   AND    AUDITION — WOODWARD. 

combination  of  the  ocular  muscles,  will  disturb  the  movements 
of  the  eyeball  and  alter  the  direction  of  the  visual  line  of  the 
affected  eye.  It  is  conceivable  that  bruising  of  the  muscles, 
without  division  of  their  fibres,  may  produce  the  same  conditions. 
While  it  may  be  expected  that  bruising  will  impair  the  use- 
fulness of  a  muscle  for  a  brief  period  only,  both  partial  and 
complete  division  of  its  fibres  will  produce  a  permanent  impair- 
ment of  function,  unless  operative  interference  be  successful  in 
repairing  the  rent. 

Such  lesions  cause  diplopia  with  strabismus,  or  diplopia 
without  apparent  deviation  of  the  line  of  sight,  according  to 
the  extent  of  injury  to  the  muscles.  Diplopia  will  not  be  pres- 
ent when  vision  is  very  much  affected,  and  may  not  be  com- 
plained of  when  the  strabismus  is  excessive,  owing  to  great 
separation  of  the  images.  Strabismus  in  these  patients  possesses 
the  characteristics  of  the  paralytic  varieties.  The  diplopia  like- 
wise is  characteristic.  Careful  observation  of  the  behavior  of 
the  double  images  will  reveal  which  muscles  are  affected,  even 
when  the  injury  is  a  minor  one.  Malingerers  may  pretend  that 
they  see  double  in  consequence  of  an  accident  to  an  eye,  or  to  the 
head.  Children  sometimes,  without  intending  to  deceive,  com- 
plain of  the  same  symptom.  Such  frauds  may  be  detected  by 
observing  the  relations  maintained  toward  each  other  by  the 
double  images,  since  it  is  not  possible  fora  patient  to  avoid  giv- 
ing answers  that  do  not  radically  conflict  with  one  another,  un- 
less diplopia  be  really  present.  Convergence  of  both  eyes  and 
diplopia  may  be  produced  by  voluntary  effort,  and  maintained 
for  a  few  moments  at  a  time.  It  is  also  possible  to  wilfully 
cause  convergence  of  one  eye  only.  A  person  of  my  acquaint- 
ance was  able  to  do  this ;  he  could  also  rotate  one  or  the  other 
eye  upward  at  will.  Such  control  of  the  ocular  muscles  is  very 
exceptional. 

Diplopia  with  slight  rotation  of  the  eyeball  is  more  trouble- 
some to  patients  than  diplopia  with  marked  strabismus ;  for,  in 
the  former,  the  double  images  are  near  together  and  both  are 
constantly  seen,  while  in  the  latter  they  may  be  widely  sepa- 
rated and  only  one  of  them  lie  in  the  field  of  fixation.  Double 
vision  is  sufficient  to  incapacitate  one  for  all  kinds  of  work.  It 
may  endanger  life  indirectly,  by  exposing  the  patient  to  mishaps 
in  the  street,  or  in  going  up  and  down  stairs,  etc.  Patients  are 


WOUNDS  OF  THE  SOFT   PARTS  OF  THE  OKBIT.  45 

obliged  to  close  the  affected  eye  to  get  about,  or  they  hold  their 
heads  in  strained  and  peculiar  positions  to  suppress  the  fake 
image.  The  false  image  is  suppressed  at  the  expense  of  vision 
in  one  part  of  the  field.  Sense  of  perspective  is  wanting. 

Careful  suturing  of  the  divided  muscle  will  restore  the  bal- 
ance of  the  ocular  muscles,  in  the  more  simple  cases.  Unless 
operative  interference  succeed  in  this  line,  the  diplopia  will  be 
permanent.  But,  after  weeks  or  months,  the  patient  will  be  able 
to  suppress  the  false  image,  and  learn  to  compensate  for  his 
sense  of  perspective,  to  some  extent.  When  more  than  one  mus- 
cle is  involved  in  the  injury,  less  benefit  may  be  anticipated 
from  operative  interference. 

Paralytic  strabismus  and  diplopia  are  likewise  the  conse- 
quence of  intraorbital  lesion  of  the  nerves  supplying  the  ocular 
muscles.  These  lesions  are  rare  and  incurable. 

Intra-orbital  branches  of  the  fifth  nerve  supplying  the  cornea 
with  sensation  have  been  wounded.  Resulting  anaesthesia  of 
the  cornea  predisposes  to  ulceration  of  that  structure  and  hence 
to  destruction  of  the  eyeball  by  inflammation. 

A  weapon  or  missile  penetrating  deeply  into  the  orbit  may 
wound  the  optic  nerve.  The  central  artery  of  the  retina  enters 
the  optic  nerve  about  10  mm.  behind  the  eyeball.  Division  of 
the  nerve  may  be  partial  or  complete,  and  may  occur  between 
the  point  of  entrance  of  the  central  artery  and  the  eyeball,  or  be- 
hind that  point.  Blindness,  either  partial  or  complete,  is  the 
immediate  consequence.  If  the  wound  lie  between  the  entrance 
of  the  artery  and  the  globe,  the  ophthalmoscopic  appearances, 
in  the  early  stages,  will  be  similar  to  those  observed  in  cases  erf 
embolism  of  the  central  artery  of  the  retina.  Subsequently  the 
nerve  atrophies.  Division  of  the  central  artery  before  it  enters 
the  sheath  of  the  nerve  will  cause  similar  disturbances.  When 
the  lesion  in  the  optic  nerve  lies  behind  the  entrance  of  the 
artery,  the  ophthalmoscopic  appearances  are  nonnal  in  tho  early 
days.  After  two  or  more  weeks,  atrophy  of  the  nerve  is  ob- 
served. When  the  atrophj'  is  partial,  it  is  probable  that  the 
optic  fibres  were  not  severed  completely. 

Fragments  of  iron,  copper,  stone,  etc.,  missiles  from  pistols, 
rifles  or  shot-guns,  pieces  of  wood,  twigs  of  trees,  ferules  from 
umbrella-handles  or  walking-sticks,  knife-blades,  needles,  and 
other  bodies  may  effect  a  lodgment  in  the  orbital  cavity.  They 


46  VISION   AND    AUDITION — WOODWARD. 

may  be  located  in  the  soft  parts,  or  they  may  become  embedded 
in  one  of  the  bony  walls  and  project  into  the  orbit.  Foreign 
bodies  lodged  in  the  orbit  may  be  large  enough  to  displace  the 
eyeball  and  restrict  its  movements.  The  displacement  may 
amount  to  dislocation  of  the  eyeball.  When  resorption  of  the 
extravasated  blood  has  taken  place,  the  eyeball  will  still  remain 
displaced,  if  a  large  body  be  lodged  in  the  orbit,  and,  similarly, 
restriction  of  the  movements  of  the  globe  will  persist  until  the 
obstruction  is  removed.  Vision  may  be  destroyed  while  the 
globe  is  displaced,  but  it  may  return  when  the  foreign  body  is 
removed  and  the  eye  restored  to  its  normal  position.  When 
the  injury  is  fresh  the  foreign  body  may  be  seen  if  the  wound 
be  large,  or  it  may  be  felt  with  the  probe  if  the  body  be  not  too 
small.  Probing,  under  antiseptic  precautions,  is  advised  when 
there  is  reason  to  suppose  that  a  foreign  body  has  lodged  in  the 
orbit.  It  is  the  most  fruitful  means  of  diagnosis  in  these  cases, 
but  it  does  not  always  give  accurate  information.1 

Wounds  of  the  orbit  heal  promptly,  as  a  rule.  Orbital  cellu- 
litis  and  abscess  are  seldom  observed  unless  the  wounds  have 
been  infected.  Even  when  foreign  bodies  are  lodged  in  the 
orbit,  unless  they  are  of  large  size  or  carry  the  germs  of  infec- 
tion, the  wounds  close  in  a  short  time.  Small  bodies  like  bird- 
shot  and  bullets  of  small  calibre,  and  other  aseptic  or  nearly  asep- 
tic substances,  frequently  become  encapsulated,  and  may  not  give 
rise  to  any  further  disturbance. 

The  wound  may  close  over  the  foreign  substance,  and  subse- 
quently open,  leaving  a  discharging  sinus.  Or  the  wound 
may  not  heal,  but  continue  to  discharge.  Both  circumstances 
are  indicative  of  the  presence  of  extraneous  matter  in  the 
tissues.  In  such  cases,  an  attempt  to  find  the  foreign  body 
should  be  made.  In  fresh  cases,  when  the  position  of  the  body 
is  located,  it  should  be  removed:  a  possible  exception  may  be 
made  when  the  foreign  body  is  imbedded  in  the  bony  walls  at 
the  apex,  or  in  the  roof  of  the  orbit.  The  propriety  of  removing 
foreign  bodies  imbedded  in  those  portions  of  the  walls  of  the 
orbit  may  be  questioned.  Surgical  interference  in  such  injuries 
may  sacrifice  the  patient's  life  by  causing  intra-cranial  hemor- 
rhage, or  inflammation  of  the  brain.  Expectant  treatment  may 
also  expose  the  patient  to  fatal  complications  within  the  cranial 
1  See  cases  cited  under  direct  fractures  of  roof  of  orbit,  pp.  33-39. 


WOUNDS   OF   THE  SOFT   PARTS  OF  THE   ORBIT.  47 

cavity.  Between  these  alternatives,  the  choice  may  very  prop- 
erly be  given  to  operative  interference  conducted  cautiously  by 
the  principles  of  the  antiseptic  method,  as  affording  the  patient 
the  best  chance  for  his  life.  If,  however,  the  foreign  body  have 
become  encapsulated  and  its  presence  be  not  causing  any  serious 
disturbance,  no  attempt  at  removal  of  it  should  be  made,  even 
though  it  be  imbedded  in  the  bones  separating  the  orbital  from 
the  cranial  cavity  and  project  into  the  cerebral  substance. 
Operations  upon  such  cases  have  proved  fatal  at  the  hands  of 
the  best  operators. ' 

The  following  case  cited  by  Mackenzie  shows  the  dangers 
encountered  in  operations  on  these  cases : 

"CASE  29. — A  girl,  10  years  of  age,  playing  along  with  other  chil- 
dren, near  a  cotton-spinning  machine,  fell  upon  one  of  the  pointed 
iron  spikes,  five  or  six  inches  long,  on  which  the  bobbin  is  placed. 
This  instrument  penetrated  to  the  depth  of  about  two  inches  into  the 
orbit,  between  the  inner  wall  and  globe  of  the  eye,  and  then  broke 
across,  so  that  2  or  3  lines'  length  of  it  projected  above  the  level  of  the 
skin.  Attempts  were  made  to  remove  it;  but  so  much  difficulty 
was  experienced  that  these  attempts  were  not  persisted  in.  Ten  days 
afterward,  the  piece  of  iron  was  found  protruded  to  the  length  of  9  or 
10  lines;  a  month  afterward,  it  was  still  more  protruded;  in  fact,  it 
now  held  apparently  so  slightly,  that  it  was  laid  hold  of  with  the  fingers 
and  extracted.  Scarcely  had  this  been  done,  when  the  child  was  seized 
with  convulsions,  and  died  in  a  quarter  of  an  hour.  The  sigbt  had  not 
been  affected,  during  the  residence  of  the  foreign  body  in  tbe  orbit,  nor 
had  its  presence  there  excited  any  very  marked  symptoms.  The  child 
had  always  been  able  to  go  about." 

The  following  cases  are  cited  by  the  same  author,  and  are 
evidence  that  removal  of  foreign  bodies  wedged  in  the  roof  of 
the  orbit  and  injuring  the  cerebral  substance  is  followed  by  a 
favorable  result,  in  some  severe  cases :  * 

"CASE  27.— Sabatier  notices  an  instance  of  wound  with  a  knife, 
through  an  upper  eyelid,  with  injury  of  the  neighboring  edge  of  the 
frontal  bone.  It  was  not,  he  says,  till  after  four  hours'  work,  that  the 
surgeon  succeeded,  by  means  of  a  hand-vice,  in  tearing  away  the  por- 
tion of  the  knife-blade  which  remained  in  the  orbit,  on  account  of  its 
projecting  so  little  from  the  wound.  The  patient  complained  of  severe 

1  Pagenstecher's  cane. ride  "Traite  »  For  other  similar  cases  t*e  arti- 
complet  d'Ophthalmologie,"  t.  iv.,  cle  on  direct  fractures  roof  of  orbit, 
p.  800.  pp.  33-39. 


43  VISION   AND   AUDITION — WOODWARD. 

pain,  as  if  one  had  been  tearing  out  his  eye.  No  ill  consequence  fol- 
lowed; the  cure  was  speedy,  and  without  any  affection  of  sight. 

"CASE  28. — A  laborer,  aged  51  years,  while  cutting  wood  in  a  forest, 
stumbled  over  the  root  of  a  tree,  and  with  the  whole  weight  of  his  body 
drove  the  end  of  a  file,  which  he  held  in  his  hand,  against  his  left  eye. 
The  file  broke  across,  and  a  portion  of  it  remained  in  the  orbit.  The 
patient  was  carried,  in  a  state  of  insensibility,  to  a  small  town  some 
miles  off,  where  three  surgeons  tried  by  turns,  but  in  vain,  to  extract 
the  foreign  body,  which,  with  the  probe  and  the  forceps,  they  felt  dis- 
tinctly, through  the  wound,  beneath  the  middle  of  the  eyebrow.  They 
enlarged  the  wound  with  the  knife,  and  during  three  days  made  re- 
iterated attempts  at  extraction;  but  the  foreign  body  continued  immov- 
able. On  the  fourth  day,  the  patient  was  brought  to  the  surgical  clinic 
at  Prague.  The  eyelid  was  greatly  swollen,  and  in  the  middle  of  it  there 
was  a  triangular  wound,  with  inverted  edges.  The  eyeball  was  motion- 
less, and  was  so  pushed  downward  and  outward  that  it  almost  lay 
on  the  cheek,  carrying  the  lower  eyelid  before  it.  The  cornea  pre- 
sented more  than  an  ordinary  degree  of  lustre.  The  patient  was  nearly 
comatose.  Fritz  endeavored,  by  means  of  sfrong  pincers  and  polypus- 
forceps,  to  withdraw  the  foreign  body,  but  these  instruments  bent 
under  the  pressure.  At  last,  with  a  pair  of  small  but  very  strong  lith- 
otomy-forceps, which  he  grasped  with  both  his  hands,  he  succeeded  in 
extracting  the  piece  of  the  file. 

"It  was  triangular,  measured  an  inch  and  a  half  in  length,  and  was 
denticulated  to  its  point,  which  was  blunt.  The  patient  answered  ques- 
tions very  slowly,  or  not  at  all;  his  face  was  pale  and  sunk,  his  eyes 
were  shut,  and  he  lay  motionless,  except  that  he  often  raised  his  left 
hand  to  the  left  side  of  his  head.  Respiration  slow;  pulse  oppressed 
and  hard.  The  wound  gaped  widely;  the  eyelid,  almost  completely 
divided  into  lateral  halves,  was  of  a  dark  red  color,  and  so  much 
swollen  as  to  allow  only  a  small  portion  of  the  displaced  eyeball  to  be 
seen. 

"Notwithstanding  the  repeated  use  of  venesection  and  of  leeches 
and  constant  cold  applications  to  the  eyes,  the  cornea  filled  with  pus, 
and  giving  way  about  the  twelfth  day,  allowed  the  iris  to  protrude. 
The  cornea  was  ultimately  left  in  an  opaque  and  atrophied  state.  The 
wound  suppurated  abundantly,  and  for  some  time  a  probe  could  be 
passed  along  it,  in  a  direction  backward  and  inward,  beneath  and 
through  the  orbitary  portion  of  the  frontal  bone,  to  the  depth  of  five 
inches,  without  causing  pain.  At  length  the  wound  closed,  the  upper 
eyelid  remaining  palsied.  The  patient's  general  health  was  perfectly 
restored. 

"CASE  33. — Marchetti  had  under  his  care  a  beggar,  who,  asking 
charity  rather  importunately  one  summer's  day  from  a  Paduan  noble- 
man, this  testy  personage  struck  the  beggar  with  the  handle  of  his  fan, 


TRAUMATIC    ENOPHTHALMUS.  49 

in  the  inner  angle  of  the  eye,  and  with  so  much  force  that  a  portion  of 
the  fan,  three  inches  long,  broke  through  the  orbit,  and  sank  out  of 
sight  in  the  direction  of  the  palate.  When  the  man  came  to  the  hos- 
pital, Marchetti  removed  some  small  bits,  which  he  found  sticking  in 
the  angle  of  the  eye,  combated  the  inilammation,  allowed  the  wound 
to  close,  and  dismissed  the  patient  as  cured.  In  three  months  he  re- 
turned with  a  large  swelling  in  the  palate.  When  Marcetti  cut  into 
it,  his  knife  struck  upon  the  handle  of  the  fan,  which  he  immediately 
extracted  with  a  pair  of  forceps.  The  patient  speedily  recovered." 


TRAUMATIC    ENOPHTHALMUS. 

Traumatic  enophtbalmus  is  an  uncommon  condition  in  which 
the  eyeball  sinks  into  the  orbit,  in  consequence  of  wounds  or 
contusions  of  the  region  of  the  eye.  Beer  has  collected  fifteen 
cases  that  constitute  the  data  of  his  dissertation,  a  translation 
of  which  may  be  found  in  Knapp-Schweigger's  Archives  of 
Ophthalmology.1  The  force  required  to  produce  enophthal- 
mus  is  a  heavy  blow  or  a  severe  wound,  such,  for  example,  88 
would  be  inflicted  by  the  horn  of  a  cow. 

In  one  case  (Schapringer's)  the  enophthalmus  disappeared 
after  three  days.  It  was  permanent  in  the  remaining  cases. 
The  affected  ej~e  was  found  to  lie  from  2  to  8  mm.  deeper  in  the 
orbit  than  its  fellow.  Vision  and  mobility  of  the  eye  remained 
normal  in  some  of  the  cases.  No  cicatrices  existed  in  the  re- 
gion of  the  eye.  In  other  cases  wounds  of  the  soft  parts,  even 
deeply  penetrating  wounds  of  the  orbit,  complicated  by  fracture 
of  the  orbital  walls,  were  present.  Vision  was  impaired  in  these 
cases. 

One  case  became  totally  blind:  "a  soldier  whose  right  eye 
was  injured  by  a  falling  stick  of  wood.  The  sight  at  once  be- 
gan to  fail  and  there  was  periodic  pain  above  the  eye.  Seven 
months  after  the  injury,  the  right  lids  were  retracted  as  in 
phthisis  bulbi,  and  the  palpebral  fissure  was  decreased  in  size. 
When  the  upper  lid  was  elevated  the  ball  rolled  upward.  Pupil 
and  fundus  normal.  In  the  right  eye,  there  was  no  vision;  in 
the  left,  fingers  were  counted  at  10  feet.  A  pulsating  pain  in 
the  region  of  the  eye,  temples,  and  ears,  particularly  at  night. 
After  some  months  there  was  complete  blindness,  while  the  pain 
and  retraction  of  the  ball  remained  as  before.  The  right  globe 

»  Vol.  xxii.,  1,  pp.  98-106. 
III.— 4 


50  VISION   AND    AUDITION — WOODWARD. 

lay  six  lines  behind  the  superior  margin  of  the  orbit,  the  left 
four  and  one-half  lines." 

In  most  of  the  cases,  the  movements  of  the  globe  were  re- 
stricted by  paralysis  of  the  muscles  or  by  cicatricial  tissue. 
Homonymous  diplopia  occurred  in  one  case. 

PULSATING  EXOPHTHALMUS. 

Protrusion  of  the  eyeball  with  exaggerated  pulsation  in  the 
orbit,  depending  upon  an  aneurismal  condition  of  the  blood-ves- 
sels (aneurism  by  anastomosis  (?),  arterio- venous  aneurism  (?), 
diffuse  aneurism,  aneurism  of  the  ophthalmic  artery,  rupture  of 
the  carotid  into  the  cavernous  sinus) ,  may  be  either  traumatic  or 
idiopathic.  The  recorded  traumatic  cases  show  that  the  follow- 
ing injuries  may  operate  as  the  exciting  cause :  a  penetrating 
wound  of  the  orbit  made  by  an  umbrella-handle,  by  a  fork-like 
ornament  of  a  parasol,  by  a  knitting-needle,  by  a  fall  upon  a  stick, 
and  by  bird-shot.  A  discharge  of  shot  received  in  the  left  orbit 
has  caused  pulsating  exoph'thalmus  of  the  right  eye.  And  a 
wound  through  the  left  lower  eyelid  by  the  handle  of  an  umbrella 
has  caused  pulsating  exophthalmus  of  the  opposite  (right)  side. 
One  patient  was  wounded  at  the  inner  side  of  the  left  upper  eye- 
lid by  the  bursting  of  a  soda-water  bottle,  and  a  pulsating  tumor 
developed  at  the  site  of  injury.  Among  the  indirect  causes 
capable  of  producing  this  disease  are  cited  falls  upon  the  head, 
blows  upon  the  temple,  blows  upon  the  back  of  the  head,  blows 
upon  the  nape  of  the  neck,  blows  upon  the  forehead,  and  blows 
in  the  region  of  the  eye.  The  blow  must  be  a  severe  one,  but 
unconsciousness  does  not  necessarily  follow.  In  one  recorded 
case  a  knock-down  blow  with  the  fist  in  the  temple  was  fol- 
lowed by  pulsating  exophthalmus.  And  a  blow  upon  the  nape 
of  the  neck  from  the  fist  of  a  very  muscular  man  has  caused 
bilateral  pulsating  exophthalmus. 

The  condition  is  confined  to  one  side,  in  nearly  all  cases.  In 
penetrating  wounds  of  the  orbit  it  may  occur  on  the  opposite 
side.  Bilateral  pulsating  exophthalmus  has  been  observed  in  a 
few  cases) 

Idiopathic  cases  begin  commonly  with  a  noise  in  the  head ; 
the  exophthalmus  develops  later  on.  In  traumatic  cases,  the 
symptoms  are  developed,  as  a  general  rule,  within  nine  months 


PULSATING    EXOPHTHALMfS.  51 

of  the  accident  preceding  the  affection.  "More  than  half  the 
cases,"  cited  by  Rivington,1  ''exhibited  all  the  symptoms  within 
two  months.  Some  of  the  cases  were  not  seen  till  a  much  later 
period,  but  from  the  history  it  is  clear  that  all  the  symptoms 
were  well  established  a  few  weeks  after  the  injury.  In  two 
cases  only  was  there  an  interval  of  years."  It  is  proliable  that 
in  most  of  the  traumatic  cases  there  was  a  fracture  of  the  base 
of  the  skull. 

According  to  Rivington,7  "the  typical  symptoms  of  the  so- 
called  '  intra-orbital  aneurism '  are  exophthalmus,  a  chemoaed 
pad  of  conjunctiva  concealing  the  lower  lid,  pain,  paralysis  of 
orbital  muscles  and  iris,  with  or  without  anaesthesia,  pulsation 
of  the  eyeball,  a  pulsating  tumor  above  the  eye  beneath  the  in- 
ner part  of  the  orbital  arch,  distention  of  conjunctival  vessels, 
obliteration  of  the  hollow  beneath  the  orbital  arch,  bruit  and 
noises  in  the  head.  Pulsation  of  the  eyeball,  a  pulsating  tumor, 
and  paralysis  of  ocular  muscles  may  be  absent  without  contra- 
indicating  the  diagnosis  of  aneurism;  but  I  do  not  think  that 
any  case  should  be  regarded  as  aneurismal  in  which  a  bruit  can- 
not be  heard,  or  be  placed  under  the  head  of  'intra-orbital  an- 
eurism' unless,  in  the  absence  of  pulsation,  exophthalmus  and 
congestion  of  conjunctiva  accompany  the  bruit." 

It  is  not  possible  to  differentiate  the  traumatic  from  the  idio- 
pathic  cases  by  studying  the  aneurismal  conditions  alone.  The 
history  of  the  case  must,  in  certain  instances,  be  positively  for- 
mulated before  such  differentiation  may  be  made.  A  trauma- 
tism  which  subsequently  results  in  pulsating  exophthalmus  may 
leave  no  other  evidence  that  it  has  been  received.  Even  pene- 
trating wounds  of  the  orbit  (e.0.,  puncture  made  by  a  knitting- 
needle)  may  leave  no  discoverable  cicatrix,  yet  such  lesions  may- 
be succeeded  by  pulsating  exophthalmus.  Traumatic  cases  are 
more  common  than  idiopathic ;  they  are  much  more  common  in 
men  than  in  women;  while,  on  the  contrary,  idiopathic  cases 
are  much  more  common  in  women  than  in  men. 

Spontaneous  recoveries  are  record ed,  but  such  cases  are  un- 
common. Traumatic  cases  may  have  a  fatal  termination 
through  secondary  hemorrhage.  Not  only  the  danger  to  life, 
but  the  deformity,  the  disturbance  of  vision,  and  the  distress 

1  Medico-Chirurj?ical  Transactions         tllnd.,  p.  213. 
(London),  vol.  Iviii.,  p.  211. 


52  VISION   AND   AUDITION — WOODWARD. 

occasioned  by  the  noises  in  the  head  must  be  considered,  while 
estimating  the  effect  of  this  affection  upon  the  welfare  of  the 
patient.  The  deformity  is  unsightly.  Vision  of  the  affected 
eye  may  be  totally  destroyed  by  the  injury,  or,  subsequently, 
by  the  exophthalmus,  by  pressure  upon  the  optic  nerves,  by 
changes  in  the  retinal  vessels,  or  by  ulceration  of  the  cornea. 
The  latter  may  or  may  not  end  in  perforation  and  panophthal- 
mitis.  Sometimes  diplopia  exists  in  a  troublesome  degree. 

Again,  it  is  likewise  important  to  take  into  consideration 
the  dangers  incident  to  the  treatment  of  this  affection,  while 
estimating  the  importance  of  it.  For,  inasmuch  as  ligation  of 
the  common  carotid  is  the  treatment  most  productive  of  favor- 
able results,  it  is  the  method  of  cure  to  be  selected  in  preference 
to  others,  and  in  itself  it  involves  a  certain  risk  to  the  patient's 
life  (8  deaths  in  63  operations).1  Even  that  operation  has  failed 
to  cure  in  17  out  of  55  cases,  collected  by  Sattler.* 

1  Sattler :  "Graef  e  -  Saem  isch      discussion  of  this  affection,  consult 
Handbuch,"  vol.  vi.,  p.  933.  Rivington,  op.  eit.,  and  Sattler,  op. 

3  Ibid. ,   p.   937.     For  exhaustive      cit. 


CHAPTER  IV. 

INJURIES   AND   WOUNDS   OF   THE   EYELTD& 

CONTUSIONS. 

CONTUSIONS  of  the  eyelids  are  followed  by  subcutaneous 
extravasation  of  blood  (ecchymosis,  suggillation,  "black  eye"). 
The  extravasation  may  be  small,  or  it  may  be  great  enough  to 
close  the  eye.  After  a  severe  contusion,  the  ecchymosis  gen- 
erally appears  immediately;  after  milder  injuries,  it  may  not 
become  visible  for  some  hours. 

Subcutaneous  extravasations  of  blood  in  the  eyelids  are  not 
always  a  consequence  of  direct  violence.  They  may  occur  spon- 
taneously in  persons  having  a  tendency  to  cerebral  apoplexy. 
They  have  been  observed,  in  rare  cases,  as  a  symptom  of  disease, 
e.g.,  purpura  hcemorrhagica.  They  have  been  caused  by 
straining  in  whooping-cough.  They  occur  in  nearly  all  cases 
of  fracture  of  the  vault  of  the  orbit,  whether  the  fracture  be  the 
result  of  direct  violence  or  not.  Fissures  in  the  vault  of  the 
orbit  may  not  extend  beyond  the  frontal  bone,  or  they  may  be 
continuous  with  a  fracture  of  the  base  of  the  skull.  Palpebral 
ecchymosis  may  be  due  also  to  fracture  of  the  bones  composing 
the  lateral  walls,  or  the  floor  of  the  orbit. 

When  ecchymosis  of  the  eyelids  originates  in  fracture  of  the 
bones  of  the  orbit,  subconjunctival  extravasation  is  observed 
as  a  precedent  symptom.  In  cases  of  this  nature,  the  extrava- 
sated  blood  infiltrates  the  deeper  tissues  of  the  orbit,  spreads 
forward  under  the  conjunctiva  of  the  eyeball,  and  appears  be- 
neath the  integument  of  the  eyelids.  Such  palpebral  extravasa- 
tions may  appear  first  near  the  inner  canthus ;  and  eighteen  or 
twenty-four  hours  may  pass  after  the  injury  before  any  discol- 
oration of  the  eyelids  becomes  manifest. 

Palpebral  ecchymoses  have  been  observed  after  contusions  of 
the  abdomen  and  of  the  thorax.  They  may  be  produced  by 

53 


54  VISION   AND    AUDITION — WOODWARD. 

strangulation.     Such  extravasations  have  the  same  aspects  as 
if  they  originated  in  fracture  of  the  base  of  the  skull. 

Ammon  described  a  "sympathetic  suggillation,"  by  which  he 
meant  an  ecchymosis  appearing  in  corresponding  parts  of  the 
face  about  both  eyes.  Fracture  of  the  skull  involving  the  walls 
of  both  orbits  may  be  the  causal  lesion  in  such  cases.  But  the 
condition  has  been  observed,  without  fracture,  after  enucleation 
of  the  eyeball. 

Cases  of  amblyopia  and  amaurosis  supposed  to  arise  by  reflex 
action  from  contusions  of  the  supra-orbital  or  of  the  infra-orbital 
nerve  have  been  reported.1  The  only  cases  of  this  description, 
which  I  have  seen  in  recent  literature,  are  those  reported  by 
Dunn.2  He  gives  the  history  of  two  attacks  of  amblyopia  oc- 
curring in  the  same  patient,  following  a  contusion  of  the  right 
and  subsequently  a  contusion  of  the  left  supra-orbital  nerve. 
Both  attacks  were  apparently  cut  short  by  section  of  the  injured 
nerve. 

Whenever  it  is  alleged  that  impairment  of  vision  is  due  to 
injury  of  one  of  these  nerves,  the  case  should  be  subjected  to 
especially  careful  scrutiny ;  for  it  is  not  intrinsically  probable 
that  amblyopia  or  amaurosis  ever  depends  upon  these  compara- 
tively simple  lesions.  If,  after  a  contusion  or  other  injury  of 
the  supra-orbital  or  the  infra-orbital  nerve,  the  patient  com- 
plain that  vision  in  the  eye  of  the  injured  side  has  become  de- 
fective, one  of  the  following  explanations  of  the  phenomena 
may  obtain, — viz.,  that  the  optic  nerve  has  been  injured  by  frac- 
ture of  the  orbital  bones,  or  that  the  defect  in  the  eye  antedates 
the  injury,  or  that  the  disturbance  in  the  eye  is  a  coincidence, 
not  a  consequence,  of  the  traumatism ;  or  that  the  patient  is 
malingering.  In  the  more  obscure  cases,  judgment  should  be 
reserved  until  sufficient  time  have  elapsed  for  the  ophthalmo- 
scopic  signs  of  pathological  changes  in  the  fundus  to  become 
manifest.  The  appearance  of  such  signs  may  be  delayed. 

WOUNDS  OF  THE  EYELIDS. 

The  eyelids  may  be  the  site  of  all  sorts  of  wounds — incised, 
punctured,  lacerated,  and  contused  wounds.  They  may  be  either 

1  Mackenzie  :  "  Dis.  of  the  Eye, "  2  New  York  Med.  Journal,  Aug- 
Philadelphia,  1855,  p.  150  et  seq.  ust  9th,  1890  ;  May  30th,  1891. 


WOUNDS   OP  THE   EYELIDS.  55 

superficial  or  deep.  The  whole  eyelid  may  be  torn  off,  or  so 
extensively  lacerated  as  to  slough  away,  leaving  the  cornea  ex- 
posed to  the  atmosphere.  They  may  be  confined  to  the  struc- 
tures of  the  eyelids,  or  they  may  involve  neighboring  structures. 
They  may  be  either  infected  or  non-infected. 

The  course  of  the  wound  is  important.  When  it  is  parallel, 
or  nearly  parallel,  with  the  free  margin  of  the  lid,  the  scar  will 
be  less  conspicuous  and  the  deformity  much  less  marked  than 
if  the  wound  were  oblique  or  vertical.  Incised  wounds  parallel 
with  the  free  margin  of  the  lid  may  heal  without  noticeable 
scar  or  deformity.  When  they  pass  through  the  levator  palpe- 
bra3  superioris,  however,  the  patient  will  not  be  able  to  open  his 
eye;  he  will  suffer  from  traumatic  ptosis.  Careful  suture  of 
the  divided  muscle  will  restore  its  usefulness,  but  it  may  be  an- 
ticipated that  evidence  of  the  traumatism,  in  the  line  of  deform- 
ity or  in  restricted  action  of  the  muscle,  will  remain  after  the 
most  skilful  handling.  The  most  favorable  time  for  operation 
in  such  cases  is  immediately  after  the  injury.  Green  made  a 
successful  operation  two  years  after  the  muscle  was  divided. 

A  wound  near  the  inner  canthus  may  divide  the  canaliculi. 
Cicatricial  tissue  may  occlude  the  lumen  of  the  tube,  causing 
epiphora,  or  weeping  of  the  eye.  Epiphora  is  an  annoying  con- 
dition that  disturbs  the  function  of  the  eye  by  virtue  of  accumu- 
lation of  tears  in  the  conjunctival  sac. 

Wounds  parallel  with  and  near  the  margin  of  the  lids,  pass- 
ing through  the  tarsus  in  the  region  of  the  Meibomian  ducte, 
will  result  in  formation  of  cj'sts  of  the  Meibomian  glands, 
through  cicatricial  occlusion  of  their  ducts. 

Wounds  dividing  the  eyelids  in  an  oblique  or  a  vertical  di- 
rection will  cause  deformity.  Incised  wounds  of  the  lid  margin 
and  tarsal  cartilage,  even  though  they  may  have  been  promptly 
and  accurately  united  by  a  suture,  may  heal  with  permanent 
deformity  (traumatic  coloboma).  The  eyelashes  about  the 
wound  may  be  turned  toward  the  eyeball  by  the  cicatrix,  so 
that  they  constantly  irritate  the  cornea.  When  this  takes 
place,  the  patient  is  very  uncomfortable;  his  eye  may  be  con- 
stantly inflamed,  and  its  function  may  be  impaired  by  loas  of 
transparency  of  the  superficial  strata  of  the  cornea. 

Lacerated  and  contused  wounds  resulting  in  loss  of  tissue 
are  productive  of  greater  evils.  Siu-h  wounds,  even  when  su- 


56  VISION   AND    AUDITION — WOODWARD. 

perficial,  will  leave  a  noticeable  scar,  and,  when  the  loss  of  tissue 
extends  over  a  sufficient  area,  the  cicatrix  will  prevent  complete 
closure  of  the  eye  (lagophthalmus) .  In  order  that  the  lagoph- 
thalmus  may  be  permanent,  considerable  loss  of  tissue  is  neces- 
sary, owing  to  the  elasticity  of  the  integument  of  the  eyelids. 
Lacerated  wounds  having  a  vertical  or  an  oblique  direction  are, 
more  frequently  than  others,  productive  of  lagophthalmus  and 
coloboma.  Lacerations  of  the  eyelids  may  destroy  sufficient 
tissue  to  uncover  the  cornea  permanently.  Unless  relieved  by 
surgical  treatment,  the  eye  will  remain  open.  Sooner  or  later 
the  drying  effect  of  the  atmosphere  and  the  dust  in  the  air, 
lodging  upon  its  surface,  will  set  up  a  persistent  inflammation 
of  the  cornea,  which  will  destroy  the  eye.  The  most  successful 
treatment  cannot  efface  the  deformity. 

Lacerated  and  contused  wounds  of  the  eyelids  may  be  suc- 
ceeded by  eversion  of  the  lid  margins  (traumatic  ectropium). 
This  is  more  commonly  due  to  wounds  of  the  lower  than  to  those 
of  the  upper  lid.  The  deformity  is  unsightly.  When  the  inner 
portion  of  the  lower  lid  is  everted,  the  eye  will  weep  constantly. 
Punctured  wounds  of  the  eyelids,  when  they  extend  into  the 
orbit,  may  result  in  eversion  of  the  lid  margin,  by  virtue  of 
cicatricial  contraction. 

Incised  wounds  of  the  eyelids  heal  promptly.  Lacerated 
and  contused  wounds,  when  infected,  or  when  they  occur  in 
persons  whose  health  is  depraved,  heal  slowly  and  usually  sup- 
purate. Such  wounds  may  be  attacked  by  erysipelas.  This 
may  endanger  the  patient's  life,  and  it  may  extend  to  the  orbital 
cellular  tissue,  causing  atrophy  of  the  optic  nerve,  or  ulceration 
of  the  cornea.  Under  such  conditions,  the  latter  would  run  a 
very  destructive  course.  Punctured  wounds  made  by  an  in- 
fected instrument  may  be  followed  by  similar  results. 

BURNS  OF  THE  EYE. 

The  eyelids  may  be  burned  by  fire,  by  explosions,  and  by 
corrosive  agents.  The  burns  may  be  superficial  or  deep.  They 
may  totally  destroy  the  eyelids.  Burns  of  the  first  degree  heal 
without  leaving  any  trace  behind.  Deeper  burns  are  followed 
by  scarring;  such  scars  contract  so  as  to  give  the  eyelids  a  false 
position.  Thus,  the  several  conditions,  ectropium,  even  to  com- 


BURNS   OF  THE   EYE.  57 

plete  eversion  of  the  eyelids  and  exposure  of  the  cornea,  lagoph- 
thalmus,  and  anchyloblepharon,  may  be  caused  by  contraction 
of  such  cicatrices  in  the  eyelids.  The  deformity  is  sometime* 
very  repulsive.  Operative  interference  will  relieve  that  feature 
to  a  considerable  extent,  but  well-marked  traces  of  the  casualty 
will  persist  in  the  more  severe  cases,  notwithstanding  the  most 
skilful  management. 

Burns  of  the  eyelids  are  associated,  in  many  cases,  with  a 
more  serious  corrosion  of  the  conjunctiva  and  eyeball.  But  burns 
of  the  latter  may  not  be  complicated  by  burns  of  the  eyelids. 
Quicklime  and  acids  (vitriol)  are  the  corrosive  agents  that  most 
frequently  enter  the  eye.  Flames  from  gunpowder  and  other 
quickly  inflammable  substances  may  scorch  or  severely  burn 
the  eyeball.  Corrosion  of  the  conjunctiva  causes  ulceration. 
When  the  palpebral  and  the  opposing  bulbar  conjunctiva  are 
involved  in  the  same  ulcerative  process,  symblepharon,  or  ad- 
hesion of  the  eyelid  to  the  eyeball,  ensues.  Such  adhesion  may 
prove  to  be  a  serious  impediment  to  the  performance  of  the 
functions  of  the  eye.  Symblepharon  may  attain  such  degree 
that  the  palpebral  conjunctiva  is  adherent  to  the  cornea.  When 
this  is  the  case  vision  is  very  much  impaired  or  destroyed. 

Burns  of  the  cornea  may  be  either  superficial  or  deep.  A 
superficial  burn  may  destroy  the  epithelial  layer  only.  Such 
an  example  came  under  the  writer's  observation.  Both  cornea) 
of  a  boy  were  burned  to  this  degree  while  he  was  examining  a 
burning  paper  that  contained  gunpowder.  The  flame  destroyed 
the  whole  epithelial  layer  of  both  cornese.  Both  eyes  recovered 
perfectly  without  a  trace  of  the  injury.  Explosions  of  blasts 
and  accidents  with  fire-arms  are  not  uncommonly  followed  by 
burns  of  the  cornea  and  lodgment  of  grains  of  powder  therein. 
In  general,  the  cornea  recovers  its  transparency,  notwithstand- 
ing the  retention  of  the  powder-grains  in  its  substance.  Burns 
of  the  cornea  may  be  sufficiently  deep  to  open  the  anterior  cham- 
ber at  once,  or  the  ulceration  following  them  may  j>erfonite  the 
cornea  subsequently.  Such  injuries  destroy  vision  in  the  in- 
jured eye  and  lead  to  sympathetic  inflammation  of  the  fellow- 
eye.  An  example  of  the  latter  came  under  the  writer's  observa- 
tion. The  right  eye  of  a  man  was  corroded  by  quicklime. 
The  anterior  chamber  was  opened.  Some  years  later,  the  eye 
appeared  as  if  an  iridectomy  outward  had  l>een  informed.  The 


58  VISION   AND    AUDITION— WOODWARD. 

uninjured  eye  was  blind,  owing  to  unmistakable  sympathetic 
inflammation. 

The  dangers  of  burns  of  the  cornea  are,  then:  1,  immediate  de- 
struction of  the  eye  by  extensive  corrosion ;  2,  in  less  severe  cases, 
perforating  ulcer  of  the  cornea,  leading  sometimes  to  sympa- 
thetic inflammation;  3,  cloudiness  of  the  cornea,  following 
ulceration  or  severe  keratitis ;  and  4,  symblepharon. 

Burns  of  the  solera  may  destroy  the  eye  by  perforating  the 
organ,  when  sympathetic  disease  may  supervene  and  destroy 
its  fellow ;  or  by  exciting  violent  inflammation  of  the  uveal 
tract.  They  injure  the  usefulness  of  the  organ  in  other  cases, 
by  virtue  of  the  symblepharon,  which  almost  invariably  suc- 
ceeds them. 


CHAPTER  V. 
INJURIES  AND  WOUNDS  OF  THE  EYEBALL. 

DISLOCATION  OP  THE  EYEBALL. 

THE  eyeball  may  be  dislocated  by  bhmt  objects  thrust  into 
the  orbit.  "  Gouging"  is  a  practice  which  consists  in  thrusting 
a  thumb  or  a  finger  into  the  victim's  orbit  between  the  eyeball 
and  the  bony  wall.  This  forces  the  globe  from  its  bed  suffi- 
ciently for  the  eyelids  to  slip  behind  it.  Injuries  of  this  charac- 
ter may  rupture  one  or  more  of  the  ocular  muscles.  They  cause 
severe  contusion  of  the  eyeball,  in  a  certain  number  of  cases. 
While  the  eye  is  dislocated  its  vision  is  suspended,  but  normal 
vision  may  return  when  the  dislocation  is  reduced.  A  progno- 
sis of  the  ultimate  effects  of  the  injury,  however,  cannot  be 
made  early;  for,  subsequently,  destructive  inflammation  may 
supervene.  Hemorrhage  into  the  vitreous,  dislocation  of  the 
lens,  detachment  of  the  retina,  rupture  of  the  choroid,  and  rup- 
ture of  the  solera  occur  as  complications,  which  terminate  the 
usefulness  of  the  organ. 

Dislocation  of  the  eyeball  may  be  due  to  blows  upon  the  eye. 
Noyes  relates  a  case  caused  by  falling  down-stairs  and  striking 
the  head  against  the  banister. '  Prominent  eyes  in  shallow  sock- 
ets are  more  easily  dislocated  than  others. 

Dislocation  of  the  eyeball  into  the  maxillary  nntnim  has 
been  described.  A  remarkable  case  of  this  nature  was  observed 
by  Langenbeck.  The  patient  was  struck  on  the  right  side  of 
his  face  by  a  locomotive.  Eight  days  later  the  eyelwll  was 
found  projecting  into  the  antrum,  through  the  floor  of  the  orbit. 
When  replaced,  it  was  found  to  be  uninjured  and  its  acutenesM 
of  vision  normal.  Four  months  after,  an  ulcer  appeared  in  tho 
cornea  and  the  eye  became  shrunken.* 

1  "Dis.  of  Eye,"  1890,  p.  447.  *  Archives  of  Ophthalmology.  N. 

Y. ,  vol.  xxii.,  1,  abstract. 

59 


60  VISION   AND    AUDITION — WOODWARD. 


EVULSION  OF  THE  EYEBALL. 

The  eyeball  may  be  torn  from  its  socket  by  accident.  Mac- 
kenzie1 cites  the  following  case :  While  intoxicated  a  man  fell 
against  the  ring  of  a  key  which  was  in  the  lock  of  the  door. 
The  ring  divided  the  upper  eyelid  and,  penetrating  into  the  orbit, 
scooped  the  eyeball  out  so  that  it  fell  upon  the  floor.  The  man, 
being  too  drunk  to  realize  the  extent  of  his  injury,  went  to  bed 
and  was  found  in  the  morning  covered  with  blood.  Under 
simple  treatment  he  made  a  speedy  recovery. 

Mackenzie  refers  also  to  a  case  in  which  the  eyeball  was  torn 
from  its  socket  by  a  cart-wheel  passing  over  the  side  of  the  pa- 
tient's head.* 

CONTUSIONS  OF  THE  EYEBALL. 

The  damage  accruing  from  contusions  of  the  eyeball  will 
vary  with  the  amount  of  force  and  the  direction  of  the  blow. 
The  bony  margins  of  the  orbit  are  arranged  in  a  way  to  protect 
the  globe  against  blows  directed  from  points  not  immediately 
in  front  of  the  eye.  Large  blunt  objects,  like  the  clenched  hand, 
striking  point-blank,  would  generally  be  arrested  by  the  bony 
margins  of  the  orbit  and  cause  only  trifling,  if  any,  injury  to 
the  eyeball.  If,  however,  the  eyeball  were  prominent  and  the 
orbit  shallow,  or  if  the  assailant's  knuckles  were  large,  and  if 
they  were  armed  with  a  metallic  reinforcement,  a  point-blank 
blow  might  cause  a  severe  contusion,  resulting  even  in  rupture 
of  the  eyeball  and  destruction  of  the  eye.  Contusions  of  the 
globe  are  more  likely  to  ensue  from  the  impact  of  small  blunt 
objects.  They  may  be  received  at  the  hands  of  an  adversary, 
who  viciously  attempts  to  gouge  the  eye  from  its  bed. 

Rupture  of  the  solera,  due  to  contusion,  is,  almost  without 
exception,  observed  in  the  anterior  portion  of  the  eyeball,  pass- 
ing through  the  ciliary  region.  Bowman  reported  one  case  of 
rupture  of  the  posterior  portion  of  the  solera.  Ruptures  of  the 
sclera  may  be  either  partial  or  complete.  They  are  more  or 
less  concentric  with  the  cornea,  and  are  found,  as  a  rule,  above 
the  cornea.  The  rent  in  the  sclera  lies  near  the  cornea,  on  the 

1  Loc.  cit.,  p.  417,  from  "Annales         *  Loc.    tit.,   p.    417,    from  Graefe 
d'Oculistique, "  t.  xxvi.,  p.  99.  and  Wai ther's  Journal,  vol.  i. 


CONTUSIONS  OP  THE  EYEBALL.  gj 

side  opposite  to  that  receiving  the  contusing  force.  A  blow 
from  in  front  will  rupture  the  sclera  above  the  cornea;  for  the 
patient  will  roll  his  eyes  upward  instinctively  to  protect  them 
from  injury,  and  the  blow  will  strike  below  the  cornea.  Blows 
delivered  upon  the  upper  and  outer  portion  of  the  globe  will 
rupture  the  sclera  on  the  opposite  side  of  the  cornea — that  is, 
downward  and  inward.  Blows  upon  the  temporal  side  of  the 
cornea  will  rupture  the  sclera  on  the  nasal  side;  and  blows  re- 
ceived above  the  cornea  will  rupture  the  sclera  below  the  cor- 
nea, and  vice  versa.1 

Large  complete  rents  in  the  sclera  are  associated  with  loss 
of  vitreous,  collapse  of  the  eyeball,  and  immediate  destruction 
of  the  organ.  Smaller  complete  ruptures  may  be  complicated 
by  prolapse  of  the  iris,  ciliary  body,  choroid,  and  vitreous,  and  by 
extrusion  of  the  crystalline  lens.  At  the  same  time,  the  con- 
junctiva is  often  torn,  so  that  there  is  direct  communication  be- 
tween the  contents  of  the  eyeball  and  the  external  world.  When 
this  occurs,  the  wound  will  generally  become  infected  by  micro- 
organisms; irido-cyclitis  will  follow,  and  may  lead  to  an  attack 
of  sympathetic  inflammation  in  the  fellow-eye.  Or,  purulent 
panophthalmitis  may  invade  the  injured  organ  and  destroy  it. 

The  scleral  rupture  in  other  cases  may  exist  without  lesion 
of  the  conjunctiva.  So  long  as  the  conjunctiva  is  not  torn,  the 
danger  of  infection  by  micro-organisms  and  the  subsequent  dis- 
asters supposed  to  be  due  to  them  is  very  much  diminished. 

Loss  of  vitreous,  and  prolapse  of  the  iris  and  of  the  choroid, 
are  always  serious  complications.  Even  a  moderate  loss  of 
vitreous  is  sometimes  followed  by  detachment  of  the  retina. 
This  may  not  supervene  .until  some  weeks  or  months  have, 
elapsed;  that  is,  until  the  cicatrices  which  form  in  the  chamber 
of  the  vitreous  have  begun  to  contract.  It  is  possible  for  the 
patient  to  recover  from  the  immediate  effects  of  the  injury 
with  useful  vision  in  the  eye;  but  this  may  be  destroyed  sub- 
sequently by  detachment  of  the  retina.  Attempts  made  to  re- 
duce prolapsed  portions  of  the  iris,  ciliary  body,  or  choroid, 
will  not  commonly  prove  entirely  successful.  Some  incarcera- 
tion of  the  stump  of  the  abscised  prolapsed  structures  will 
persist  in  the  scar.  It  must  follow,  in  most  cases  of  that 
nature,  when  the  cicatrices  contract,  that  irritation,  or  a  low 
1  Alt.  Wiener  med.  Wochenschrift,  1874,  pp.  280.  281. 


G2  VISION   AND   AUDITION — WOODWARD. 

grade  of  inflammation,  will  keep  the  eye  tender  and  menacing 
to  its  fellow.  The  comfort  of  the  patient  will  be  seriously 
disturbed,  the  usefulness  of  both  eyes  greatly  impaired,  and, 
subsequently,  an  attack  of  sympathetic  inflammation  may 
cause  blindness  of  both  eyes. 

Judged  from  the  standpoint  of  the  rupture  alone,  contusions 
of  the  eyeball  sufficiently  severe  to  produce  such  a  lesion  are 
among  the  most  serious  injuries  that  befall  the  eye. 

Moreover,  such  contusions  may  cause  hemorrhage  into  the 
anterior  and  the  posterior  chambers,  and  into  the  chamber  of 
the  vitreous ;  they  may  cause  partial  or  complete  luxation  of  the 
lens,  or  even  extrusion  of  the  lens  from  the  eyeball ;"  they  may 
be  complicated  by  irido-dialysis,  or  by  retroversion  of  the  iris,  by 
rupture  of  the  choroid  or  the  retina,  or  by  detachment  of  those 
structures;  and  they  may  be  complicated  by  fracture  of  the 
walls  of  the  orbit.  An  eye  subjected  to  such  an  injury  is,  there- 
fore, often  destroyed  at  once. 

CONTUSIONS  OF  THE  CORNEA. 

The  cornea  may  be  contused  by  a  force  applied  to  the  closed 
eyelids,  or  by  one  striking  the  cornea  directly.  Unless  the  blow 
is  delivered  with  great  velocity,  the  eyelids  will  close  before 
the  eyeball  is  struck.  In  this  manner,  the  organ  is  protected 
in  many  instances  against  accidents  that  would  otherwise  pro- 
duce serious  results.  Evidence  of  contusion  of  the  eyelids  will 
be  present  when  the  injury  has  been  received  by  them. 

Contusions  of  the  cornea  may  be  the  cause  of  inflammation 
of  that  structure,  and  the  inflammation  may  be  superficial,  or  it 
may  involve  the  deeper  layers.  The  cornea  will  lose  much  of 
its  transparency  and  vision  may  be  considerably  below  normal. 
But  complete  resolution  of  the  morbid  process  may  be  antici- 
pated in  most  cases,  under  appropriate  treatment. 

When  the  blow  of  a  blunt  object  falls  directly  upon  the  cor- 
neal  tissue,  an  abrasion  of  the  epithelium, or  even  a  deeper  wound, 
may  be  the  result.  Such  solutions  of  continuity  may  ulcerate. 
Then  destruction  of  tissue  may  be  sufficient  to  ruin  the  eye. 
Abrasions  of  the  cornea  may  heal  without  leaving  a  trace  of 
their  existence.  They  may  be  converted  into  ulcerations,  if  in- 
fective material  come  in  contact  with  them.  The  sources  of 


CONTUSIONS  OF  THE  CORNEA.  03 

such  infection  are  commonly  a  purulent  discharge  from  the  con- 
junctiva, a  purulent  discharge  from  the  lachrymal  sac,  a  dirty 
body  causing  the  contusion,  rubbing  the  eye  with  dirty  fingers 
or  a  dirty  handkerchief,  or  carelessness  on  the  part  of  the  at- 
tending physician.  Ulceration  may  appear  first  as  an  abrasion, 
and,  without  the  intervention  of  infection,  necrosis  of  the  cornea 
may  supervene  in  consequence  of  the  violence  of  the  blow.  The 
corneal  tissue,  in  such  a  case,  is  killed  by  the  traumatism,  and 
the  dead  part  is  separated  and  thrown  off  from  the  living  by  the 
process  of  ulceration. 

'  Contused  wounds  of  the  cornea  amounting  to  more  than  an 
abrasion  of  the  epithelium  heal  by  cicatrization.  The  tissue 
composing  the  scar  is  opaque.  If  the  loss  of  substance  extend 
over  more  than  a  very  limited  area,  the  scar  will  be  a  notice- 
able deformity.  Sometimes  small  ulcerated  spots  heal  without 
the  development  of  opaque  scar  tissue.  The  spot  appears,  when 
healed,  as  a  small  pit  or  facet  in  the  surface  of  the  cornea,  and 
it  is  apparently  covered  with  epithelium  as  transparent  as  that 
which  extends  over  the  adjacent  normal  tissue.  Delicate  scars 
are  developed  from  superficial  ulcerations.  They  may  be  almost 
or  quite  invisible  to  the  unpractised  observer. 

Whether  these  traces  of  the  pre-existing  loss  of  substance 
be  marked  or  insignificant,  their  chief  importance,  as  regards 
the  function  of  the  eye,  depends  upon  the  position  occupied  by 
them.  When  they  invade  the  region  through  which  the  visual 
line  should  pass,  they  always  impair  the  acuteness  of  vision. 
A  large  opaque  scar  located  over  the  pupil  will  produce  blind- 
ness. A  delicate  nebula  in  the  same  position  will  destroy  read- 
ing vision.  In  such  cases,  loss  of  normal  transparency  of  the 
cornea  will  explain  the  effect  upon  sight.  When  a  facet  of  the 
cornea  lies  over  the  pupil,  the  acuteness  of  vision  is  also  seriously 
impaired.  For  the  surface  of  the  cornea  is  no  longer  regular, 
and,  in  the  affected  region,  the  rays  of  light  passing  into  the  eye 
are  irregularly  refracted  (irregular  astigmatism).  Hence  the 
retina  does  not  receive  a  perfectly  formed  image  of  the  object 
looked  at.  Distortion  of  the  retinal  image  in  some  of  these 
cases  is  so  marked  that  the  usefulness  of  the  eye  is  destroyed. 

Eventually  external  strabismus  may  supervene,  in  conse- 
quence of  disuse  of  the  affected  eye. 

Inflammation,  abscess,  and  ulceration  of  the  cornea  result- 


04  VISION   AND    AUDITION — WOODWARD. 

ing  from  contusions  are  more  prone  to  follow  such  injuries  in 
patients  who  are  old  or  badly  nourished.1 

Rupture  of  the  cornea  alone  has  been  observed.  De  Wecker a 
refers  to  two  cases  that  occurred  in  his  own  practice.  In  one, 
the  lesion  was  due  to  a  violent  blow  of  the  fist ;  in  the  other,  it 
was  due  to  gouging,  the  assailant's  thumb  being  thrust  between 
the  inner  wall  of  the  orbit  and  the  eyeball. 

Contusions  sufficiently  forcible  to  rupture  the  cornea  would, 
in  most  cases,  cause  other  severe  injuries  of  the  eye.  The  rent 
may  extend  into  the  solera,  and  would  then  involve  -the  ciliary 
region.  The  iris  would  be  prolapsed.  The  lens  might  be  dislo- 
cated or  even  extruded.  Rupture  of  the  choroid,  detachment 
of  the  retina,  or  loss  of  vitreous  may  also  complicate  the  case. 

Simple  rupture  of  the  cornea,  in  the  most  favorable  cases, 
would  endanger  the  preservation  of  the  eyeball;  for  it  is  a 
penetrating  injury.  Iritis  of  a  severe  type  may  be  expected. 
Purulent  panophthalmitis  may  ensue,  and  removal  of  the  eye 
become  a  necessity. 

But,  even  though  the  rupture  be  uncomplicated  by  injury  of 
other  structures,  and  the  healing  be  prompt  and  uneventful,  the 
function  of  the  eye  will  be  seriously  impaired  or  perhaps  totally 
destroyed.  For,  in  the  first  place,  the  line  of  union  may  cross 
the  pupil  and  mechanically  interfere  with  the  passage  of  light 
into  the  eye ;  and,  in  the  second  place,  the  union  will  result  in 
irregularity  of  the  cornea,  and,  therefore,  irregular  astigmatism 
and  its  consequences. 

Ruptures  of  the  cornea,  or  of  the  cornea  and  sclera  together, 
may  be  followed  by  chronic  iritis  or  chronic  irido-cyclitis.  The 
eye  will  remain  tender  and  irritable  after  the  wounds  have 
healed,  and,  subsequently,  the  fellow-eye  maybe  invaded  by  an 
attack  of  sympathetic  inflammation. 

AFFECTIONS   OF  THE    IRIS,    DUE   TO    CONTUSIONS    OF    THE 

EYEBALL. 

Contusions  of  the  eyeball  often  separate  the  iris  to  a  certain 
extent  from  its  peripheral  attachments.  That  condition  is 
known  as  irido-dialysis — the  iris  retracts  toward  the  pupil  at 

'Alt:     Wiener     med.     Wochen-          2  "Traite    complet  d'Ophthalmo- 
schrift,  1874,  p.  231.  logie,"  1886,  p.  216. 


AFFECTIONS   OF   THE   IRIS   DUE  TO  CONTUSIONS.  65 

the  site  of  the  detachment,  thus  forming  an  aperture  by  the  cor- 
neal  margin,  through  which  the  fundus-reflex  may  be  seen, 
when  the  eye  is  illuminated  with  the  ophthalmoscopic  mirror. 
The  aperture  may  be  large  enough  to  permit  an  ophthalmoscopic 
examination  of  the  fundus  through  it.  The  pupil  will  not 
maintain  its  normal  roundness,  and  does  not  respond  properly 
to  the  stimulus  of  light.  In  fresh  cases,  blood  will  be  found 
in  the  anterior  chamber,  but  it  scon  undergoes  resorption. 
Hemorrhage  into  the  vitreous  and  traumatic  cataract  occur  as 
the  more  common  complications,  together  with  transient  loss  of 
transparency  of  the  cornea. 

Cases  are  observed  in  which  the  eye  is  inflamed  and  painful 
for  a  number  of  months,  especially  when  the  contusion  has  in- 
jured the  deeper  structures,  causing  profuse  hemorrhage  into 
the  vitreous.  As  a  rule,  however,  all  irritation  subsides  after 
a  few  days  or  a  few  weeks.  Transparency  of  the  media  may 
become  normal,  with  normal  vision  in  the  eye.  A  partial  opac- 
ity in  the  posterior  capsule  of  the  lens,  with  diminished  vision, 
occurred  in  two  cases  under  my  observation.  The  vitreous  in 
both  cases  contained  a  few  particles  of  extra vasated  blood,  which 
soon  disappeared,  leaving  the  media  clear  in  every  part  except- 
ing the  small  area  of  the  posterior  capsule.  One  of  these  pa- 
tients was  injured  nearly  four  years  ago,  but  no  extension  of 
the  area  of  opacity  was  visible  at  a  recent  examination.  The 
eye  had  not  been  troublesome  after  the  primary  irritation  sub- 
sided, although  the  boy  had  attended  school  regularly. 

Irido-dialysis  may  be  sufficiently  marked  to  excite  comment 
from  casual  observers.  Its  situation  and  size  may  cause  mon- 
ocular diplopia.  Another  patient  was  annoyed  by  this  symp- 
tom, until  he  learned  to  disregard  the  false  image.  He  can  still 
see  through  the  false  pupil,  however,  by  directing  his  attention 
to  it.  The  glare  of  light  may  dazzle  such  eyes;  for,  owing 
to  the  imperfect  movements  of  the  pupil  and  the  fault  in  the 
periphery  of  the  iris,  the  eye  receives  more  light  than  an  unin- 
jured eye.  Vision  may,  also,  l>e  imperfect  on  dark  days,  by 
virtue  of  an  imperfect  dilation  of  the  pupil. 

Rents  in  the  substance  of  the  iris  may  be  due  to  contusions. 
De  Wecker '  cites  a  case  from  Lawson,  in  which  the  rent  occurred 
above  and  near  the  pupil.  The  appearance  was  that  of  a  large 

1  "Graefe-Saemisch  Handbuch,"  4,  p.  536. 
III.— 5 


66  VISION    AND    AUDITION — WOODWARD. 

pupil  divided  transversely  by  a  narrow  band  of  iris-fibres. 
Vision  was  quite  imperfect.  If  vision  through  either  aperture 
alone  had  been  normal,  it  would,  nevertheless,  have  been  con- 
fused when  both  were  uncovered.  The  force  of  a  blow  sufficient 
to  cause  a  rent  in  the  substance  of  the  iris  may  be  expected  to 
injure  other  structures  (lens,  choroid,  retina),  so  as  to  perma- 
nently depreciate  the  acuteness  of  vision,  if  not  to  destroy  use- 
ful sight. 

Severe  contusions  cause  absolute  dilatation  of  the  pupil. 
Blows  upon  the  eye  may,  rarely,  produce  either  complete  or  par- 
tial retroversign  of  the  iris.  Complete  retroversion  resembles 
both  absolute  dilatation  of  the  pupil,  and  absence  of  the  iris. 
Partial  retroversion  resembles  coloboma  of  the  iris.  Congenital 
coloboma  always  occurs  downward,  or  downward  and  inward, 
and  is  generally  binocular.1  When  the  iris  is  retro  verted  in 
any  case,  ophthalmoscopic  examination  of  the  ciliary  processes 
is  not  possible.  This  fact  does  not  obtain  in  dilatation  of  the 
pupil,  or  in  aniridia,  or  in  coloboma.  Traumatic  and  post-opera- 
tive colobomata  of  the  iris  are  associated  with  scarring  of  the 
cornea. 

These  conditions  are  permanent,  almost  without  exception. 
An  instance,  however,  of  healing  in  a  case  of  irido-dialysis  fol- 
lowing a  "  combined  extraction  "  of  cataract  has  come  under  my 
observation.  Berry  refers  to  a  case  of  recovery,  recorded  from 
the  Dublin  EjTe  Hospital.* 

AFFECTIONS    OF   THE   CRYSTALLINE    LENS,    DUE    TO   CON- 
TUSIONS OF   THE  EYEBALL. 

Traumatic  Cataract.  —  Cataract  may  be  the  principal  re- 
sult of  a  contusion  of  the  eyeball.  Changes  in  the  transparency 
of  the  lens  may  not  be  observed  until  weeks  or  months  have 
passed.  When  the  opacity  begins,  it  generally  becomes  com- 
plete and  reduces  the  visual  power  to  perception  of  light.  Evi- 
dence of  the  existence  of  any  other  lesion  may  be  wanting.  It 
is  supposed  that  the  anterior  capsule  is  ruptured  in  most  of  the 
cases,  and  that  cloudiness  of  the  lens  is  due  to  the  action  of  the 
aqueous  humor,  which  is  admitted  to  the  lens  tissue  through 
the  rent  in  the  capsule.  But  in  other  instances  the  existence 
1  Berry :  "Dis.  of  Eye,"  p.  270.  *  Loc.  tit.,  p.  269. 


TRAUMATIC  CATARACT.  67 

of  a  rent  in  the  capsule  cannot  be  made  out.  When  the  capsule 
is  ruptured,  the  incipient  stage  of  traumatic  cataract  ought  to 
become  visible  in  a  few  hours,  or  a  few  days.  When  the  cap- 
sule is  not  ruptured,  the  cataractous  degeneration  of  the  lens 
ought  to  be  developed  much  more  tardily.  At  all  events,  after 
contusions  of  the  eyeball,  cataract  may  develop,  whether  the  in- 
jury does  or  does  not  appear  to  be  serious,  when  the  patient  is  first 
examined.  Liegey  '  reported  such  a  case.  A  man  was  struck 
in  the  face  with  a  whip-stock.  The  right  side  of  the  face,  when 
the  first  examination  occurred,  was  smeared 'with  blood,  which 
still  flowed  from  a  small,  clean  wound  1|  cm.  long,  situated  at 
the  base  of  the  lower  eyelid,  but  not  penetrating  to  the  bone. 
The  lower  eyelid  was  swollen  and  ecchymosed.  The  superior 
lid  was  slightly  swollen  and  ecchymosed.  The  palpebral  and 
bulbar  conjunctiva  was  injected  with  blood ;  there  was  slight 
chemosis;  media  clear,  fundus  normal,  as  seen  with  the  oph- 
thalmoscope. Patient  avowed  that  he  could  see  light  only. 
Liegey  did  not  think  that  the  eye  had  been  seriously  injured, 
and  gave  a  favorable  prognosis.  About  five  weeks  later  the 
man  returned  to  him  saying  that  the  eye  was  entirely  blind. 
Iris  was  immobile  and  pupil  dilated.  No  physical  signs  of  the 
injury.  Media  still  clear  and  fundus  appeared  normal.  The 
diagnosis  at  this  time  was  incomplete  traumatic  amaurosis, 
which  may  or  may  not  continue  and  may  become  total.  Two 
weeks  later,  no  especial  change  had  taken  place.  Five  weeks 
after  this  visit  Liegey  examined  the  eye  again  and  found  signs 
of  cataractous  degeneration  of  the  lens.  The  court  allowed  the 
plaintiff  damages. 

In  every  case,  traumatic  cataract  permanently  injures  the 
eye.  The  cataract  may  be  extracted,  or  its  solution  may  be 
effected  by  operation.  In  either  case,  the  images  of  objects 
may  be  formed  upon  the  retina  again,  as  soon  as  the  obstruc- 
tion is  removed.  But  a  cataract  glass  must  be  fitted  to  the 
eye  in  order  that  vision  may  be  distinct.  With  glasses,  how- 
ever, the  patient  will  not  be  able  to  adjust  his  eye  for  objects  at 
variable  distances.  The  power  of  accommodation  is  wanting; 
and  the  injured  eye  cannot  work  harmoniously  with  the  sound 
eye.  For  this  reason,  patients  soon  abandon  attempts  to  use 
both  eyes  again,  for  such  attempts  always  prove  abortive. 
>  Journal  de  Medecine,  1871,  p.  496- 


68  VISION  AND   AUDITION — WOODWARD. 

Traumatic  cataract  is  a  noticeable  deformity.  The  white 
pupil  attracts  attention;  and,  therefore,  it  is  a  source  of  annoy- 
ance to  the  patient.  Eventually,  the  injured  eye  turns  outward ; 
thus,  divergent  strabismus  is  added  to  the  disfigurement  already 
present.  Operation  upon  these  cataracts  improves  the  appear- 
ance of  the  eye,  and  restores  sufficient  vision  to  improve  slightly 
the  sense  of  perspective,  even  without  glasses.  When  the  pa- 
tient has  only  one  eye,  or  when  the  fellow-eye  does  not  retain 
sufficient  visual  power,  operations  on  these  cataracts  will  restore 
useful  vision. 

Traumatic  cataracts  may,  in  some  cases,  undergo  complete 
solution,  without  operative  interference.  The  pupil  may  thus 
become  clear  and  black,  and  the  eye  may  appear  perfectly  nor- 
mal to  the  casual  observer.  In  many  cases,  however,  the  solu- 
tion is  not  complete,  or  the  capsule  of  the  lens  subsequently 
becomes  cloudy  and  the  pupil  remains  white,  or,  after  a  variable 
period,  becomes  white,  and  the  eye  has  an  unsightly  appear- 
ance. Operation  (discission)  will  often  clear  the  pupil  in  these 
cases. 

Dislocation  of  the  Lens.— Contusions  of  the  eyeball  may 
cause  dislocation  of  the  lens.  The  dislocation  may  be  either 
partial  or  complete.  The  suspensory  ligament,  or  zone  of  Zinn, 
is  ruptured.  The  lens  may  be  expelled  from  the  eyeball  and 
lodge  under  the  conjunctiva,  or  it  may  be  extruded  from  the  eye 
altogether.  Complete  dislocation  of  the  lens  is  spoken  of  as 
luxation  of  the  lens ;  partial  dislocation  as  subluxation  of  the 
lens. 

LUXATION  OF  THE  LENS. — The  lens  may  be  dislocated  into 
the  vitreous,  and  will  be  found  lying  below  the  pupil.  If  the 
vitreous  be  fluid,  the  lens  will  change  position  when  the  eye  or 
head  is  moved  in  certain  directions.  It  may  remain  clear  for 
some  time,  but  will  finally  become  opaque.  After  the  primary 
irritation  subsides,  the  eye  may  remain  quiet  during  a  number 
of  years ;  or  the  eye  may  continue  irritable  and  become  very 
painful.  This  happened  in  the  case  of  a  patient  who  consulted 
me  about  eight  months  after  the  accident.  She  had  attempted 
to  break  a  stick  of  kindling-wood  with  an  axe.  The  stick  flew 
against  her  right  eye,  striking  it  with  considerable  force. 
Vision  was  immediately  impaired.  There  was  no  laceration  or 
other  wound  of  the  eye.  Severe  inflammation  followed.  The 


8UBLUXATION   OF  THK   LENS.  C9 

eye  continued  painful  for  months,  in  spite  of  the  treatment  ad- 
vised by  her  physician.  Owing  to  excessive  pain,  she  acquired 
the  morphine  habit.  When  I  saw  her,  the  eyeball  was  enlarged, 
hard,  and  tender  to  pressure.  The  pupil  was  semi-dilated. 
Ciliary  staphylomata  were  present.  The  lens  was  dislocated 
downward  into  the  vitreous.  Vision  was  perception  of  light 
only.  Her  general  health  was  very  much  shattered.  The  case 
was  one  of  luxation  of  the  lens,  followed  by  secondary  glaucoma. 
Enucleation  was  imperative. 

The  lens  may  be  dislocated  into  the  anterior  chamber  by 
contusions  of  the  eyeball.  The  luxated  lens  appears  trans- 
parent, like  a  drop  of  oil.  By  oblique  illumination  its  pecu- 
liar structure  may  be  discerned.  The  lens  may  remain  clear 
for  some  weeks,  but  eventually  it  becomes  opaque ;  in  certain 
cases,  opacity  of  the  lens  is  noted  soon  after  the  injury.  An 
opaque  lens  in  the  anterior  chamber  resembles  in  appearance 
a  collection  of  thick  pus.  In  every  case  vision  is  very  much 
impaired. 

A  lens  dislocated  into  the  anterior  chamber,  and  lying  in 
contact  with  the  cornea,  will  very  often  excite  inflammation  of 
that  structure,  which  may  terminate  in  a  perforating  ulceration 
of  the  cornea,  expulsion  of  the  lens,  and  phthisis  bulbi.  On  the 
other  hand,  in  some  instances,  a  dislocated  lens  may  lie  in  the 
anterior  chamber  for  months  without  exciting  much  irritation. 
Very  frequently,  however,  secondary  glaucoma  supervenes, 
causing  excruciating  distress.  The  lens  may  lodge  in  the  pupil. 
When  this  occurs,  secondary  glaucoma  is  inevitable. 

Dislocation  of  the  lens  under  the  conjunctiva  occurs  only 
when  the  tunics  of  the  eyeball  have  been  ruptured  by  the  blow. 
Immediately  after  the  injury  the  diagnosis  may  be  obscured 
by  the  presence  of  extravasated  blood.  Subsequently,  resorption 
of  the  blood  will  enable  the  attendant  to  detect  the  lens  in  its 
false  position.  A  contusion  which  gives  rise  to  such  an  injury 
as  this  must  necessarily  be  a  severe  one. 

SUBLUXATION  OP  THE  LENS. — Subluxation  of  the  lens  de- 
pends upon  a  partial  rupture  of  the  zone  of  Zinn.  The  free 
margin  of  the  lens,  when  the  zone  is  torn,  may  fall  away  from 
the  iris,  while  the  opposite  edge  of  the  lens  advances  toward  the 
anterior  chamber.  Hence,  the  lens  lies  in  an- oblique  position 
in  the  pupil.  Such  a  condition  will  cause  irregular  lenticular 


70  VISION   AND    AUDITION — WOODWARD. 

astigmatism.  This  is  not  always  easy  to  diagnosticate.  But 
it  may  be  presumed  to  exist  when,  in  an  eye  the  refraction  of 
which  was  previously  known,  irregular  astigmatism  is  detected 
for  the  first  time  after  an  injury,  the  media  being  clear  and  the 
fundus  normal.  The  ophthalmometer  will  assist  in  making  the 
differential  diagnosis  between  corneal  and  lenticular  astigma- 
tism. The  depth  of  the  anterior  chamber  will  not  be  the  same 
at  all  points,  and  the  iris  will  be  tremulous,  where  it  is  not 
supported  by  the  lens.  Glasses  will  not  improve  the  vision 
much. 

When  tilting  of  the  lens  is  more  marked,  its  free  margin  may 
be  seen  in  the  pupillary  space.  So  long  as  the  lens  remains 
clear  the  patient  may  complain  of  monocular  diplopia. 

Lateral,  or  vertical,  displacement  of  the  lens  is  revealed  by 
the  presence  of  the  margin  of  the  lens  in  the  pupillary  space:  it 
appears  as  a  dark  crescentic  line.  When  the  lens  is  displaced, 
the  iris  is  no  longer  supported  and  trembles  when  the  eye  is 
moved  quickly.  The  power  of  accommodation  is  wanting;  and 
while  the  lens  remains  clear  and  its  edge  passes  through  the 
pupillary  space,  the  patient  may  complain  of  monocular 
diplopia. 

Monocular  diplopia  exists  in  these  cases  because  the  light 
entering  the  pupil  passes  in  part  through  the  lens  and  in  part 
through  the  space  from  which  the  lens  has  moved.  The  rays 
of  light  passing  through  these  two  regions  will  be  refracted 
differently,  and  two  imperfect  images  of  the  same  object  will 
be  formed  upon  different  portions  of  the  retina  at  the  same  time. 
Both  images  may  be  perceived  by  the  patient.  On  account  of 
this,  the  usefulness  of  the  eye  will  be  destroyed,  unless  the  pa- 
tient learn  to  suppress  the  less  distinct  image. 

Subluxation  ends  sooner  or  later  in  complete  dislocation.  In 
time,  the  lens  becomes  cataractous.  And,  owing  to  the  changes 
of  position  which  some  of  these  lenses  undergo  when  the  con- 
ditions are  favorable,  the  eye  may  be  irritated  and  cyclitis, 
choroiditis,  or  secondary  glaucoma  may  supervene  to  destroy 
the  eye  definitively. 

Dislocation  of  the  lens  of  any  sort  always  permanently  in- 
jures the  function  of  the  eye.  Nothing  can  be  done  to  restore 
the  lens  to  its  nc-rmal  position,  nor  is  it  possible  to  prevent  the 
cataractous  degeneration  that  is  certain  to  ensue  sooner  or  later. 


SCBLUXATION   OP  THE   LENS.  71 

When  the  eye  becomes  irritable,  or  when  cyclitis,  choroitlitis,  or 
secondary  glaucoma  develops,  in  a  certain  number  of  cases,  the 
lens  may  be  removed,  and  the  necessity  for  enucleation  of  the 
eyeball  obviated.  Operations  upon  these  lenses  are  most  diffi- 
cult when  the  dislocation  is  into  the  vitreous.  In  every  case, 
the  operation  is  a  delicate  one.  It  is  least  difficult  when  the  lens 
lies  under  the  conjunctiva.  Glasses  may  improve  the  vision 
very  much,  but  the  disparity  between  the  eyes  (supposing  the 
fellow-organ  to  have  ordinary  visual  power),  is  such  that,  in 
general,  patients  are  not  as  comfortable  with  as  without  them. 
A  dislocated  lens  may  excite  irido-cyclitis,  and  some  ophthal- 
mologists believe  that  it  is  one  cause  of  sympathetic  inflam- 
mation. 

Not  all  dislocations  of  the  crystalline  lens  are  traumatic. 
Congenital  dislocation,  or  ectopia  lentis,  is  a  well-known  de- 
formity of  the  eye.  In  such  cases  both  eyes  are  affected,  and 
generally  the  lenses  are  partially  dislocated  in  an  upward  and 
outward  direction.  Such  lenses  are  smaller  than  normal.  The 
anomaly  is  symmetrical.1  "Ectopia  lent  is  occurs  mostly  up- 
ward, or  upward  and  inward,  and  upward  and  outward.  It 
is  often  met  with  in  several  members  of  the  same  family,  and 
is  hereditary.  ...  It  probably  always  occurs  in  both  eyes 
and  is  frequently  associated  with  a  defect  in  the  power  of  con- 
vergence."* According  to  De  Schweinitz,  "complete  congeni- 
tal luxation  is  also  described."  ' 

Spontaneous  dislocation  of  the  lens  into  the  anterior  chamber 
or  into  the  vitreous  may  occur,  especially  in  cases  of  fluid  vitre- 
ous, in  myopia  of  high  degree,  and  in  cases  of  choroiditis.  Hy- 
permature  cataracts  may  become  spontaneously  dislocated. 

I  have  observed  a  case  of  subluxation  of  the  lens,  toward 
the  nasal  side  into  the  chamber  of  the  vitreous,  in  an  eye  which 
had  been  destroyed  years  before  by  a  burn  of  the  cornea.  The 
cornea  had  been  perforated,  the  iris  had  prolapsed,  the  pupil 
was  irregular  and  presented  the  appearance  which  a  large  iri- 
dectomy  would  leave.  There  was  absolutely  no  history  of  con- 
tusion of  the  eyeball.  No  operation  had  been  performed  upon 
the  eye. 

'Becker:     "  Graefe  -  Saemisch          *  Berry  :  "  Dis.  of  Eye, "  1893.  pp. 
Handbuch,"  5,  p.  286.  180.  181. 

»"Di».  of  Eye.  "p.  402. 


72  VISION  AND  AUDITION — WOODWARD. 

RUPTURE  OF  THE  CHOROID  AND  DETACHMENT  OF  THE 

RETINA. 

Profuse  hemorrhage  into  the  vitreous  arises  from  severe  con- 
tusions of  the  eyeball.  Until  resorption  of  the  blood  has  taken 
place,  it  is  not  possible  to  examine  the  fundus.  When  the 
media  have  become  clear,  a  rupture  of  the  choroid,  or  a  de- 
tachment of  the  retina  may  be  found.  Ruptures  of  the  choroid 
are  situated  between  the  macula  and  the  optic  disc,  and  are 
more  or  less  concentric  with  the  latter.  They  appear  at  first  as 
a  yellowish  stripe,  sometimes  branched,  becoming  pale  later  on, 
with  pigment  deposits  along  the  margins.  Choroidal  rupture 
has  been  observed  near  the  equator  of  the  eyeball. 

Vision  is  commonly  very  much  disturbed :  in  rare  cases  the 
eye  may  still  retain  useful  vision.  After  resorption  of  the  blood 
has  become  complete  and  the  eye  has  become  perfectly  quiet, 
no  further  improvement  in  function  may  be  expected. 

Traumatic  detachment  of  the  retina  may  be  diagnosticated 
only  after  the  extravasation  has  been  resorbed.  It  may  be  par- 
tial or  complete.  Partial  detachments  become  complete  sooner 
or  later.  The  lesion  is  most  easily  produced  in  myopic  eyes. 
The  ophthalmoscopic  appearances  are  characteristic.  Useful 
vision  is  permanently  destroyed  in  every  case. 

WOUNDS  OF  THE  EYEBALL. 

Wounds  of  the  eyeball  may  be  incised,  punctured,  lacerated, 
or  contused.  Lacerated  and  contused  wounds  differ  from  others 
especially  in  that  the  injured  tissues  are  so  torn  and  bruised 
that  primary  union  is  not  possible,  healing  is  prolonged,  and 
danger  of  infection  is  correspondingly  increased.  Moreover, 
inasmuch  as  they  are  due  to  impact  of  blunt  weapons,  the  force 
required  to  produce  them  is  sufficient  to  cause  a  contusion,  as 
well  as  a  laceration  of  the  eyeball. 

Wounds  of  the  eyeball  may  be  infected  or  non-infected: 
that  is  to  say,  some  wounds  are  contaminated  by  pathogenic 
microbes,  and  others  are  not.  Such  contamination  may  be  due 
to  an  unclean  instrument  or  weapon,  to  a  pre-existing  purulent 
inflammation  of  the  conjunctiva,  or  the  lachrymal  sac,  or  to 
carelessness  on  the  part  of  the  patient  or  his  attending  physi- 


WOUNDS  OF  THE  CORNEA.  73 

cian.  Non-infected,  or  aseptic,  wounds  heal  with  little  or  no 
inflammatory  reaction,  provided  that  close  apposition  of  their 
edges  may  be  maintained.  Infected,  or  septic,  wounds,  eveu 
though  trifling  in  appearance,  heal  slowly,  and  the  consecutive 
inflammation  often  invades  the  whole  eye  and  destroys  it.  Dis- 
infection of  wounds  of  the  eyeball  is  much  less  readily  accom- 
plished than  is  the  case  with  wounds  of  other  parts  of  the  body. 
Strong  antiseptic  solutions  irritate  the  delicate  structures  of  that 
organ  and  may  seriously  injure  them.  Moreover,  the  deeper 
parts  of  the  wound  are  comparatively  inaccessible.  Hence  it 
follows,  that  when  infection  of  these  lesions  occurs,  the  conse- 
quences of  them  are  much  more  disastrous  than  the  nature  of 
the  injury  would,  at  first  sight,  appear  to  warrant. 

WOUNDS  OP  THE  CORNEA. 

Wounds  of  the  cornea  may  be  either  superficial  or  perforat- 
ing. Perforating  wounds  open  the  anterior  chamber.  Wounds 
of  the  cornea  heal  by  the  formation  of  an  opaque  cicatrix.  The 
cicatrix  of  an  incised  or  a  punctured  wound  is  much  less  notice- 
able than  that  of  a  lacerated  or  a  contused  wound  having  the 
same  linear  measurement. 

Both  superficial  and  perforating  wounds  of  the  cornea  cause 
distortion  of  its  surface,  resulting  in  irregular  astigmatism, 
which  may  be  only  partially  corrected  by  glasses.  Vision  is 
permanently  impaired.  The  function  of  the  eye  is  more  dis- 
turbed when  the  cicatrix  crosses  the  pupil  than  when  it  does 
not.  In  the  former  case,  vision  is  impaired  by  the  opaque  scar 
and  by  the  irregular  astigmatism ;  in  the  latter,  the  uncorrect- 
able  astigmatism  is  responsible  for  the  disturbance  of  sight. 

Perforating  wounds  of  the  cornea,  moreover,  are  frequently 
complicated  by  prolapse  of  the  iris,  which  is  washed  into  the 
wound  by  the  flood  of  outpouring  aqueous  humor.  Speaking 
generally,  loss  of  the  aqueous  is  not  a  serious  accident,  for  it  is 
reproduced  within  twenty-four  hours.  Sudden  loss  of  a  volume 
of  aqueous,  however,  through  a  large  wound  in  the  cornea, 
may  be  followed  by  dislocation  of  the  crystalline  lens  into  the 
anterior  chamber.  Prolapsed  iris  commonly  hoals  in  the  scar 
(anterior  synechia),  and  the  pupil  is  distorted.  Dilatation  and 
contraction  of  such  pupils  go  on  under  the  varying  intensities 


74  VISION   AND    AUDITION — WOODWARD. 

of  light,  and  dragging  upon  the  adhesion  is  the  consequence. 
In  many  cases,  this  irritates  the  eye  and  may  excite  sympa- 
thetic irritation,  or  sympathetic  inflammation.  Or,  if  sympa- 
thetic disease  be  due  to  transmission  of  microbes,  the  entrance 
of  the  pathogenic  germs  into  the  exciting  eye  may  be  facilitated 
by  the  presence  of  iris-tissue  in  the  corneal  wound. 

Wounds  of  the  cornea  may  be  so  destructive  in  themselves 
that  enucleation  of  the  eyeball  should  be  performed  at  once. 
And  when  they  are  followed  by  plastic  irido-cyclitis,  removal 
of  the  eye  may  be  indicated  to  terminate  the  patient's  suffering 
and  to  prevent  an  outbreak  of  sympathetic  inflammation. 

WOUNDS    OF  THE  CILIARY  BODY. 

Penetrating  wounds  of  the  eyeball,  involving  the  circum- 
corneal  zone,  injure  the  ciliary  body.  When  the  wound  is 
large,  prolapse  of  the  ciliary  body  may  follow.  This  is  always 
a  serious  complication ;  for  it  is  not  always  advisable  to  abscise 
the  prolapsed  tissues,  and  incarceration  of  the  ciliary  body  in 
the  scar  will  rarely  fail  to  excite  a  persistent  cyclitis  which 
will  endanger  the  fellow-eye.  Wounds  of  the  ciliary  body 
are  universally  regarded  as  among  the  most  serious,  if  not  actu- 
ally the  most  dangerous,  injuries  that  befall  the  eye.  Even 
when  the  wound  is  aseptic  and  the  healing  is  prompt,  subse- 
quent contraction  of  the  scar  is  likely  to  result  in  chronic  irri- 
tation, with  great  disturbance  of  vision,  and  may  become  the 
exciting  cause  of  sympathetic  disease.  Septic  wounds  in  this 
region  are  followed  by  violent  inflammation,  suppuration  in  the 
vitreous,  and  loss  of  the  eyeball ;  or  they  may  be  followed  by  a 
less  severe  attack  of  cyclitis,  which  runs  a  chronic  course,  even- 
tually blinding  the  eye  and  possibly  exciting  sympathetic  dis- 
ease. Profuse  hemorrhage  into  the  vitreous  may  occur  with 
wounds  of  the  .ciliary  body. 

WOUNDS  OF  THE  LENS. 

Penetrating  wounds  frequently  injure  the  crystalline  lens  or 
its  capsule.  Contused  and  lacerated  wounds  may  be  compli- 
cated by  dislocation,  or  by  extrusion,  of  the  lens.  When  the 
capsule  or  the  lens  tissue  is  wounded,  traumatic  cataract  sub- 
sequently develops.  In  the  great  majority  of  cases,  the  anterior 


WOUNDS  OF  THE   IRIS.  75 

capsule  is  injured, — then  the  aqueous  humor  is  admitted  to  the 
lens  tissue.  The  lens  hecomes  opaque,  and,  if  the  wound  in  the 
capsule  do  not  heal  too  rapidly,  solution  of  its  tissue  is  effected 
by  the  aqueous.  Solution  of  the  lens  may  be  complete  after 
several  weeks,  when  the  pupil  will  become  black  and  clear;  or 
the  solution  may  be  incomplete,  when  opaque  lens  tissue  will 
give  a  white  appearance  to  the  pupil  and  obstruct  the  passage 
of  light.  In  the  former  set  of  cases,  evidence  of  the  leaion  is 
not  obvious  to  the  casual  observer,  provided  that  the  corneal 
wound  have  healed,  leaving  a  narrow  linear  cicatrix.  Subse- 
quently the  capsule,  which  remains  unabsorbed,  may  become 
opaque  and  white.  After  complete  solution  of  the  traumatic 
cataract,  before  opacity  of  the  capsule  sets  in,  vision  of  the  eye 
may  be  normal  with  proper  lenses.  But,  power  of  accommoda- 
tion is  wanting  in  such  eyes,  the  sense  of  perspective  is  impaired, 
the  eyes  cannot  work  harmoniously,  and  the  patient  is  not  able 
to  perform  work  requiring  correct  binocular  vision.  When  the 
rent  in  the  capsule  is  large  and  the  substance  of  the  lens  is  much 
torn,  it  may  swell  so  rapidly  as  to  fill  the  anterior  chamber;  se- 
vere iritis  may  then  set  in,  or  secondary  glaucoma  may  destroy 
the  sight  of  the  eye  permanently.  If  solution  of  the  lens  be 
partial,  or  if,  after  complete  solution,  the  capsule  become 
opaque,  vision  is  very  much  impaired,  and  the  appearance  of 
the  eye  is  not  pleasing.  Divergent  strabismus  usually  super- 
venes after  a  few  weeks  or  a  few  months. 

WOUNDS  OF   THE  IRIS. 

Wounds  of  the  cornea  and  wounds  of  the  lens  may  be  com- 
plicated by  wounds  of  the  iris.  Hemorrhage  into  the  anterior 
and  the  posterior  chambers  occurs  at  once,  anil  may  fill  those 
chambers  so  that  inspection  of  the  structures  behind  the  cornea 
cannot  be  made.  Resorption  of  blood  in  the  anterior  or  the 
posterior  chamber  takes  place  in  a  few  days  or  a  few  weeks. 
The  wound  may  have  excited  such  an  attack  of  plastic  iritis 
that  when  the  transparency  of  the  aqueous  is  restored,  the 
pupil  may  be  found  closed  by  an  organized  exudate.  Plastic 
iritis  and  occlusion  of  the  pupil  are  the  great  dangers  to  be 
met  in  wounds  of  the  iris.  Exclusion  of  the  pupil  (complete 
attachment  of  the  margin  of  the  pupil  to  the  anterior  cap- 


7G  VISION  AND   AUDITION — WOODWARD. 

sule  of  the  lens)  may  supervene.  This  condition,  as  well  as 
occlusion  of  the  pupil,  is  productive  of  secondary  glaucoma, 
unless  relieved  by  a  successful  iridectomy.  Naturally,  septic 
wounds  of  the  iris  are  followed  by  greater  reaction  than  are 
aseptic  wounds.  The  inflammatory  reaction  in  the  latter  may 
be  trifling;  in  the  former,  it  will  be  intense  and  will  extend  to 
other  portions  of  the  uveal  tract,  viz. ,  the  ciliary  body  and  the 
choroid. 

WOUNDS  OF  THE  EYEBALL  OPENING  THE  CHAMBER  OF  THE 

VITREOUS. 

Penetrating  wounds  of  the  eyeball  may  open  the  chamber 
of  the  vitreous  and  allow  more  or  less  of  that  tissue  to  escape. 
Loss  of  a  small  amount  of  vitreous  may  not  prove  harmful. 
Greater  losses  are  followed  eventually  by  detachment  of  the 
retina  and  blindness.  When  large  losses  of  vitreous  occur,  the 
globe  collapses  and  the  eye  is  immediately  destroyed.  Prolapse 
of  vitreous  will  be  greatest,  other  things  being  equal,  when  the 
wound  in  the  sclera  runs  at  right  angles  to  an  antero-posterior 
meridian  of  the  eyeball.  Such  wounds  gape  more  than  others 
and  heal  more  slowly  on  that  account.  Profuse  hemorrhage 
into  the  vitreous  may  occur  in  such  injuries,  and  may  destroy 
the  visual  power  of  the  eye.  Aseptic  wounds  entering  the 
vitreous  and  parallel  with  the  antero-posterior  meridian  of  the 
globe,  even  when  they  are  not  trifling  in  extent,  may  not  be  com- 
plicated by  dangerous  prolapse  of  vitreous  or  profuse  hemorrhage, 
and  they  may  heal  kindly,  leaving  the  eye  in  a  condition  of 
usefulness.  But,  in  general,  such  large  wounds  let  out  so  much 
vitreous,  cause  so  great  intra-ocular  hemorrhage,  and  injure  the 
choroid  and  retina  to  such  an  extent,  that  the  visual  power  of 
the  eye  is  lost,  although  in  some  cases  the  eyeball  may  be  pre- 
served. Such  eyes,  however,  generally  become  shrunken  after 
a  few  weeks,  or  a  few  months.  Septic  wounds  of  the  vitreous, 
both  small  and  large,  are  followed  by  suppurative  inflamma- 
tion. Then  the  patient's  suffering  may  be  severe.  Unrelieved 
by  surgical  interference,  the  ocular  inflammation  may  possibly 
threaten  his  life  by  extending  to  the  brain.  Enucleation  of  eyes 
which  were  the  seat  of  suppurative  panophthalmitis  has  been 
followed  by  metastatic  meningitis  and  death.  Such  eyes  may 
be  eviscerated  without  incurring  such  risks. 


CHAPTER  VI. 

FOREIGN  BODIES  IN  THE  EYES. 

FOREIGN  bodies  in  great  variety  effect  a  lodgment  in  the  eye. 
They  may  enter  in  consequence  of  an  accident,  or  they  may  be 
introduced  by  an  adversary,  or,  in  rare  cases,  the  patient  may 
introduce  them  into  his  own  eye.  In  the  last  set  of  cases, 
introduction  of  foreign  bodies  into  an  eye  by  the  patient  is 
the  product  of  a  desire  to  keep  up  an  irritation  of  the  organ 
for  the  purpose  of  gain,  or  of  an  hysterical  condition  of  the 
nervous  system  that  thrives  upon  the  interest  and  sympathy 
which  the  "  peculiar  "  case  excites.  Foreign  bodies  may  tra- 
verse the  eyelid  on  their  way  to  the  eyeball,  or  they  enter 
through  the  palpebral  slit.  They  may  reach  the  ej'eball  after 
traversing  one  of  the  bony  walls  of  the  orbit.  In  gunshot 
wounds,  splinters  of  bone  may  be  forced  into  the  eyeball. 

FOREIGN  BODIES  IN  THE  EYELIDS. 

When  the  foreign  body  is  diminutive,  the  wound  of  entrance 
may  be  so  small  that  the  existence  of  a  corpus  alienum  in  the 
eyelid  may  not  be  suspected.  Even  a  moderately  large  fragment 
of  metal  may  lodge  in  the  eyelid  without  making  a  wound  suffi- 
cient to  attract  much  attention,  if  the  wound  of  entrance  be 
linear  and  parallel  to  the  margin  of  the  eyelids,  and,  especially, 
if  several  days  have  elapsed  before  the  wound  is  carefully  ex- 
amined. 

Lodgment  of  foreign  bodies  in  the  eyelids  may  result  in  ab- 
scess, after  which  cicatricial  contraction  may  lead  to  deformity 
of  the  lid.  Occasionally,  a  foreign  body  remains  quiescent  in 
the  eyelid  for  a  number  of  years,  possibly  becoming  encapsulated, 
and  does  not  excite  any  further  reaction,  or  occasion  an}'  symp- 
toms whatever.  A  body  which  has  been  lodged  in  this  way 
for  a  long  time  may,  for  one  reason  or  another,  set  up  an  attack 
of  inflammation  in  the  eyelid,  and  be  eventually  extruded  from 


78  VISION   AND    AUDITION — WOODWARD. 

the  tissues  altogether.  Septic  bodies  cause  suppurative  inflam- 
mation, which  may  be  followed  by  an  attack  of  erysipelas, 
unless  the  offending  substance  be  removed  and  the  wound  be 
thoroughly  disinfected.  Erysipelatous  inflammation  of  the 
eyelids  may  extend  to  the  orbital  cellular  tissue.  Notwith- 
standing the  indication  that  a  septic  foreign  body  is  lodged  in 
the  eyelid  which  is  given  by  the  history  of  the  injury  and  the 
symptoms  immediately  following,  it  is  not  possible  to  locate  and 
remove  the  foreign  body  in  every  case.  It  is  even  possible  that 
a  comparatively  large  body  may  escape  detection,  especially 
when  it  is  lodged  in  a  swollen  ej'elid. 

A  foreign  body  may  lodge  in  the  eyelid  in  such  position  that 
it  perforates  the  conjunctival  surface  and  irritates  the  eyeball. 
It  is  conceivable  that  in  such  a  case  the  swollen  conjunctiva  may 
envelop  and  conceal  the  foreign  body.  A  severe  grade  of  in- 
flammation of  the  globe  would  doubtless  ensue.  Sooner  or  later 
the  foreign  body  will  be  expelled,  and  then  the  inflammation 
subsides. 

FOREIGN  BODIES  IN  THE  CONJUNCTIVA. 

Foreign  bodies  frequently  lodge  in  the  bulbar  or  palpebral 
conjunctiva.  A  favorite  site  for  them  is  the  under  surface 
of  the  superior  eyelid.  Minute  particles  of  metal  are  not  readily 
discovered.  And  even  large  bodies  lodged  in  the  superior  retro- 
tarsal  fold  are  sometimes  found  only  after  prolonged  search.  A 
foreign  body  in  the  conjunctiva  excites  inflammation.  It  may 
scratch  the  cornea,  and,  unless  removed,  set  up  a  keratitis.  The 
conjunctiva  becomes  swollen  and  may  enclose  the  body  and 
conceal  it  from  discovery.  As  a  rule,  the  offending  substance 
is  extruded  from  the  conjunctival  sac  after  a  longer  or  shorter 
period  of  inflammation.  In  some  instances,  encapsulation  oc- 
curs, or  the  foreign  body  remains  lodged  in  the  mucous  mem- 
brane without  exciting  any  secondary  reaction.  The  latter  is 
observed  most  frequently  in  case  of  powder-grains  blown  into 
the  eye. 

FOREIGN  BODIES  IN  THE  CORNEA. 

Foreign  bodies  may  lodge  in  any  part  of  the  cornea ;  they 
may  be  imbedded  in  the  superficial  layers,  or  they  may  lie  in 


FOREIGN    BODIES    IN   THE   CORNEA.  79 

the  deeper  layers,  and  they  may  project  into  the  anterior  cham- 
ber. Large  bodies  may  lacerate  the  cornea  so  extensively  that 
vision  is  destroyed  by  the  resulting  cicatrix,  the  appearance  of 
which  is  not  pleasing.  Small  bodies,  unless  very  suj)erficially 
imbedded,  leave  a  small  scar.  When  the  epithelial  laver  only 
is  wounded,  healing  will  not  leave  a  scar.  Minute  scare  in 
the  cornea  are  most  certainly  detected  by  oblique  illumination. 
The  location  of  them  is  important;  for  when  they  lie  in  that 
region  of  the  cornea  through  which  the  visual  line  pisses,  ir- 
remediable dimness  of  vision  will  be  noted;  whereas,  if  they 
be  laterally  located,  they  do  no  harm  whatever.  If  small  bodies 
in  the  epithelial  layers  even  of  the  cornea  are  not  removed 
promptly,  inflammation  with  ulceration  is  most  likely  to  ensue, 
and  the  resultant  cicatrix  is  correspondingly  increased  in  size. 
This  will  hold  true  in  the  case  of  more  deeply  imbedded  bodies. 
A  minute  septic  foreign  body,  even  though  very  superficially 
lodged  in  the  cornea,  excites  destructive  ulceration,  leading  to 
loss  of  the  eye,  by  perforation  of  the  cornea,  or  by  the  presence 
of  a  large  cicatrix  formed  in  the  process  of  repair. 

Deeply  imbedded  foreign  bodies  excite  inflammatory  reac- 
tions and  lead  to  results  similar  to  those  already  mentioned. 
Septic  bodies  deeply  lodged  excite  very  serious  inflammation, 
which  may  extend  to  the  uveal  tract.  Hypopyon,  plastic  iritis, 
and  even  cyclitis  may  follow  in  the  train  of  such  injuries.  The 
offending  substance  may  work  its  way  to  the  surface  and  be 
extruded,  or  it  may  ulcerate  through  the  posterior  layers  and 
drop  into  the  anterior  chamber.  The  latter  event  is  a  decisive 
catastrophe. 

In  certain  uncommon  cases,  the  corneal  wound  may  close 
over  the  foreign  body  which  may  remain  imbedded,  either 
encapsulated  or  not,  without  exciting  secondary  reaction, 
through  a  period  of  years.  But  it  is  not  uncommon  to  observe 
powder-grains  in  the  cornea  which  have  been  lodged  there  many 
years  without  causing  any  irritation. 

The  presence  of  a  foreign  body  in  the  cornea  is  not  always 
easy  to  detect.  This  is  true  of  the  following  sets  of  cases :  those 
appearing  for  examination  after  an  intense  keratitis  has  set  in; 
those  in  which  awkward  and  unsuccessful  attempts  have  lx>en 
made  to  extract  the  foreign  body ;  those  in  whirh  the  foreign 
body  has  lodged  deeply,  and  the  adjacent  cornea  ha*  become 


80  VISION   AND    AUDITION — WOODWARD. 

opaque.  Under  such  circumstances  it  may  be  impossible  to 
detect  the  foreign  body.  But  the  attending  physician  should 
assume  that  a  corpus  alienum  has  lodged  in  the  eye,  whether 
he  can  find  it  or  not,  provided  that  the  circumstances  under 
which  the  accident  occurred,  together  with  the  symptoms  ob- 
served in  the  case,  create  a  strong  probability  that  a  missile  has 
entered  the  eye. 

Foreign  bodies  in  the  cornea  should  be  removed  as  soon  as 
possible.  Fragments  of  metal  often  enter  the  cornea  in  a  heated 
state.  The  only  disadvantage  arising  from  this  circumstance 
is  that  they  adhere  very  firmly  to  their  bed,  and  are  therefore 
more  difficult  of  removal.  Deeply  lodged  bodies  may  drop  into 
the  anterior  chamber  during  attempts  to  extract  them.  The 
eyeball  must  then  be  opened.  Vegetable  substances  may  be 
broken  during  attempts  to  extract  them,  and  a  small  fragment 
be  retained  in  the  eye  undetected.  In  still  other  cases,  it  may 
not  be  possible  to  remove  the  foreign  body  from  the  cornea. 

FOREIGN    BODIES    IN    THE    IRIS,   THE  ANTERIOR    AND  THE 
POSTERIOR  CHAMBER,  AND  IN  THE  CILIARY  BODY. 

Foreign  bodies  obtain  access  to  the  iris  by  passing  through 
the  cornea,  or  by  penetrating  the  deeper  regions  behind  the  iris. 
As  a  rule,  they  enter  through  the  cornea.  They  may  lodge  at 
any  point  on  the  surface  of  the  iris;  they  may  penetrate  its 
tissues,  they  may  perforate  the  iris  and  pass  on  to  the  lens  or 
the  ciliary  body.  The  propulsive  force  may  drive  the  body  so 
that  it  simply  impinges  upon  the  anterior  surface  of  the  iris, 
from  which  it  falls  into  the  anterior  chamber;  or  the  force 
drives  the  body  through  the  iris  and  it  falls  into  the  posterior 
chamber,  where  it  may  lie  so  as  to  persistently  irritate  the 
ciliary  processes. 

Aseptic  foreign  bodies  may  lodge  in  the  iris  or  in  the  an- 
terior or  the  posterior  chamber,  and  remain  there  without  doing 
much,  if  any  harm,  provided  that  they  are  of  small  size  and 
their  chemical  composition  is  not  deleterious.  Small  particles 
of  iron  or  glass,  in  especial,  may  lodge  in  this  way.  They  may 
become  encapsulated.  But  these  cases  are  exceptional.  Septic 
bodies  lodged  in  these  regions  excite  violent  suppurative  irido- 
cyclitis,  which  will  prove  fatal  to  the  eye,  and  endanger  its 


FOREIGN  BODIES  IN   THE   IRIS.  81 

fellow.  Whether  the  foreign  body  be  septic  or  aseptic,  the 
mechanical  injury  to  the  iris  may  be  followed  by  plastic  iritis, 
resulting  in  a  more  or  less  permanent  injury  to  the  eye. 

Foreign  bodies  in  the  iris,  or  the  anterior  chamber,  are,  as  a 
rule,  open  to  detection  in  recent  injuries,  unless  considerable 
effusion  of  blood  into  the  anterior  chamber  have  occurred.  After 
inflammation  has  set  in,  cloudiness  of  the  cornea,  swelling  and 
discoloration  of  the  iris,  turbidity  of  the  aqueous  humor,  a  col- 
lection of  blood  or  pus  in  the  anterior  chamber,  may  so  obscure 
the  view  that  the  foreign  body  may  not  be  found.  A  probable 
diagnosis  of  the  presence  of  a  foreign  body  in  these  regions  of 
the  eye  may  be  based  upon  the  history  of  the  injury,  the  exist- 
ence of  a  perforating  wound  of  the  cornea,  the  presence  of  blood 
or  pus  in  the  anterior  chamber,  irregularity  of  the  pupil,  and 
the  existence  of  synechia3,  especially  anterior  synechia.  It 
should  be  assumed  that  a  foreign  body  has  entered  these  regions, 
if  the  probability  is  strong  that  one  has  so  entered.  A  few  eyes 
may  be  sacrificed,  perhaps,  unnecessarily,  by  adhering  to  such 
a  rule  of  action ;  but  the  danger  of  subsequent  sympathetic  dis- 
ease and  total  blindness  is  sufficient  reason  for  keeping  on  the 
safest  side  in  all  cases. 

Mauthner '  cites  the  following  experience,  which  illustrates 
very  forcibly  the  obscurity  which  enshrouds  some  of  these  in- 
juries :  "  The  patient  had  severely  wounded  his  right  eye  while 
discharging  a  musket.  He  avowed  with  the  utmost  confidence 
that  no  foreign  body  was  lodged  in  the  eye.  But  it  was  evident 
that  a  perforation,  located  in  the  centre  of  the  cornea,  had  been 
made  by  a  bit  of  an  exploded  percussion-cap.  Had  the  frag- 
ment rebounded  from  the  capsule  of  the  lens,  or  had  it,  per- 
chance, penetrated  the  lens  itself?  These  points  could  not  be 
then  determined,  for  a  large  amount  of  pus  occupied  the  anterior 
chamber  and  concealed  the  pupil.  The  iris  was  prolapsed  into 
a  puncture,  which  had  been  made  in  the  lower  border  of  the 
cornea  for  the  purpose  of  evacuating  the  pus.  It  was  in  this 
condition  that  I  first  saw  the  patient.  It  was  impossible,  at 
that  time,  to  decide  whether  the  purulent  masses  which  still 
occupied  the  pupil  were  nodules  of  exudation  upon  the  anterior 
capsule,  or  were  swollen  and  suppurating  fragments  of  the 
wounded  lens;  the  latter  condition,  however,  seemed  the  more 
1  "Sympath.  Dis.  of  Eye,"  pp.  18.  19,  20. 

in.— 6 


82  VISION   AND   AUDITION— WOODWARD. 

probable.  Nevertheless,  the  pus  gradually  disappeared,  and 
although  the  pupillary  border  of  the  iris  was  found  extensively 
adherent  to  the  anterior  capsule,  neither  the  latter  nor  the  lens 
had  been  wounded.  The  eye  continued  to  improve,  but,  along 
with  some  lachrymation  and  pain,  a  slight  conjunctival  injec- 
tion persisted  around  the  dark-colored  spot  where  the  iris  had 
prolapsed.  One  day,  while  examining  the  eye  more  carefully, 
in  order  to  discover  the  cause  of  the  obstinate  irritation,  I  no- 
ticed that  the  dark,  prolapsed  iris  had  a  distinct  metallic  lustre, 
so  that  I  at  once  suspected  the  presence  of  a  piece  of  metal. 
With  a  pair  of  fine  forceps  I  extracted,  from  a  small  excavation 
in  the  corneal  edge  ot  the  sclerotica,  where  it  lay  imbedded,  a 
rolled-up  piece  of  copper  cap,  4  mm.  long  and  2£  mm.  wide. 
All  the  signs  of  irritation  now  disappeared  in  a  short  time.  A 
fortunate  accident  had  saved  the  wounded  eye  and  its  mate. 
The  piece  of  metal  had  penetrated  the  cornea,  struck  the  anterior 
capsule  of  the  lens  without  opening  it,  and  had  then  rebounded 
to  the  bottom  of  the  posterior  chamber,  where  it  lay  directly 
upon  the  ciliary  body  and  excited  a  severe  inflammation  of  the 
whole  anterior  part  of  the  eyeball.  The  puncture  of  the  cornea 
which  had  been  made  for  the  removal  of  pus  from  the  anterior 
chamber  having  luckily  been  unskilfully  performed,  a  portion 
of  the  iris  fell  through  the  incision,  and  into  the  pocket-like 
duplication  thus  made  the  piece  of  metal  was  received.  After 
necrosis  of  the  prolapsed  iris  the  metal  lay  freely  exposed  at  the 
edge  of  the  cornea.  Had  the  operation  been  made  according  to 
rule  the  iris  would  not  have  prolapsed,  and  the  foreign  body 
left  within  the  globe  would,  in  all  probability,  have  produced  a 
dangerous  cyclitis,  with  the  chance  of  involving  the  second  eye.*' 
Disappearance,  by  chemical  action,  of  small  particles  of  iron, 
and  copper,  which  had  lodged  in  the  iris,  has  been  reported. 
Such  occurrences,  and  also  examples  of  encapsulation  or  of  innoc- 
uous lodgment  of  foreign  bodies  in  the  iris,  or  anterior  chamber, 
are  observed  so  exceptionally,  the  onset  of  dangerous  irido- 
cyclitis  being  quite  common  to  these  injuries,  it  follows  that 
the  only  safe  rule  to  adopt  for  the  management  of  the  cases 
is  to  remove  the  foreign  body  as  soon  as  possible.  In  the  great 
majority  of  cases,  so  long  as  a  foreign  body  remains  lodged  in 
the  anterior  chamber,  the  iris,  the  posterior  chamber,  or  the 
ciliary  body,  so  long  is  the  eye  in  a  dangerous  state,  both  as 


FOREIGN   BODIES  IN   THE  CRYSTALLINE   LENS.  83 

regards  its  own  integrity,  as  well  as  that  of  its  fellow,  by 
virtue  of  the  pathogenic,  the  mechanical,  or  tho  chemical  in- 
fluences exerted  by  the  foreign  body.  No  certainty  exists,  in 
any  case,  that  an  encapsulated  foreign  body  will  always  be 
innocuous.  It  may  subsequently  excite  a  violent  secondary  re- 
action, precluding  the  possibility  of  saving  the  vision  of 
either  eye. 

Foreign  bodies  enter  the  ciliary  body  through  the  cornea  and 
iris,  or  through  the  sclera.  In  the  most  common  cases,  the 
wound  of  entrance  is  near  the  sclero-corneal  junction.  As  a 
rule,  severe  cyclitis  immediately  supervenes.  The  inflamma- 
tory process  extends  forward  to  the  iris  and  backward  to  the 
choroid.  Suppuration  may  occur  in  the  vitreous.  The  dangers 
incident  to  wounds  of  the  ciliary  body,  referred  to  in  a  preced- 
ing section,  are  intensified  when  the  injury  is  complicated  by 
lodgment  of  a  foreign  body  in  that  region.  Unless  removed, 
the  foreign  body  in  the  ciliary  region  will  almost  certainly 
destroy  the  eye  and  excite  a  fatal  sympathetic  inflammation  in 
the  uninjured  eye.  After  removal  of  the  foreign  body,  the  eye 
may  become  quiescent  and  remain  so,  or  a  chronic  cyclitis  may 
persist  and  obstinately  threaten  the  fellow-eye,  while  it  destroys 
the  usefulness  of  the  injured  organ.  A  foreign  body  lodged  in 
the  ciliary  region  may,  however,  in  very  rare  cases,  remain  there, 
doing  comparatively  little  harm,  after  the  primary  reaction  has 
subsided.  Years  afterward,  relapses  of  the  cyclitis  may  set 
in  and  the  foreign  body  be  expelled.  After  this  has  occurred, 
the  eye  may  remain  quiescent  for  the  remainder  of  the  patient's 
life,  or  relapses  of  cyclitis  may  recur,  owing  to  the  irritation 
incident  to  contraction  of  the  cicatrices,  and  sympathetic  in- 
flammation may  eventually  break  out  in  the  sound  eye. 

FOREIGN  BODIES  IN  THE  CRYSTALLINE  LENS. 

The  lens  may  be  invaded  from  in  front  or  from  behind.  The 
foreign  body,  in  nearlj*  all  cases,  penetrates  the  cornea  before 
striking  the  lens.  It  may,  or  may  not,  wound  the  iris.  It  may 
lodge  near  the  anterior  capsule,  or  it  may  penetrate  more  deeply 
into  the  substance  of  the  lens.  Foreign  bodies  entering  the 
lens  from  any  direction  wound  the  capsule.  Either  the  aque- 
ous or  the  vitreous  then  comes  in  contact  with  the  lens  tissue, 


84  VISION  AND   AUDITION — WOODWARD. 

and  a  traumatic  cataract  will  be  developed.  Lesions  of  the 
anterior  capsule  admit  the  aqueous  humor  to  the  lens.  When 
the  rent  in  the  capsule  is  small,  it  may  heal  promptly,  leaving 
the  foreign  body  imbedded  in  the  traumatic  cataract,  where  it 
may  remain  for  years  without  originating  further  irritation. 
Vision  is  obscured  by  the  cataract.  Large  rents  in  the  anterior 
capsule  do  not  heal  quickly  enough  to  prevent  solution  of  the 
cortex  of  the  lens  by  the  aqueous  humor.  The  cases  run  the 
same  course  as  that  already  described  for  wounds  of  the  lens. 
When  solution  has  advanced  a  certain  stage,  the  foreign  body 
may  become  loose  in  the  capsule  and  excite  a  persistent  irrita- 
tion, leading  to  irido-cyclitis,  and,  possibly,  sympathetic  oph- 
thalmia; or  the  foreign  body  may  still  be  firmly  attached  in 
such  position  that  it  does  not  irritate  the  eye.  As  solution  of 
the  cataract  progresses,  vision  of  the  eye  improves,  until  even- 
tually the  media  may  be  clear  again,  leaving  the  sight  good 
with  cataract  glasses.  The  usefulness  of  the  organ  is  impaired, 
however,  as  explained  when  discussing  wounds  of  the  lens. 

It  may  be  predicted  as  true  of  nearly  all  cases  that  small 
fragments  of  metal  or  stone  lodged  in  a  lens,  which  becomes 
cataractous  but  does  not  undergo  solution,  will  remain  imbedded 
for  many  years,  without  exciting  secondary  irritation  of  the  eye 
and  without  predisposing  to  sympathetic  inflammation.  Bodies 
in  a  septic  state,  however,  will  excite  suppuration  and  its  at- 
tendant dangers.  Whenever,  therefore,  a  small  fragment  of 
metal  has  entered  the  lens,  the  eye  may  be  kept  under  observa- 
tion for  a  time  before  any  surgical  interference  is  undertaken. 
This  is  especially  applicable  to  cases  injured  by  fragments  of 
iron,  copper,  stone,  or  glass,  the  temperature  of  which  had  been 
elevated  immediately  before  entering  the  eye ;  for  the  elevation 
of  temperature  will  more  or  less  completely  disinfect  the  foreign 
body.  Should  the  primary  irritation  be  moderate  in  severity 
and  show  a  tendency  to  subside  promptly,  the  foreign  body  may 
be  allowed  to  remain  in  the  eye.  It  may  be  extracted  subse- 
quently with  the  cataractous  lens,  if  secondary  irritation  super- 
vene, or  if  the  patient  desire  the  operation  for  cosmetic  effect. 
If,  however,  the  primary  irritation  become  severe  and  threaten 
the  eye  by  irido-cyclitis,  an  attempt  must  be  made  to  remove 
the  offending  substance,  lest  the  inflammatory  reaction  advance 
beyond  control.  Panophthalmitis  and  loss  of  the  eyeball  may 


FOREIGN   BODIES   IN   THE   VITREOUS.  85 

result,  and  the  danger  of  sympathetic  ophthalmia  must  be  kept 
constantly  in  mind. 

Larger  bodies  cause  larger  rents  in  the  capsule,  through 
which  the  aqueous  reaches  the  lens  and  may  cause  so  rapid 
swelling  of  it  that  iritis,  or  secondary  glaucoma,  may  supervene. 
Moreover,  such  bodies  excite  greater  reaction  in  the  eye  by  vir- 
tue of  mechanical  irritation  and  the  septic  material  borne  into 
the  eye  by  them.  It  may  be  possible  to  combat  such  conditions 
successfully,  and  the  foreign  body  may  become  encapsulated  in 
such  a  position  that  secondary  irritation  may  not  arise.  But, 
while  attempts  are  being  made  to  attain  this  result,  the  patient 
is  exposed  to  a  greater  danger  than  that  incident  to  an  operation 
for  the  removal  of  the  foreign  body.  No  guarantee  may  be 
given  that  the  foreign  body  will  become  encapsulated;  it  is 
much  more  probable  that  it  will  sink  into  the  ciliary  region  and 
cause  a  very  dangerous  irido-cyclitis,  or  it  may  fall  into  the 
vitreous  and  set  up  inflammation  there.  In  either  contingency, 
an  outbreak  of  sympathetic  ophthalmia  may  be  anticipated. 
On  the  whole,  therefore,  extraction  of  such  large  bodies  should 
be  undertaken  at  the  very  beginning.  Removal  of  the  foreign 
body  may  not  be  accomplished  in  some  cases,  even  by  compe- 
tent ophthalmic  surgeons.  Then  the  question  of  enucleation  of 
the  eyeball  must  be  entertained. 

FOREIGN  BODIES  IN  THE  VITREOUS. 

A  foreign  body  may  penetrate  the  cornea  with  sufficient 
force  to  pass  on  through  the  iris  and  lens  into  the  vitreous. 
More  frequently,  foreign  bodies  enter  the  vitreous  by  perfo- 
rating the  sclera.  When  they  pass  through  the  circum-corneal 
zone,  in  their  transit  to  the  vitreous,  they  must  penetrate  the 
ciliary  body.  Foreign  bodies  may  lodge  in  the  scleral  wound 
or  in  the  ciliary  body.  They  may  have  been  propelled  by  a 
force  just  sufficient  to  drive  them  through  the  tunics  of  the 
eyeball  (sclera,  choroid,  retina),  when  they  will  drop  into  the 
vitreous ;  or  they  may  traverse  the  vitreous,  impinge  upon  the  op- 
posite side  and  drop  back,  and  sink  to  the  bottom  of  the  eye.  Or, 
they  may  become  imbedded  in  the  retina,  choroid,  or  sclern,  on 
the  opposite  side  of  the  eye.  Cases  showing  that  foreign 
bodies  may  be  imbedded  in  the  optic  disc  are  on  record. 


86  VISION   AND    AUDITION — WOODWARD. 

foreign  body  (e.g.,  bird-shot)  may  perforate  the  eyeball  and 
lodge  in  the  tissues  of  the  orbit.  Splinters  of  wood,  thorns,  etc. , 
may  transfix  the  eyeball. 

When  a  foreign  body  enters  the  vitreous  by  way  of  the  cor- 
nea, the  danger  incident  to  the  presence  of  the  body  in  the  vitre- 
ous is  complicated  by  the  perforating  wound  of  the  cornea,  iris,1 
lens,  and  probably  of  the  ciliary  body.  Other  things  being 
equal,  such  lesions  are  the  most  dangerous  of  this  class  of 
injuries. 

When  a  foreign  body  enters  the  vitreous  by  way  of  the  cili- 
ary region,  the  case  is  complicated  by  wound  of  the  ciliary 
body,  often  resulting  in  a  destructive  inflammation  of  the  whole 
uveal  tract. 

The  simplest  cases  of  entrance  of  foreign  bodies  into  the 
vitreous  are  those  not  complicated  by  traumatism  of  the  ciliary 
body,  lens,  iris,  or  cornea.  In  these  simpler  lesions,  much  de- 
pends upon  the  size  of  the  foreign  body.  Large  fragments  of 
stone,  metal,  glass,  etc.,  rend  the  sclera  so  widely  that  a  large 
prolapse  of  vitreous  takes  place  immediately,  the  eye  will  fill 
with  blood,  and  these  two  effects  suffice  to  destroy  the  eye  at 
once.  The  presence  of  a  large  body  in  the  vitreous  will  me- 
chanically excite  so  much  inflammation  that  no  hope  may  be 
entertained  of  preserving  the  function  of  the  eye.  Smaller 
bodies  may  enter  the  vitreous  after  slitting  the  sclera  by  strik- 
ing it  in  an  oblique  direction  and  cause  a  fatal  prolapse  of 
vitreous. 

Even  large  bodies  may  lodge  in  the  vitreous  chamber,  and 
after  the  initial  inflammation  has  subsided,  the  shrunken  and 
useless  globe  may  remain  free  from  irritation  for  a  number  of 
years.  Eventually,  however,  the  inflammation  will  recur,  and 
may  subside  again.  Such  recurrent  inflammatory  outbreaks  will 
be  noted  from  time  to  time  until  eventually  the  other  eye  may 
be  sympathetically  diseased.  The  resulting  blindness  will  then 
be  a  consequence  of  an  injury  sustained  many  years  before.  In 
some  cases,  the  eyeball  opens  during  one  of  the  relapses  of  in- 
flammation, and  the  foreign  body  is  expelled,  thus  greatly  di- 
minishing the  danger  of  sympathetic  disease.  Fragments  of 
glass  seem  to  be  better  tolerated  in  the  vitreous  chamber  than 
other  large  foreign  bodies. 

1  Iris  may  escape  injury. 


FOREIGN    BODIES    IN    THE    VITREOUS.  87 

Small  particles  of  metal  entering  the  vitreous  may  lodge  in 
the  retina,  choroid,  or  optic  nerve.  They  may  fall  to  the  bottom 
of  the  eye,  where  they  may  become  encapsulated.  They  may 
lodge  in  the  retina,  choroid,  or  nerve,  where  they  may  become 
encapsulated,  or  they  may  not.  It  is  not  a  very  uncommon  ex- 
perience to  observe  small  particles  of  metal  lodged  in  the  retina 
or  choroid  (apparently  not  encapsulated),  which  have  remained 
in  the  eye  for  a  number  of  years  without  destroying  the  useful- 
ness of  the  organ  and  without  endangering  the  fellow-eye. 

In  Hirschberg's  Clinic,  the  writer  saw  a  patient  in  whose 
retina  a  fragment  of  iron  could  be  seen  perfectly  distinctly  with 
the  ophthalmoscope;  the  iron  had  entered  the  eye  twenty  years 
earlier  and  had  neither  destroyed  vision,  nor  endangered  the 
fellow-eye  since  the  primary  effects  of  the  injury  had  subsided. 
Since  then  I  have  seen  cases  of  a  similar  nature.  One  of  them 
was  a  man  whose  right  eye  was  useless,  owing  to  a  wound  of 
the  cornea  received  when  ho  was  a  child.  While  driving  nails, 
a  fragment  of  iron  penetrated  his  sound  eye.  The  fragment 
made  a  very  small  wound  in  the  conjunctiva  and  sclera  about 
one  centimetre  from  the  nasal  margin  of  the  cornea.  Vision 
was  much  blurred  by  hemorrhage  into  the  vitreous.  Alxmt  one 
week  after  the  accident  he  came  under  my  observation.  The 
track  of  the  missile  through  the  anterior  portion  of  the  vitreous 
was  then  visible;  but  the  position  of  the  missile  could  not  be  lo- 
cated. Subsequently,  however,  the  vitreous  cleared  up  and  the 
fragment  of  iron  was  seen  lodged  in  the  retina  below  the  optic 
nerve.  Inflammatory  reaction  subsided  in  a  few  weeks,  and 
the  patient  returned  to  work,  with  glasses  for  his  hypermetropia 
and  as  a  protection  against  further  accident.  Three  years  later, 
he  called  to  inquire  about  his  glasses.  The  fragment  of  iron 
was  still  in  the  retina,  but  appeared  to  be  smaller.  It  bad  not 
given  him  any  trouble,  and  he  had  worked  as  usual.  He  was 
enjoined  to  return  if  the  eye  troubled  him.  I  have  not  seen  him 
since,  five  years  after  the  injury.  Recently  I  have  seen  another 
case  in  which  a  fragment  of  iron  or  steel  has  been  Icxlged  in  the 
retina  for  seven  years  (after  perforating  the  sclera),  without  in- 
juring the  usefulness  of  the  eye.  The  missile  is  still  readily 
detected  with  the  ophthalmoscope. 

The  favorable  course  observed  in  cases  of  this  nature  is  de- 
pendent upon  the  following  conditions,  namely :  The  small  size 


88  VISION   AND    AUDITION — WOODWARD. 

of  the  foreign  body,  freedom  from  septic  infection,  the  compara- 
tively trifling  hemorrhage  into  the  vitreous,  fixation  of  the 
missile,  and  the  material  of  which  it  is  composed.  Attention 
has  been  directed  to  the  effect  that  may  be  expected  when  large 
bodies  enter  the  eye.  Small  foreign  bodies  generally  make 
small  wounds;  prolapse  of  vitreous,  therefore,  either  does  not 
occur,  or  it  is  very  trifling  in  amount.  Other  things  being 
equal,  small  bodies  are  less  likely  to  carry  septic  infection  than 
large  bodies.  In  a  large  number  of  cases,  the  small  foreign 
body  is  a  fragment  of  iron  or  steel,  the  temperature  of  which 
had  been  raised  immediately  before  it  entered  the  eye.  Such 
missiles  are  aseptic,  or  nearly  so.  Missiles,  such  as  bird- 
shot  and  heated  fragments  of  glass  are  likewise  aseptic.  Par- 
ticles of  copper  may  enter  the  eye  in  an  aseptic  state.  But 
fragments  of  stone  and  vegetable  substances,  for  example, 
twigs,  pieces  of  bark,  etc.,  are  never  in  an  aseptic  condition. 
Not  all  particles  of  iron  or  steel,  or  glass,  or  copper,  or  gunshot 
missiles  enter  the  eye  in  an  aseptic  state.  When  they  carry 
septic  infection  into  the  vitreous,  suppurative  panophthalmitis 
will  follow  and  destroy  the  eye.  Hemorrhage  into  the  vitreous 
occurs  when  foreign  bodies  penetrate  into  that  tissue.  Large 
hemorrhages  in  themselves  destroy,  or  seriously  injure  vision 
permanently.  Small  hemorrhages  may  be  resorbed,  leaving  the 
vitreous  clear. 

Aseptic  particles  of  iron,  steel,  or  glass  lodged  in  the  interior 
of  the  eye,  and  immovably  fixed  by  encapsulation  or  otherwise, 
may  not  cause  very  serious  injury.  But  foreign  bodies  of  any 
variety  that  are  not  fixed  in  the  eye,  but  change  their  position 
from  time  to  time,  are  exciters  of  destructive  inflammation  of 
the  uveal  tract,  and  of  sympathetic  ophthalmia.  A  foreign  body 
having  remained  fixed  for  a  number  of  years,  may  subsequently 
become  movable.  When  this  occurs,  the  eye,  which  had  been 
free  from  irritation  and  perhaps  as  useful  as  its  fellow,  is  at- 
tacked by  an  inflammation  that  may  exist  a  few  weeks  and  then 
subside,  leaving  the  sight  more  or  less  impaired.  Relapses  re- 
cur at  variable  intervals,  until  the  sight  is  lost,  the  globe  shrinks, 
and  sympathetic  disease  of  the  other  eye  sets  in.  In  other  cases, 
the  inflammation  does  not  subside  until  these  effects  have  taken 
place.  The  patient  may  thus  become  blind  in  consequence  of 
the  primary  inflammation,  aggravated  by  the  existence  of  a 


FOREIGN  BODIES  IN   THE   VITREOUS.  89 

movable  foreign  body  in  the  chamber  of  the  vitreous.  A  foreign 
body,  that  may  at  first  have  been  movable,  may  l>ecome  fixed  by 
the  products  of  inflammation,  and  the  eye  may  recover  with 
more  or  less  vision,  or  the  globe  may  be  preserved,  though 
sightless. 

Vegetable  substances,  copper,  and  mercury  are  not  tolerated 
in  the  eye.  Copper  and  mercury  excite  chemical  reactions,  that 
in  turn  excite  destructive  inflammation. 

The  treatment  of  one  of  these  cases  may  be  the  subject  of  a 
medico-legal  investigation.  And  the  question  arises,  what  con- 
stitutes an  appropriate  treatment  of  a  case  of  foreign  body  in 
the  vitreous?  Obviously,  no  hard  and  fast  rules  may  be  laid 
down  for  the  surgeon's  guidance.  In  general,  it  may  be  said 
that  the  body  should  be  extracted  as  soon  as  possible.  The  cases 
cited  show  that  this  rule  should  not  be  applied  to  all  eyes  con- 
taining foreign  bodies.  When  the  scleral  wound  is  large  and 
the  loss  of  vitreous  is  great,  no  hope  should  be  fostered  that  con- 
servative measures  will  give  a  favorable  issue ;  then,  the  eyeball 
should  be  removed  to  prevent  suffering,  and  to  obviate  danger 
to  the  fellow-eye.  Chronic  inflammation  of  the  uveal  tract,  or 
relapsing  inflammation  of  the  uveal  tract,  in  eyes  that  contain 
a  foreign  body,  must  be  treated  by  removal  of  the  foreign  body, 
or  by  enucleation  of  the  eye ;  for  by  such  management  only  may 
an  attack  of  sympathetic  disease  be  prevented. 


CHAPTER  VII. 
SYMPATHETIC  DISEASES  OF   THE  EYE. 

I.    SYMPATHETIC    IRRITATION. — II.    SYMPATHETIC    INFLAM- 
MATION. 

SYN. — Sympathetic  Ophthalmia;  Sympathetic  Ophthalmi- 
tis ;  Ophthalmia  Sympathica ;  Irido-Cyclitis  Sym- 
pathetica. 

WHEN  a  morbid  state  of  one  eye  depends  for  its  existence 
upon  a  pre-existing  disturbance  of  the  other,  the  eye  is  said  to 
be  sympathetically  affected.  We  have  to  consider  sympathetic 
irritation  and  sympathetic  inflammation.  In  both,  the  eye 
first  affected  is  the  exciting  eye,  or  exciter,  and  the  eye  secon- 
darily diseased  is  the  sympathizing  eye,  or  sympathizer.  In 
the  former,  the  changes  in  the  sympathizer  are  not  structural, 
but  have  the  nature  of  a  functional  disturbance.  In  the  latter, 
the  sympathizer  exhibits  the  lesions  of  an  inflammatory  process 
involving  a  greater  or  less  extent  of  the  uveal  tract.  The  former 
is  a  disease  which  responds  promptly  to  treatment;  the  latter 
is  a  very  grave  malady,  difficult  to  handle,  ending,  in  the 
majority  of  cases,  in  blindness. 

I.  SYMPATHETIC   IRRITATION. 

Symptoms  in  the  Exciting  Eye.— They  are  attacks  of 
ciliary  injection,  tenderness  in  the  ciliary  region,  pain,  photo- 
phobia, and  lachrymation.  Vision  is  more  or  less  impaired; 
the  eye  may  be  blind.  Objectively,  inflammatory  changes  may 
be  readily  discovered,  although  in  some  they  may  be  so  incon- 
spicuous as  to  be  overlooked.  The  subjective  symptoms  may 
subside  and  recur  from  time  to  time. 

The  Symptoms  in  the  Sympathizing  Eye. — The  eye 
is  weak  and  easily  fatigued.  The  acuteness  of  vision  is  usually 

90 


SYMPATHETIC   IRRITATION.  91 

impaired,  but  it  may  be  normal.  Photophobia,  lachrymation, 
and  pericorneal  injection  are  more  or  less  marked.  The  ciliary 
region  may  be  tender  to  pressure  at  a  point  corresponding  to  the 
region  of  greatest  tenderness  in  the  exciter.  Ciliary  neuralgia 
may  become  a  prominent  symptom.  Blepharospasm,  phutopsia, 
and  contraction  of  the  field  of  vision  have  been  observed. 

The  symptoms  of  sympathetic  irritation  usually  come  on 
immediately  after  the  outbreak  of  the  disturbance  in  the  ex- 
citer, or  their  appearance  may  be  delayed  a  few  days  or  a  few 
weeks.  The  attacks  may  come  and  go  at  irregular  intervals 
for  months  and  years.  That  sympathetic  irritation  may  pa** 
into  sympathetic  inflammation  is  denied  by  Swanzy,'  Meyer,1 
and  D'Oench.1  But  Fuchs,4  Nettleship/  Juler,'  Mauthner,' 
and  De  Schweinitz "  are  of  the  opinion  that,  in  some  cases,  sym- 
pathetic irritation  is  the  premonitory  stage  of  sympathetic  in- 
flammation. Rossander*  holds  that  sympathetic  inflammation 
may  succeed  sympathetic  irritation,  and  accounts  for  the  infre- 
quent occurrence  of  such  a  change  by  the  fact  that  competent 
surgeons  resort  to  the  preventive  treatment  early  in  the  case. 
According  to  Lawson,10  "sympathetic  irritation  is  closely  allied 
to  sympathetic  ophthalmia,  and  although  it  presents  features 
different  from  sympathetic  inflammation,  yet  it  may  and  fre- 
quently does  drift  into  it.  .  .  ."  In  the  report  of  the  committee 
on  sympathetic  ophthalmitis,"  Cases  2  and  40  in  the  tables  are 
examples  of  irritation  passing  into,  or  succeeded  by  inflamma- 
tion, after  excision  of  the  exciter. 

Sympathetic  irritation  may  run  a  course  of  a  few  days  or  a 
few  weeks  and  terminate  in  permanent  recovery ;  or  the  recov- 
ery may  be  temporary,  and  the  symptoms  may  recur  again  and 
again  at  irregular  intervals  for  years,  without  change  in  the 
character  of  the  malady;  or,  in  one  of  the  attacks,  the  sympa- 
thizer may  become  the  seat  of  true  sympathetic  inflammation. 

1  "Dis.  of  the  Eye,"  1890,  p.  255.  '  "Sympathetic    Diseases  of  the 

«  "A  Practical  Treatise  on  Dis.  of  Eye,"  New  York.  1881.  pp  68. 

Eye,"  1887,  p.  216  "Diseased  of  the  Eye,       '92.  p. 

1  Archives  of  Ophthalmology,  New  337. 

York,  1887.  p.  201,  vol.  xvi.  »  Annales  d'Oculietique,  18i6.  p. 

4"Lehrbuch       der       Augenheil-  301  et  *eq .,  alwtrart. 

kunde  "  1891    pp.  320,  321.  10  Royal  London  Oph.  Hosp.  Re- 

•  "Dis.  of  the  Eye,"  1890,  p.  173.  porte,  vol.  x..  1880.  p.  2 

•"Handbook    of     Oph.    Science  "  Tr.  Ophth.   Soc.  Unit.    King., 

and  Practice, "  1884,  p.  162.  vol.  vi. 


92  VISION   AND    AUDITION — WOODWARD. 


II.  SYMPATHETIC  INFLAMMATION. 

Sympathetic  inflammation  has  no  typical  form ;  it  has  no 
character  sui  generis  which  differentiates  it  from  other  cases 
of  irido-choroiditis,  whether  they  be  serous  or  plastic.1  To  this 
opinion  of  De  Wecker's  there  can  be  no  valid  objection ;  and  it 
follows  that  by  the  objective  symptoms  alone  a  diagnosis  of  the 
sympathetic  nature  of  the  disease  cannot  be  sustained. 

Symptoms  in  the  Exciter. — There  is,  commonly,  well- 
marked  objective  evidence  of  inflammation  in  the  uveal  tract, 
but  the  lesions  may  be  indistinct  and  unnoticed.  "  An  inflamma- 
tion in  the  uveal  tract  of  the  exciting  eye  is  a  necessary  factor  in 
the  production  of  sympathetic  inflammation."  *  Vision  may  be 
good ;  commonly  it  is  seriously  impaired,  and  often  it  is  totally 
destroyed.  Pain,  photophobia,  lachrymation,  ciliary  injection, 
and  tenderness  are  usually  present.  In  some  cases,  however, 
the  exciter  may  be  quiet,  that  is,  it  may  give  no  signs  of  irrita- 
tion, when  sympathetic  inflammation  breaks  out  in  the  sympa- 
thizer.3 Tenderness  in  the  ciliary  region,  causing  the  patient 
to  shrink  away  in  a  significant  manner  when  that  point  is 
touched  gently  through  the  closed  eyelid,  is  often  marked.  But 
that  does  not  necessarily  imply  that  an  attack  of  S3rmpathetic 
inflammation  is  imminent.4 

Symptoms  in  the  Sympathizer. — They  depend  in  some 
measure  upon  the  form  of  the  disease.  Sympathetic  inflamma- 
tion may  present  a  variety  of  lesions.  The  greater  number  of 
the  cases  are  examples  of  plastic  irido-cyclitis  and  plastic  irido- 
choroiditis.5  A  certain  number  of  cases  are  instances  of  plastic 
iritis  only.  Frequently  the  sympathetic  inflammation  exhibits 
the  characteristics  of  serous  iritis  and  serous  irido-choroiditis. 
Swanzy  and  others '  believe  that  the  serous  form  of  inflamma- 

1  De  Wecker:  Annales  d'Oculis-  Brailey,  W.  Adams  Frost,  R.  Mar- 
tique,  June,  1892,  p.  413.  cus  Gunn,  Wm.  Lang,   J.   B.  Law- 

2  Schirmer :  Ophthalmic  Review,  ford,  E.  Nettleship. 
London,  vol.  xii.,   March,   1893,  p.  4  Swanzy,  op.  cit.,  p.  256. 

89.  5  "Graefe-Saemisch  Handbuch  d. 

3Tr.   Ophth.    Soc.    Unit.    King.,  Augenheilkunde,"  4,  p.  520. 

vol.     vi.     Tables    of  211    cases  of  6  Op.    cit.,    p.    256:   De   Wecker, 

sympathetic  ophthalmia.  The  com-  "Traite  complet  d'Ophthal. ,"  tome 

mittee     making    the    report    was  ii.,    Paris,    1886,     p.     321.     Milles, 

composed  of    the  following    oph-  Brailey,    Royal  London  Oph.  Hos. 

thalmologists  :  John  Couper,  W.  A.  Rep.,  vol.  x. 


SYMPATHETIC   INFLAMMATION.  03 

tion  is  the  first  stage  of  nearly  all  cases  of  sympathetic  ophthal- 
mitis,  which  as  a  rule  passes  into  the  plastic  variety.  This 
opinion  should  be  accepted  with  some  reserve.  Admitting  that 
the  presence  of  "keratitis  punctata"  is  presumptive  evidence 
that  severe  inflammation  is  present  in  the  uveal  tract,  I  exam- 
ined the  histories  of  the  211  cases  of  sympathetic  ophthalmitis  in 
the  report '  already  alluded  to,  and  found  "  keratitis  punctata" 
mentioned  in  only  20  cases.  After  making  duo  allowance  for 
the  unavoidable  imperfections  in  the  histories,  this  finding  still 
casts  a  measure  of  doubt  upon  the  accuracy  of  Swanzy's  ob- 
servation.* 

Neuro-retinitis,  in  rare  cases,  is  the  form  of  the  sympathetic 
disease.1  Schirmer  thinks  there  is  "ample  evidence  that  there 
is  such  a  condition  as  a  primary  sympathetic  papillo-retinitis." 
It  is  a  benign  affection,  cured  by  enucleation,  and  depends  upon 
the  transmission  of  bacterial  products  from  the  exciter.' 

Exceptional  cases  of  sympathetic  conjunctivitis  and  sympa- 
thetic keratitis  are  mentioned  by  Noyes  and  others.* 

The  disease  may  come  on  insidiously  and  pass  beyond  the 
initial  stages  before  the  patient's  attention  is  attracted.  Law- 
son  *  says :  "  The  disease  usually  commences  without  pain  as  a 
warning,  though  it  is  commonly  preceded  by  a  certain  amount 
of  irritation,  slight  photophobia,  impairment  of  accommodation 
sufficient  to  give  rise  to  fatigue  of  the  eye,  and  lachrymation. 
One  or  all  of  these  symptoms  may  be  present,  and  in  an  adult 
would  probably  draw  attention  to  the  state  of  the  eye,  but  in  a 
child  they  are  not,  as  a  rule,  sufficient  to  lead  him  to  make 
complaint,  so  that  in  children  the  disease  is  not  infrequently  far 
advanced  before  it  is  detected."  In  40  of  the  211  cases  already 
referred  to,  the  sympathetic  disease  began  insidiously.  In  36 

1  Tr.  Oph.  Soc.  Unit.  King.,  vol.  *  Ophthalmic  Review,    vol.    xii., 

vi.  March.  1893. 

»  Compare  Mauthner,  "  Sympathe-  *  Noyes, "  Dia.  of  the  Eye. "  1X90.  p. 

tic  Diseases  of  the  Eye,  p.  81  etfteq.,  492  ;  G.  L.  Johnson,  Arrhivetul'Oph- 

and   p.    168.     In   same    line  is  the  thalmolojiie,  Jan..  1H92.  p.  58.  ca«« 

evidence  in    Gunn's    cases,    R.    L.  of  sympathetic  keratitis.     Forcriti- 

Ophth.  Hosp.  Rep.,  xi..  1886-87.  cisiii  of  record«>d  cases  of  syinpathe- 

J  Tr.  Oph.  Soc.  Unit.  King.  ;  Alt,  tic  conjunctivitis,  and  sympnthftic 

Archives  of  Oph.  and  Otol.,    New  keratitis,   see  Deutwhmann.  "Oph- 

York,  vol.  v.  ;  Deutechmann.  "Oph-  thahnin    Migrntoria."    pp.    1 

thalmia    Migratoria,"  gives    many  also  Schirmer.  Ophthalmic  Review, 

references  to   cases  of  this  nature,  March.  1H93.  pp.  91-92. 

pp.  117-119.  «  R.  L.  Onh.  Hosp.  Report*. 

vol.  x. ,  p.  1. 


94  VISION   AND    AUDITION — WOODWARD. 

of  these  both  eyes  were  not  painful,  or  were  quiet.  In  2  of  the 
remaining  4,  the  exciter  was  quiet,  while  the  sympathizer  was 
painful ;  and  in  2  the  sympathizer  was  quiet,  while  the  exciter 
was  painful. 

In  the  plastic  form  of  inflammation  in  the  sympathizer, 
ciliary  injection  and  tenderness  are  usually  well  marked,  the 
pupil  is  contracted,  and  numerous  synechia3  quickly  attach  the 
pupillary  margin  of  the  iris  to  the  capsule  of  the  lens.  The 
posterior  synechiaB  may  be  complete,  shutting  off  all  communi- 
cation through  the  pupil  between  the  anterior  and  the  posterior 
chambers.  The  pupillary  space  may  be  filled  with  a  plastic 
exudate,  which  may  also  fill  the  posterior  chamber  and  invade 
the  ciliary  body.  In  rare  cases,  pus  and  blood  may  be  found  in 
the  anterior  chamber.  The  choroid  may  be  invaded  by  the 
plastic  inflammation.  The  vitreous  becomes  turbid  with  parti- 
cles of  plastic  material.  Thus,  the  eye  may  be  the  seat  of  plastic 
iritis,  plastic  cyclitis,  and  plastic  choroiditis  at  the  same  time. 
Early  in  the  disease,  the  intra-ocular  tension  may  rise,  but 
eventually,  in  severe  cases,  the  eyeball  becomes  soft  and  atrophic. 

The  subjective  symptoms  are  ciliary  neuralgia,  photophobia, 
lachrymation  and  impairment  of  vision,  amounting  to  absolute 
blindness  in  the  worst  cases.  The  neuralgic  pains  may  be  very 
severe  in  the  eye,  and  in  bad  cases  they  may  extend  to  branches 
of  the  fifth  nerve,  other  than  the  ophthalmic. 

Both  the  objective  and  the  subjective  symptoms  vary  greatly 
in  severity  in  the  different  cases.  The  symptoms  may  amelior- 
ate and  the  eye  may  return  to  a  state  of  usefulness,  though  gen- 
erally it  still  exhibits  some  sequels  of  its  hazardous  experience. 
Exceptional  cases  have  been  observed  in  which  there  has  been 
a  single  attack  of  sympathetic  inflammation,  resulting  in  recov- 
ery with  a  useful  eye.  As  a  rule,  the  course  is  less  favorable. 
After  a  period  of  quiescence,  a  relapse  occurs,  and  after  one  or 
more  relapses  the  eye  is  destroyed.  The  severest  cases  are  the 
more  common  and  end  in  blindness.1 

In  the  serous  variety  of  inflammation  in  the  sympathizer, 
the  circumcorneal  injection  is  not  very  marked ;  the  iris  is  dis- 
colored, the  pupil  is  small;  there  may  be  a  few  posterior  syn- 
echise;  the  anterior  chamber  is  deep;  the  aqueous  humor  is 

1  Fuchs,    op.    tit.,    p.   312;    Schirmer,   Ophthalmic   Review,   vol.    xii., 
March,  1893,  p.  94. 


SYMPATHETIC   INFLAMMATION.  95 

cloudy.  Small  grayish-white  dots  in  variable  numbers  are 
found  on  the  posterior  surface  of  the  cornea — this  is  "  keratitia 
punctata."  The  vitreous  is  turbid,  and  chorio-retinitis  or  pa- 
pillitis  may  be  noted,  if  the  media  are  sufficiently  clear.  Vision 
is  impaired.  Photophobia,  lachrymation,  and  mild  attacks  of 
pain  complete  the  list  of  symptoms. 

The  disease  may  run  a  chronic  course,  and,  in  exceptional 
cases,  terminate  in  recovery  with  a  useful  organ,  without  opera- 
tive interference  directed  to  the  exciter.1  Other  cases  make  a 
less  complete  recovery  and  are  subject  to  relapses.  Still  other 
cases,  the  greater  number,  end  in  blindness.  The  serous  vari- 
ety of  sympathetic  inflammation  is  considered  the  benign  form 
of  the  disease,  whereas  the  plastic  variety  is  justly  regarded  as 
the  malignant  form. 

Etiology. — Sj-mpathetic  irritation  may  appear  in  conse- 
qence  of  a  variety  of  injuries  and  diseases  of  the  eye.  The  cau- 
sation of  sympathetic  inflammation  has  been  held  to  be  the 
same.  But  the  more  thoroughly  the  matter  is  sifted  the  clearer 
does  it  appear  that  in  order  that  sympathetic  inflammation  may 
break  out  in  the  fellow-eye,  it  is  necessary  that  inflammation  of 
the  iris  and  ciliary  body  in  the  exciter  shall  be  present.  An 
irido-cyclitis  not  due  to  a  perforating  lesion  of  the  tunics  of  the 
eyeball  is  very  exceptionally  the  cause  of  sympathetic  inflam- 
mation. The  committee  on  sj'mpathetic  ophthalmitis  were 
of  the  opinion  that  ''sympathetic  ophthalmitis  occurring  with- 
out a  perforating  lesion  of  the  exciting  eye  is,  if  not  unknown, 
at  any  rate  extremely  rare."  *  The  perforating  lesions  that  may 
be  followed  by  irido-cyclitis  are  wounds  of  all  varieties — lace- 
rated, contused,  incised,  punctured,  accidental,  and  operative. 
The  wound  is  most  dangerous  when  it  involves  the  ciliary  re- 
gion. This  is  the  general  opinion  of  ophthalmic  surgeons. 
The  strongest  objection  to  this  view  of  the  matter  is  that  made 
by  Alt.  Having  critically  examined  110  eyes  enucleated  for 
sympathetic  ophthalmia,  Alt  reports  the  following  conclusion 
bearing  upon  this  question:  "Cicatrices  and  foreign  bodies  in 
the  ciliary  body  or  incarceration  of  it — which  are  usually  looked 
upon  as  the  most  important  factor  in  sympathetic  affections— 
appear  in  only  17^  per  cent,  while  the  affections  of  tho  ciliary 
body  all  together  amount  to  7G*  per  cent.  The  iris  is  changed  in 
1  Noyes,  op.  cit.,  p.  490.  *  Tr.  Oph.  Soc.  U.  K..  vol.  vi.,  p.  179. 


9G  VISION    AND    AUDITION — WOODWARD. 

but  68  per  cent,  and  the  choroid  in  73  per  cent,  thus  showing 
about  the  same  number  of  changes  in  each  of  the  parts  of  the 
uveal  tract,  with  only  a  slight  percentage  in  favor  of  the  ciliary 
body. "  *  Gunn  found  that  "  as  regards  the  accidental  wounds, 
the  mere  position  of  the  injury  did  not  seem  to  influence  the 
character  of  the  inflammation  or  the  result;  wounds  of  the  cili- 
ary region  had  as  low  a  percentage  of  severity  as  those  confined 
to  the  cornea  with  implication  of  the  iris.  Similarly  the  nature 
of  the  instrument  appeared  to  make  no  difference  in  this  re- 
spect." a 

The  entrance  of  foreign  bodies  into  the  eye  must  cause  a 
penetrating  lesion.  Such  injuries  may  be  the  initial  stage  in 
the  etiology  of  sympathetic  inflammation.  When  the  foreign 
body  has  lodged  in  the  tissues  of  the  eyeball  in  such  a  position 
that  extraction  of  it  is  impossible,  the  gravity  of  the  case  is 
aggravated.  Randolph  thinks  that  "  by  far  the  greater  num- 
ber of  sympathetic  eye-troubles  are  caused  by  the  entrance  of 
foreign  bodies.  Clinical  experience  shows  us  every  day  that 
wounds  resulting  from  infectious  foreign  bodies  cause  the  most 
violent  inflammations,  and,  on  the  contrary,  wounds  caused  by 
aseptic  matter  result  in  comparatively  little  disturbance.  "3  Schir- 
mer's  conclusions  are  doubtless  nearer  the  truth.  He  is  of  the 
opinion  that  "  it  is  the  inflammation  which  follows  a  perforating 
wound,  and  not  the  wound  itself,  which  threatens  the  fellow- 
eye,  and  such  inflammation  is  usually  due  to  infection  through 
the  wound.  The  danger  attaching  to  the  presence  of  a  foreign 
body  in  the  interior  of  the  eye  has  probably  been  somewhat 
overrated,  for  there  is  no  evidence  that  aseptic  foreign  bodies 
can  cause  sympathetic  inflammation,  even  though,  as  in  the 
case  of  fragments  of  copper,  they  may  by  chemical  action  dam- 
age the  injured  eye.  The  danger  lies  in  the  fact  that  very 
many  foreign  bodies  carry  infective  organisms  with  them  into 
the  eye.  The  only  cases  in  which  a  foreign  body  was  supposed 
to  affect  the  fellow-eye  without  the  intervention  of  uveitis  in 
the  injured  eye,  were  cases  of  sympathetic  irritation  only.  The 
most  dangerous  cases  are  those  in  which  the  injured  eye  seems 

1  "Anat.    Causes  of  Sympathetic  3  "  Pathogenesis    of    Sympathetic 
Ophthalmia,  "  Archives  of  Ophthal-  Ophthalmia,"  Archives  of  Ophthal- 
mology, N.  Y.,  vol.  v.  mology,  N.  Y.,  vol.    xvii.,  1888,  p. 

2  Royal  London  Oph.    Hosp.    Re-  192. 
ports,  vol.  xv. ,  1886-87,  p.  316. 


SYMPATHETIC   INFLAMMATION.  97 

at  first  to  tend  toward  recovery,  but  nevertheless  remains  more 
or  less  injected  and  tender  on  pressure.  This  tenderness  is  the 
expression  of  a  persistent  cyclitis,  and  is  a  most  important  in- 
dication. Its  absence  cannot,  unfortunately,  be  taken  as  a  proof 
that  there  is  no  cyclitis,  for  a  slight  eycTitis  does  not  always  re- 
veal itself  by  tenderness  on  pressure."  Hirsehberg  finds  that 
a  foreign  body  lodged  in  the  eye  may  excite  destructive  inflam- 
mation even  though  it  may  not  have  been  infected.1 

Perforating  ulcers  of  the  cornea  may  lx»  succeeded  by  relaps- 
ing irido-cyclitis  and  lead  to  sympathetic  inflammation  of  the 
fellow-eye. 

Burns  of  the  cornea  and  symblepharon  are  given  as  causes 
of  sympathetic  inflammation.  It  is  altogether  improbable  that 
such  could  be  the  cause  unless  perforation  of  the  cornea  had 
occurred. 

Panas  has  reported  two  cases  of  sympathetic  irido-cyclitis 
following  tattooing  of  the  cornea.' 

Intra-ocular  tumors  are  said  to  cause  sympathetic  inflam- 
mation. Schirmer,  after  a  careful  search,  found  "twenty -eight 
cases  attributed  to  sarcoma  of  the  choroid  and  two  to  glioma  of 
the  retina.  The  analysis  of  these  shows  that  nine  were  cases 
of  sympathetic  irritation;  that  some  others  were  of  doubtful 
character;  and  that  in  several  more  a  perforation  of  the  excit- 
ing eye  had  occurred  either  spontaneously  or  by  operation.  Ex- 
cluding these,  there  remain  at  least  three  cases  in  which  a  cho- 
roidal  sarcoma,  with  no  j>erforation  of  the  tunics,  apjK'ared  to 
cause  a  true  sympathetic  inflammation  in  the  fellow-eye.  In 
these  three  cases  the  exciting  eye  presented  in  addition  to  the 
tumor  a  well-marked  irido-cyclitis,  and  this  complication  was 
present  also  in  some  of  the  more  doubtful  cases  just  referred  to. 
It  appears,  therefore,  that  a  choroidal  sarcoma  can  only  cause 
sympathetic  inflammation  when  it  is  associated  with  irido-cy- 
clitis, and  seeing  that  only  a  small  minority  of  such  tumors  are 
complicated  in  this  way,  the  irido-cyclitis  and  not  the  tumor 
must  be  regarded  as  the  chief  agent." 

Intra-ocular  cysticercus  is  mentioned  as  a  cause  of  sympn- 

'Ophthalmic  Review,    vol.   xii.,  4  Oph.    Review,  vol.  xii..  March. 

March,  1893,  pp.  87.  88.  1H93.    p.    85.     Sw    also    Ik-port 

»  Graefe'a  Archiv  fur  Ophthal.  Com.  Symp.  Ophthalmitit.  op.  ctt., 

3  Cited  in  "Ophthalmia  Migrate-  for  similar  criticism. 

ria, "  p.  87. 

Ill  -7 


03  VISION   AND    AUDITION — WOODWARD. 

tiieiie  inflammation.  Deutschmann  could  not  find  such  a  case 
in  literature,  but  Schirmer  found  one  case  of  mild  sympathetic 
irritation  due  to  that  cause. 

Irritation  due  to  wearing  an  artificial  eye  is  also  given  as  a 
cause  of  sympathetic  inflammation.  Such  might  be  the  conse- 
quence of  wearing  an  artificial  eye  over  a  phthisical  globe,  for 
that  might  excite  a  relapse  of  irido-cyclitis  in  the  degenerated 
eye.  But  it  is  highly  improbable  that  an  artificial  eye  ever  ex- 
cites sympathetic  inflammation  under  other  circumstances. 

Incubation. — The  onset  of  sympathetic  inflammation  occurs 
generally  in  from  three  to  twelve  weeks  after  the  injury  to  the 
exciter.  The  shortest  interval  between  the  injury  to  the  exciter 
and  the  outbreak  of  sympathetic  inflammation,  according  to  the 
Committee  of  the  Ophthalmological  Society  of  the  United  King- 
dom,1 was  three  days  in  Case  134,  but  this  record  is  not  above 
suspicion.  In  Case  95,  the  interval  was  only  three  or  four  days, 
but  may  have  been  much  longer.  De  Schweinitz  states  that  it 
occurs  exceptionally  as  early  as  the  seventh  day.5  According  to 
Fuchs,3  the  shortest  period  is  two  weeks.  Deutschmann 4  asserts 
that  the  shortest  interval  recorded  in  literature  is  ten  days,  in 
the  case  described  by  O.  Becker.  In  his  monograph  on  "  The 
Sympathetic  Diseases  of  the  Eye,"6  Mauthner  says:  "I  must 
emphasize  the  fact  that,  in  my  own  experience,  I  know  of  no 
case  in  which  I  ever  saw  sympathetic  ophthalmia  appear  sooner 
than  in  four  weeks  after  the  injury.  I  grant,  indeed,  that  this 
period  of  four  weeks  might  be  somewhat  shortened,  in  occasional 
cases,  but  I  will  not  grant  that  the  necessary  period  can  be  re- 
duced to  a  few  days,  as  is  alleged  to  have  been  observed  by 
several  authors." 

There  is  no  definite  limit  to  the  period  during  which  an  at- 
tack of  sympathetic  ophthalmia  may  occur.  Cases  observed 
twenty,  thirty,  forty,  and  even  sixty  years  after  the  injury  to 
the  exciter  are  on  record.  According  to  Fuchs,'  "  so  long  as  an 
eye  destroyed  by  injury  remains  free  from  inflammation  and 
tenderness  it  is  not  liable  to  excite  sympathetic  inflammation. 
But  if  such  an  eye  become  irritable  and  inflamed,  which  it  is 
apt  to  do  if  there  be  a  foreign  body  lodged  in  it,  the  danger  of 

1  Tr.  Oph.   Soc.  U.  K.,  vol.    vi.,  4  "Ophthalmia     Migratoria,"     p. 
p.  264.                                                           104. 

2  Op.  cit. ,  p.  338.  s  P.  143. 

3  Op.  cit.,  p.  322.  •  Op.  cit.,  pp.  321,  322. 


SYMPATHETIC    INFLAMMATION.  99 

sympathetic  inflammation  again  appears,  An  eye  destroyed 
by  a  traumatism  is  a  standing  menace,  u^  its  .Jello^.  The  dan- 
ger of  sympathetic  infi&nuua&on  is  greatest  uiu'ing.  the  most 
active  stage  of  irido^ycHtis  in  the  exciting  eye."  ThM  he  curds 
with  the  experience  cf  ophthalmic  surgeons  in  general. 

Frequency  of  Occurrence.— As  q^.i.tribut^n. to  this  part 
of  the  subject  the  following  facts  ara  offered.  They  will  give 
an  approximately  correct  idea  of  the  matter.  Among  the  in- 
mates of  asylums  for  the  blind,  about  4.5  per  cent  lost  their 
vision  by  sympathetic  ophthalmia.1  Among  02?  blind  inmates 
of  the  Hospice  des  Quinze  Vingts,  Paris,  Trousseau '  found  that 
14,  or  2.2  per  cent  of  the  number,  became  blind  in  consequence 
of  sympathetic  ophthalmia.  Out  of  500  enucleations  of  the  eye 
in  the  practice  of  Knapp,*51  eyes  were  removed  for  sympathetic 
irritation  and  21  were  removed  for  genuine  sympathetic  oph- 
thalmia. Among  the  360  enucleations  made  by  Becker,'  the 
eye  was  removed  for  irido-cyclitis  with  sympathetic  disease  in 
10  cases.  From  the  practice  of  Roosa,  131  cases  of  enucleation 
are  reported ;  *  among  them  were  35  cases  of  sympathetic  oph- 
thalmia and  15  cases  of  sympathetic  irritation. 

Diagnosis. — Ordinarily  it  is  not  difficult  to  detect  inflam- 
matory changes  in  the  uveal  tract.  But  there  are  cases  of  sym- 
pathetic ophthalmia  which,  in  the  early  stages  at  least,  may 
deceive  the  observer.  The  diagnosis  of  papillitis,  neuro-retini- 
tis,  and  chorio-retinitis,  when  the  changes  are  inconspicuous, 
will  be  more  difficult  to  establish,  should  the  refraction  of  the 
eye  present  a  high  degree  of  hypermetropia  or  astigmatism,  es- 
pecially if  the  observer  be  not  on  his  guard.  In  obscure  cases 
of  sympathetic  ophthalmia,  atropine  may  l>e  used  to  facilitate 
the  ophthalmoscopic  examination  and  to  reveal  inflammatory 
lesions  that  might  otherwise  pass  unnoticed.  Esj>ecial  attention 
should  be  given  to  the  cornea  and  iris,  for  the  existence  of  kera- 
titis  puuctata  and  slight  posterior  synechia  may  be  overlooked 
unless  the  examination  be  thorough. 

Having  noted  the  presence  of  a  lesion  in  the  fellow-eye,  the 
question  arises,  Is  that  lesion  due  to  the  presence  of  disease  in 
the  eye  primarily  affected;  in  other  words,  have  we  to  deal  with 

1  Noyea,  op.  nt. ,  p.  698  ft  *eq.  *  Aiin«'"klinik      in      Heidelberg. 

*  "  Hygidne  <le  ITKil."  p.  16.  1888.  p.  93. 

8  Archives  of  Ophthalmology,  N.  »  N.    Y.    Mwl.   Record.  Oct.  Jotb. 

Y.,  vol.  xv i.,  p.  201.  1892,  pp.  44.%,  446. 


100  VISION   AND    AUDITION — WOODWARD. 

a  case  of  sympathetic  trouble?  The  differential  diagnosis  is 
very  important,  a'nd,  in  certam  cases,  is  surrounded  by  great 
difficulties/  For,  lesions"  umlistinguishable  from  those  observed 
in  sympathetic  inflammation  are  the  effect  of  a  variety  of  causes. 
Inflammations  of  the  uveal  tract  dependent  'upon  constitutional 
causes  may  find*  appear  in  cr-ie  e.yp  and  subsequently  break  out 
in  the  other,'  but  it' cannot  be  said  of  s'ucli  cases  that  the  disease 
has  been  transmitted  from  one  eye  to  the  other.  In  both  in- 
stances the  cause  of  the  disease  is  a  constitutional  one.  Thus, 
inflammations  of  the  cornea,  iris,  ciliary  body,  and  choroid  may 
be  due  to  syphilis,  scrofula,  rheumatism,  diabetes,  gonorrhoea, 
acute  febrile  diseases,  and  traumatisms,  or  they  may  be  idio- 
pathic.  Inflammation  of  the  choroid  may  be  due  also  to  ane- 
mia, chlorosis,  septic  emboli,  meningitis  and  cerebro- spinal 
meningitis,  orbital  abscess,  and  thrombosis  of  the  orbital  veins. 
Inflammations  of  the  retina  may  be  due  to  syphilis,  nephritis, 
diabetes,  leukemia,  or  they  may  be  idiopathic.  Inflammations 
of  the  optic  nerve  may  be  due  to  syphilis,  scrofula,  nephritis, 
diabetes,  cerebral  disease,  acute  febrile  diseases,  severe  hemor- 
rhages, menstrual  disorders,  pregnancy,  childbirth,  lead  poi- 
soning, prolonged  exposure  to  cold,  inflammation  and  tumors 
of  the  orbit,  and  heredity.1  The  presence  of  any  of  those  con- 
ditions and  their  etiological  bearing  upon  the  case  under  con- 
sideration must  be  ascertained  before  a  correct  opinion  respect- 
ing the  sympathetic  nature  of  the  disease  may  be  formulated. 
Primary  glaucoma  also  must  be  excluded. 

The  nature  of  the  injury  and  the  condition  of  the  eye  first 
affected  will  throw  some  light  on  the  differential  diagnosis. 
Severe  injuries  resulting  in  penetration  of  the  eyeball  and  lesion 
of  the  ciliary  body,  especially  when  they  are  followed  by  a 
chronic  irido-cyclitis  showing  marked  and  persistent  tenderness 
in  the  ciliary  region,  are  very  dangerous.  Foreign  bodies  re- 
maining in  the  eye,  especially  fragments  of  stone,  copper,  and 
lead,  and  infected  bodies  of  all  kinds  are  very  prone  to  excite 
sympathetic  ophthalmia  sooner  or  later.  On  the  other  hand, 
eyes  in  the  condition  of  purulent  panophthalmitis  are  compara- 
tively infrequently  exciters  of  sympathetic  disease.  Sympa- 
thetic disease  does  occur,  however,  when  the  exciter  is  in  a  state 
of  panophthalmitis. J 

1  Fuchs,  op.  dt. ,  pp.  316,  347,  353,  446,  479,  480.  8  Alt,  op.  tit. 


SYMPATHETIC   INFLAMMATION.  101 

Should  the  inflammation  in  the  second  eye  begin  in  from 
three  to  twelve  weeks  after  the  injury  to  the  first  eye,  or  after  an 
outbreak  of  cyclitis  in  an  eye  disorganized  by  a  penetrating 
wound  received  months  or  years  before,  a  suspicion  tliut  the 
disease  is  sympathetic  must  be  entertained.  But  should  the 
disease  break  out  in  the  second  eye  after  a  much  shorter  or  a 
much  longer  interval,  the  opinion  that  the  disease  is  sympa- 
thetic should  be  accepted  with  greater  reserve. 

If  the  injured  eye  be  enucleated  and  the  disease  in  the  fellow- 
eye  promptly  abate,  the  second  eye  was  probably  sympatheti- 
cally affected.  On  the  contrary,  should  inflammation  in  the 
second  eye  remain  unchanged  after  excision  of  the  first,  or  should 
the  disease  increase  in  severity,  it  cannot  be  said  that  the  sec- 
ond eye  was  not  sympathetically  diseased;  for,  after  sympa- 
thetic inflammation  has  appeared,  enucleation  of  the  exciter  may 
not  produce  any  effect  upon  it. 

Prognosis. — In  addition  to  what  has  preceded,  it  may  be 
stated  that  sympathetic  irritation,  although  it  may  have  re- 
curred again  and  again,  is  very  amenable  to  treatment.  Meyer ' 
says :  "  The  prognosis  may  be  regarded  as  very  good  in  sympa- 
thetic irritation,  favorable  in  serous  iritis,  very  bad  for  plastic 
irido-cyclitis,  for  useful  vision  is  rarely  preserved."  According 
to  Swanzy,a  "  the  vast  majority  of  cases  of  sympathetic  inflam- 
mation end  in  blindness."  Nettleship1  remarks:  "  When  once 
sym pathetic  inflammation  has  begun  we  can  do  little  to  modify 
its  course."  De  Schweinitz4  says:  "  The  prognosis  of  sympa- 
thetic ophthalmitis  is  usually  grave.  In  some  cases  recovery 
occurs;  this  has  been  seen  in  those  cases  in  which  neuro-retini- 
tis  is  present.  More  frequently,  especially  in  the  forms  which 
appear  as  an  irido-cyclitis  or  irido-choroiditis,  the  sight  of  the 
eye  is  lost,  and  the  organ  shrinks.  The  varieties  which  appear 
as  a  serous  iritis  give  the  greatest  ho|>e  of  a  good  result.  It  it 
extremely  important  to  warn  patients  of  the  grave  nature  ot 
this  malady,  and  if  an  attempt  is  made  to  save  an  eye  injured 
in  the  way  already  described,  it  must  bo  done  with  the  full  un- 
derstanding of  the  serious  risks  which  are  undertaken." 

Referring  again  to  the  report  of  the  committee  on  sympa- 
thetic ophthalmitis,*  we  find  that  of  211  cases  the  details  of  the 

1  Op.  cit.,  p.  217.  4  <>!>  «'/.,  PP   841.  342. 

»Oj>.  cit.,  p.  258.  *Tr.  Oph.  Soc.   U.  K.,  vol.    vi., 

3  Op.  cit.,  p.  175.  p.  173. 


102  VISION  AND   AUDITION— WOODWARD. 

treatment  were  given  in  90 ;  of  these  50  recovered  completely. 
Taking  203  of  these  cases  for  the  basis  of  calculation,  I  found 
that  about  26  per  cent  were  totally  lost,  about  23  per  cent  re- 
covered with  V=f-£,  and  about  50  per  cent  partially  recovered. 
It  should  be  noted  that  a  reasonable  doubt  may  be  entertained 
respecting  the  sympathetic  nature  of  the  inflammation  in  a 
few  of  the  cases;  and  that  in  others  the  records  were  very  im- 
perfect. Eyes  reported  as  having  recovered  may  have  been  de- 
stroyed subsequently  by  a  relapse  of  the  inflammation.  The 
committee  were  of  the  opinion  that  "  the  prognosis  in  sympa- 
thetic ophthalmitis  is,  on  the  whole,  more  favorable  if  the  dis- 
ease comes  on  after  a  short  than  after  a  long  interval."  * 

Gunn,2  in  a  carefully  prepared  paper,  reported  47  cases  of 
sympathetic  ophthalmia  in  which  the  final  condition  of  the  pa- 
tient is  given  as  follows :  "  In  34  cases  the  exciting  eye  was 
lost;  in  30  of  these  it  was  excised.  In  3  cases  the  exciter  al- 
though not  really  lost  was  excised.  In  6  cases  the  exciter  re- 
tained useful  vision,  although  the  sympathizer  was  lost  in  5  and 
greatly  damaged  in  the  sixth."  "  In  5  cases  the  final  condition 
of  the  sympathizing  eye  was  good,  i.  e. ,  retained  at  least  f  of 
normal  vision ;  in  12  the  result  was  moderate  (able  to  get  about) ; 
in  25  cases  the  sympathizer  was  known  to  have  been  rendered 
useless.  In  8  of  the  12  cases  in  which  the  result  was  "moder- 
ate," a  progressive  degeneration  was  noticeable. 

Propagation  of  the  Sympathetic  Diseases. — It  is  gen- 
erally believed  that  sympathetic  irritation  is  due  to  reflex  action 
through  the  ciliary  nerves.  But  the  raison  d'etre  of  sympa- 
thetic inflammation  is  still  under  discussion.  Mackenzie,8  in 
the  earliest  systematic  description  of  the  disease,  speaking  of 
the  ratio  symptomatum,  offered  the  conjecture  that  the  blood- 
vessels, the  ciliary  nerves,  and  especially  the  optic  nerves  may 
be  the  various  channels  by  which  the  morbid  process  is  trans- 
mitted from  one  eye  to  the  other.  In  1858,  Miiller  enunciated 
the  theory  that  the  disease  is  propagated  by  reflex  action  through 
the  ciliary  nerves.  This  theory  has  been  supported  by  various 
eminent  observers  and  still  claims  many  partisans.  Deutsch- 
mann*  opposes  that  theory  and  has  undertaken  to  prove,  by  ex- 

'Tr.    Oph.   Soc.  U.  K.,  vol.   vi.,          3  " Diseases  of  the  Eye, "  1844. 
p.  189.  4  "Ophthalmia  Migratoria,"  1889. 

2  R.  L.   Oph.  Hosp.  Reports,  vol. 
xi.(  1886-87. 


SYMPATHETIC   INFLAMMATION.  103 

perimenta  on  animals  and  by  pathological  and  bacteriological 
examinations  of  human  eyes,  that  sympathetic  ophthalmia  is 
due  to  the  action  of  micro-organisms  and  is  propagated  from 
the  exciter  to  the  sympathizer  by  the  lymph  channels  of  the 
optic  nerves.  This  theory  has  excited  much  discussion.  It  has 
been  provisionally  accepted  by  many  competent  ophthalmologists 
and  totally  repudiated  by  as  many  others.  At  the  present  time, 
the  most  that  can  be  said  of  this  matter  is  that  no  theory  pre- 
tending to  explain  the  propagation  of  sympathetic  ophthalmia 
has  withstood  the  assaults  of  adverse  criticism. 

Treatment.  I.  THE  PREVENTIVE  TREATMENT,  WHEN 
THE  EXCITER  is  DESTROYED.— The  surest  prophylaxis  of  sym- 
pathetic inflammation  consists  in  enucleation  of  the  exciter. 
The  operation  is  indicated  when  useful  vision  has  been  destroyed 
by  a  penetrating  injury  or  by  disease  of  the  cornea,  resulting  in 
perforation  of  that  structure,  if  the  eye  be  painful  or  tender  to 
pressure,  and  especially  if  it  contain  or  may  be  supposed  to  con- 
tain a  foreign  body.  Enucleation  should  be  more  urgently  ad- 
vised, when  the  symptoms  of  sympathetic  irritation  have  become 
manifest  in  the  fellow-eye.  Globes  in  the  state  of  phthisis 
bulbi,  and  stumps  of  the  optic  nerve,  when  tender  to  pressure, 
should  be  removed,  and  especially  if  the  other  ejre  show  any 
signs  of  sympathetic  disturbance.'  It  is  the  duty  of  the  phy- 
sician in  charge  of  such  cases  to  warn  the  patient  against  the 
dangers  of  sympathetic  inflammation.  And  too  much  faith 
should  not  be  put  in  the  patient's  ability  to  note  the  first  sign 
of  disturbance  in  the  healthy  eye,  which  shall  bring  him  to  an 
operation  for  excision  of  the  injured  organ.  The  disease  some- 
times begins  insidiously  and  its  existence  may  not  be  suspected 
until  well-marked  structural  changes  are  developed ;  this  is  es- 
pecially true  of  children  and  ignorant  persons.  But  not  all  such 
eyes,  or  stumps  of  eyes,  are  exciters  of  sympathetic  inflamma- 
tion or  even  sympathetic  irritation,  although  they  may  be  pain- 
ful and  tender  and  contain  a  foreign  body.  Just  how  many, 
or  which  one,  will  cause  sympathetic  disease  cannot  be  predicted 
with  certainty.  Some  latitude,  therefore,  must  be  allowed  to 

'Compare    Fuchs,    op.    cit.,    pp.  218 ;  Juler,  op.  cit.,  p.  1&4 ;  Noyes, 

828,  329 ;  Graefe-Saemisch,  op.  cit.,  op.  cit.,  p.  494  ;  De  Schxveimtx.  op. 

4,  p.  520;  Lawson,  op.  cit.,  p.  130;  cit.,   p.    340;   Warlomeut,   AnuaU>« 

Nettleship,  op.cit..  p.  175;  Swanzy,  d'Oculistique,  1876.  t.  Ixxv.,  p.  53, 

op.  cit.,  p.  259;  Meyer,  op.  cit.,  p.  Kossunder,  ibid.,  p.  805.  abstract. 


104  VISION   AND    AUDITION — WOODWARD. 

the  judgment  of  the  attendant  in  a  given  case  respecting  the 
time  when  an  excision  of  the  eye  should  be  performed,  but 
the  patient  must  be  made  to  understand  that  attempts  to  save 
the  injured  eye  are  fraught  with  more  or  less  danger  to  the 
other.  Should  the  patient  wish  that  every  possible  precaution 
be  taken  against  the  outbreak  of  disease  in  his  remaining 
eye,  the  injured  organ  should  be  enucleated  without  further 
delay. 

So  far  as  regards  sympathetic  irritation,  excision  of  the  ex- 
citer is  an  almost  absolutely  certain  preventive,  and  is  curative 
in  nearly  all  cases  even  after  the  disease  has  broken  out.  Rhein- 
dorf,  in  1865,  collected  75  cases  of  sympathetic  disease,  55  of 
which  were  treated  by  enucleation.  Of  these,  28  were  cases  of 
sympathetic  irritation,  in  27  the  result  was  cure  or  improve- 
ment, and  in  one  the  disease  was  said  to  have  been  aggravated 
by  the  operation.  Mooren,  in  1869,  published  a  series  of  35 
cases  of  sympathetic  ophthalmia  treated  by  enucleation.  Of 
these,  16  were  cases  of  sympathetic  irritation,  and  all  were 
cured.  In  1876,  Rossander  published  117  enucleations  for  di- 
verse causes:  in  68  the  disease  was  sympathetic  ophthalmia. 
Of  these,  33  were  cases  of  sjTmpathetic  irritation,  and  all  were 
cured.  Vignaux,  in  1877,  published  48  cases  of  sympathetic 
irritation  treated  by  enucleation;  complete  cure  in  43,  cure 
incomplete  or  disease  stationary  in  3,  and  in  2  the  treatment 
failed.  In  16  cases  in  which  the  appearance  of  sympathetic 
inflammation  was  imminent  at  the  moment  of  enucleation,  he 
was  able  to  determine  in  all  cases  the  persistence  of  the  normal 
state  after  a  period  of  one  to  four  and  one-half  years.  D'Oench, 
1887,  reports  from  Knapp's  practice  51  enucleations,  for  sym- 
pathetic irritation,  with  a  speedy  cure  in  every  case,  although 
in  some  the  symptoms  had  existed  for  a  long  time. 

In  a  certain  number  of  cases  of  sympathetic  inflammation, 
neither  enucleation  of  the  exciter  nor  any  other  treatment  will 
prevent  an  outbreak  of  the  disease.  The  report  on  sympathetic 
ophthalmitis  '  gives  "  three  cases  in  which  the  damaged  eye  was 
excised  almost  immediately  after  the  injury  and  yet  iritis  after- 
ward occurred  in  the  other.  We  think  it  well  to  quote  these 
cases  without  expressing  an  opinion  as  to  their  nature,  pointing 
out,  however,  that  the  attack  in  each  case  differed  materially 
1  Tr.  Oph  Soc.  U.  K.,  vol.  vi.,  pp.  192-194. 


SYMPATHETIC    INFLAMMATION.  103 

from  common  sympathetic  ophthalrnitis,  and  that  in  each  case 
the  damaged  exciting  eye  had  been  ruptured  by  a  severe  blow. 

"  In  Case  48,  a  woman,  set.  45,  had  her  left  eye  ruptured  by  u  blow, 
on  January  15th,  1884.  It  was  excised  by  Dr.  Little,  of  Manchester,  on 
the  same  day.  The  other  (right)  eye  seemed  healthy  at  the  date  of  excis- 
ion. On  the  20th  there  was  slight  muco-puruleut  conjunctivitis,  but 
pupil  was  clear  and  active.  On  the  23d,  chemosis,  pupil  sluggish,  acting 
imperfectly  to  atropiue.  24th,  distinct  iritis  with  lymph  in  iris  and 
pupil,  severe  congestion  and  pain,  conjunctival  discharge  nearly 
stopped.  25th,  iritis  worse,  no  keratitis  punctata  could  be  made  out;  there 
was  marked  congestion  at  the  limbus  corneju.  From  this  time  rapid 
improvement,  and  by  February  20th  the  eye  was  practically  well,  free 
from  synechiic  and  V.  perfect.  There  was  no  history  or  evidence  of 
syphilis  and  no  other  apparent  cause  for  the  iritis. 

"  CASE  112. — Man,  aged  about  20,  left  eye  hurt  by  a  blow  on  Janu- 
ary 22d,  1883,  and  excised  the  next  day.  The  socket  healed  well  and  re- 
mained free  from  irritation.  A  glass  shell  worn  after  two  weeks. 
Seven  weeks  after  excision  acute  iritis  with  ciliary  congestion  and  |Miin 
set  in  in  the  other  (right)  eye.  The  attack  not  severe,  and  was  well  in 
a  few  days,  vision  not  being  affected.  It  remained  well  for  seven 
months,  when  a  relapse  occurred  with  more  syneehhe.  This  attack 
lasted  nearly  two  months,  but  the  eye  recovered  with  V=|jj.  No  kera- 
titis punctata  was  observed.  None  of  the  ordinary  causes  of  iritis 
noted." 

"CASE  109. — An  engine-driver,  aet.  41,  had  his  right  eye  smashed 
and  orbital  tissue  much  bruised  in  a  railway  accident.  The  eye  was 
excised  within  forty-eight  hours.  The  tissues  healed  tardily  and  dis- 
charged more  than  usual.  From  four  to  six  weeks  later  severe  acute 
iritis  came  on  in  the  other  (left)  eye.  The  attack  lasted  alxmt  a  month. 
Then  the  eye  became  quiet  and  sight  improved  somewhat,  but  a  few 
days  before  admission,  six  months  after  the  accident,  a  tolerably  severe 
relapse  took  place,  vision  not  20  Jaeger,  Tn.  Rapid  improvement. 
Five  weeks  later  V=Jg,  numerous  synechiie,  thin  membrane  in  the 
pupil,  iris  texture  natural.  The  eye  remained  quiet  for  the  few  follow- 
ing weeks,  during  which  he  remained  under  notice.  Chronic  articular 
rheumatism  in  hip,  knee,  and  elbow,  on  same  side  as  the  iritis,  four 
years  previously;  but  no  inflammation  of  the  eye  then;  no  syphilis." 

It  may  be  assumed  that  these  three  cases  belong  to  the  mild 
grade  of  sympathetic  inflammation.  As  such  they  are  abso- 
lutely exceptional;  and,  if  it  be  admitted  that  they  are  genuine 
cases  of  sympathetic  inflammation,  the  cause  of  the  outbreak  of 
the  sympathetic  disease,  after  the  prompt  excision  of  the  injured 
organ,  may  be  sought  in  the  bruising  of  the  tissues  of  the  orbit 


106  VISION   AND   AUDITION — WOODWARD. 

On  the  other  hand,  sympathetic  inflammation  may  occur 
after  excision  of  the  exciter,  when  the  operation  is  performed 
after  a  longer  delay.  Mauthner '  has  claimed  that  in  some  of 
those  cases  the  operation  was  the  starting-point  of  the  sympa- 
thetic disease.  He  cites  two  cases  of  neuro-retinitis  published 
from  Mooren's  practice,  and  another  case  of  "  hyperaBsthesia 
ciliaris"  also  Mooren's,  all  of  which,  he  claims,  were  produced 
by  the  enucleation.  Davis8  has  reported  from  the  practice  of 
Roosa  two  cases  of  sympathetic  inflammation  occurring  after 
enucleation  of  the  exciter.  In  the  first,  enucleation  of  an  atro- 
phied globe,  resulting  from  an  accident  after  a  cataract  extrac- 
tion two  months  earlier,  was  performed,  June  7th,  1890.  On  July 
16th,  1890,  the  patient  returned  with  sympathetic  irido-cyclitis 
in  the  remaining  (right)  eye.  Removal  of  the  stump  of  left  eye  on 
the  following  day.  Other  treatment  immediately  inaugurated. 
Finally  the  eye  became  soft  and  V=pl  (?).  The  second  case 
was  one  of  injury  and  traumatic  cataract,  seen  August  5th,  1890. 
Cataract  removed,  iridectomy  performed ;  eye  remained  painful 
and  was  enucleated,  November  20th,  1890.  Good  recovery,  no 
sympathetic  irritation  when  discharged.  December  20th,  1890, 
patient  returned  with  sympathetic  irido-cyclitis.  Patient  had 
noticed  for  a  week  that  he  could  not  see  distinctly.  In  June, 
1892,  V=^-1o%-;  patient  gets  about  with  difficulty.  "The  plastic 
irido-cyclitis  is  slowly  destroying  his  sight." 

Referring  again  to  the  Report  on  Sympathetic  Ophthalmitis3 
for  further  information  regarding  this  question,  we  find  that 
there  were  "  30  cases  of  genuine  sympathetic  ophthalmitis  set- 
ting in  after  enucleation  of  the  exciter,  and  6  others  the  sympa- 
thetic nature  of  which  is  doubtful.  Taking  the  30  true  cases 
we  find  that  18  recovered  completely,  3  partially,  and  9  were  lost. 

"  The  first  subject  of  inquiry  in  this  group  is  whether  the 
sympathetic  disease  is  caused  by  the  injured  eye  or  by  the  ope- 
ration for  its  removal.  If  the  disease  were  due  to  the  excision 
we  should  expect  to  meet  occasionally  with  cases  coming  on  a 
long  time  afterward.  We  find  the  following  four  cases  in  which 
such  is  said  to  be  the  case : 

"CASE  1. — A  young  woman  lost  the  left  eye  from  spontaneous 
irido-choroiditis.  Many  years  after,  at  the  age  of  30,  it  was  excised  on 

I  "Symp.  Dis.  of  the  Eye,"  p.  153.          3  Tr.  Oph.  Soc.  U.  K.,  vol.  vi., 

II  N.  Y.  Med.  Rec.,Oct.  15th,  1892.      pp.  190-192. 


SYMPATHETIC   INFLAMMATION.  107 

account  of  irritation  in  the  right.  Tins  ceased  after  excision,  but  twelve 
months  after  the  operation  the  right  eye  passed  through  a  painless 
attack  of  iritis  with  keratitis  punctata  and  opacities  in  the  vitreous.  It 
improved  for  a  time,  but  four  years  later  the  disease  was  still  active 
and  vision  very  bad.  Other  possible  causes  of  iritis  not  mentioned. 
(Cant,  Case  1,  unpublished. ) 

"CASE  191. — A  woman  lost  her  left  eye  by  sloughing  of  the  cornea 
in  gonorrhceal  ophthalmia  at  36.  After  being  quiet  ten  years  it  became 
painful,  and  was  excised.  A  year  afterward,  at  the  age  of  47,  there 
was  pain  in  this  orbit  with  puckering  around  the  end  of  the  optic  nerve. 
At  the  same  time  acute  iritis  came  on  in  the  other  (right)  eye.  The 
stump  of  the  left  optic  nerve  was  cut  out,  and  under  treatment  the 
right  rapidly  and  completely  recovered,  and  did  not  relapse.  There  is 
no  note  as  to  syphilis  or  gonorrhoea!  rheumatism.  (Ay res,  Knapp's 
Archives,  XL,  199.) 

"CASE  199. — The  left  eye  of  a  man,  set.  30,  was  excised,  reason  not 
stated.  He  wore  an  artificial  eye  without  trouble  for  the  next  fifteen 
years,  when,  on  getting  a  new  eye,  much  irritation  of  the  conjunctiva 
came  on.  Two  and  one-half  weeks  after  beginning  the  use  of  this  eye, 
well-marked  plastic  iritis  with  much  effusion  began  in  the  other  (right) 
eye.  It  recovered  perfectly  under  the  usual  measures,  including  mer- 
cury and  removal  of  the  artificial  eye.  Three  months  later  vision  per- 
fect. No  history  of  rheumatism  or  syphilis.  (Culbertson,  Amer.  Jour. 
Ophth.,  I.,  161.) 

"CASE  200. — A  man,  aet.  23.  Blow  on  right  eye  with  a  small  piece 
of  wood,  probably  causing  rupture.  Excised  seven  mouths  later  for 
irritation  in  the  left.  All  irritation  ceased,  and  for  nearly  nine  years 
he  could  see  as  well  as  ever  he  did  in  his  life.  Then  (nine  years  after 
excision)  slight  pain  in  the  eye  and  progressive  failure  of  sight.  When 
seen  twelve  months  later,  very  severe  plastic  iritis  with  ciliary  staphy- 
lomata,  T  slightly  +,  severe  pain,  V=  p.  1.  in  the  outer  part  of  the 
field.  After  sclerotomy,  pain  subsided,  but  the  eye  became  soft.  Other 
possible  causes  of  iritis  not  mentioned.  (Lawson,  O.  H.  R.,  X.,  p.  3.) 

"Another  case  by  Colsmann  (Case  207)  may  be  mentioned,  in  which 
the  interval  was  six  months,  but  as  the  disease  in  the  second  eye  took 
the  form  of  neuro-retinitis  only,  the  sympathetic  nature  of  the  attack 
is  very  doubtful. 

"  The  only  two  of  these  cases  which  are  at  all  convincing  are 
Cases  1  and  200,  and  to  them  we  do  not  see  that  any  exception 
can  be  taken,  unless  it  be  assumed  that  the  disease  in  the  sec- 
ond eye  was  spontaneous. 

"  Again  if  the  sympathetic  disease  were  due  to  the  excision, 
we  should  expect  to  meet  with  it  sometimes  after  the  removal 
of  eyes  which,  had  they  been  left,  would  not  have  produced  it. 


108  VISION   AND    AUDITION — WOODWARD. 

But  in  turning  to  the  cases  we  find  only  a  single  instance,  and 
that  one  already  quoted  as  doubtful  (Case  1  above) ,  in  which 
the  exciter  was  lost  by  spontaneous  inflammation.  In  all  the 
others  there  had  been  a  complicated  wound,  operation,  or  per- 
forating ulcer. 

"  Assume  then  that  sympathetic  disease  beginning  after  ex- 
cision is  due  to  the  eye  and  not  to  the  operation  for  its  removal, 
we  may  next  ask:  What  is  the  interval  that  may  elapse  be- 
tween removal  of  exciter  and  the  onset  of  the  sympathetic  in- 
flammation? We  find  that  this  (the  'second  interval')  was  be- 
tween two  and  five  days  in  1 1  cases ;  between  one  and  two  weeks 
in  7  cases;  about  three  weeks  in  6  cases;  and  from  one  month 
to  eight  weeks  in  5  cases.  The  5  cases  just  quoted  in  which 
the  interval  was  extraordinary  in  length  are  not  here  included. 
Although  the  length  of  the  'second  interval ' l  thus  varied  from 
two  or  three  days  to  seven  or  eight  weeks,  the  sum  of  the  first 
and  second  intervals  showed  a  much  smaller  range,  viz.,  from 
four  to  eight  weeks,  only  exceeding  the  latter  in  two  cases. 
Now,  from  four  to  eight  weeks  is  a  common  interval  between 
injury  and  sympathetic  disease,  but  the  second  interval  alone 
was,  as  the  above  figures  show,  usually  too  short  to  permit  of 
our  assuming  the  excision  to  have  been  the  cause.  It  may  fur- 
ther be  observed  that  in  none  of  these  cases  was  the  eye  excised 
promptly ;  ample  time  was  always  allowed  for  traumatic  in- 
flammation to  set  in.  In  fact  the  'first  interval'  alone  was 
nearly  always  of  sufficient  length  to  account  for  the  occurrence." 

Such  is  the  nature  of  the  evidence  both  for  and  against  the 
opinion  that  enucleation  may  excite  sympathetic  inflammation. 
In  conclusion,  it  may  be  said  that  while  the  possibility  that 
the  operation  may  be  the  starting-point  of  sympathetic  disease 
cannot  be  denied  absolutely,  still  the  burden  of  proof  remains 
with  those  who  maintain  that  in  a  given  case  it  has  excited  an 
attack  of  sympathetic  inflammation. 

II.  THE  PREVENTIVE  TREATMENT,  WHEN  THE  EXCITER 
is  NOT  DESTROYED. — Traumatisms  may  destroy  an  eye  directly 
and  immediately,  or  indirectly  through  the  consecutive  inflam- 
mation. It  follows,  in  some  instances,  that  an  injured  eye  may, 

1  "First  interval"  equals  time  in-  time  intervening  between  the  ex- 
terven ing  between  the  lesion  and  the  cision  and  occurrence  of  sympa- 
excision  ;  "second  interval"  equals  thetic  ophthalmia. 


SYMPATHETIC   INFLAMMATION.  109 

in  the  early  days,  retain  a  fair  amount  of  vision,  which  later  on 
is  destroyed  more  or  less  thoroughly  by  the  inflammatory  process. 
Hence,  in  coming  to  a  decision  regarding  the  treatment  to  be 
adopted  in  a  case  of  injury,  it  is  necessary  to  consider  both  the 
immediate  and  the  remote  effects  of  the  accident  upon  the  use- 
fulness of  the  organ.  Should  the  eye  still  retain  fair  vision,  and, 
after  a  few  days'  observation  of  the  case,  should  it  appear  highly 
probable  that  the  function  of  the  eye  will  IK?  permanently  de- 
stroyed by  the  inflammatory  process,  enitcleation  may  IMS  ad- 
vised as  a  protective  measure  against  sympathetic  ophthalmia. 

If,  after  an  accident  which  has  not  totally  destroyed  the  use- 
fulness of  an  eye,  the  symptoms  of  sympathetic  irritation  ap- 
pear in  the  fellow-eye,  the  injured  organ  may  be  removed ;  and 
it  is  not  advisable  to  delay  the  radical  treatment  when  the  sym- 
toms  of  irritation  are  intense  enough  to  excite  apprehension 
that  the  other  eye  may  experience  an  outbreak  of  sympathetic 
inflammation.1 

As  a  general  rule,  to  which  there  are  exceptions,  it  may  be 
advised  that  all  eyes  in  a  state  of  chronic  irido-cyclitis,  which 
contain  foreign  bodies  that  cannot  be  removed,  should  be  enu- 
cleated to  prevent  sympathetic  ophthalmia,  even  though  they 
may  retain  useful  vision.* 

In  many  cases,  when  the  exciter  retains  considerable  visual 
power,  it  is  difficult  to  decide  upon  the  l>est  treatment  to  adopt. 
The  dangers  incident  to  an  attempt  to  save  some  of  these  eye- 
balls should  be  fully  and  fairly  explained  to  the  patient  and  his 
family.  Should  they  leave  the  attendant  untrammelled  in  his 
management  of  the  case,  he  should  adopt  the  surest  method  of 
saving  his  patient's  vision,  even  at  the  expense  of  an  eye  which 
may  still  retain  considerable  visual  acuteness.  On  the  other 
hand,  the  patient  or  his  family  may  interdict  operative  inter- 
ference, and  it  is  then  the  surgeon's  duty  to  do  as  well  as  possi- 
ble  under  the  circumstances,  in  which  contingency  ho  should 
not  be  held  responsible  for  a  disastrous  termination  of  the 
case. 

III.  CURATIVE  TREATMENT,  WHEN  THE  EXCITER  is  DE- 
STROYED.—Should  enucleation  of  the  exciter  be  performed  after 
sympathetic  inflammation  has  broken  out?  The  strongest  ob- 

1  Mauthner.   "Sympath.    Dis.    of          «  Swanzy.  op.  cit.,  1890.  p.  259. 
the  Eye,"  p.   167. 


110  VISION   AND   AUDITION — WOODWARD. 

jection  to  that  practice  is  raised  by  Mauthner,1  who  says:  "In 
my  opinion,  there  cannot  be  the  least  doubt  that  iritis  serosa 
may  become  transfored  into  iritis  maligna  by  the  operation 
of  enucleating  the  other  eye/'  Enucleation  "  may  cause  sym- 
pathetic inflammation  in  a  previously  healthy  eye,  as  well  as 
increase  a  mild  inflammation  to  the  most  severe.  Enucleation 
is  of  no  benefit  whatever  in  genuine  iritis  maligna,  but  occa- 
sionally, when  the  sympathizer  is  extremely  irritated,  does 
harm."  This  opinion  is  defended  by  the  citations  of  a  few  un- 
decisive cases.  Opposed  to  Mauthner  stands  the  report  of  the 
committee  on  sympathetic  ophthalmitis.2  In  it  we  find  the  fol- 
lowing: "When  sympathetic  inflammation  has  begun  does  ex- 
cision of  the  exciting  eye  influence  its  progress?  ...  Of  our 
total  (about  200)  we  find  4  cases  in  which  the  exciter  was  re- 
moved within  a  short  time  of  the  outset  of  sympathetic  inflam- 
mation (that  is,  within  three  weeks  of  the  outbreak  of  the  symp- 
toms of  structural  disease  in  the  sympathizing  eye)  and  of  these 
the  sympathizing  eye  was  known  to  be  lost  in  only  8.  In  an 
almost  identical  number  (65),  the  exciter  was  either  not  removed 
at  all,  or  not  till  long  after  the  sympathetic  disease  had  set  in, 
and  in  no  less  than  26  of  these  the  sympathizer  was  lost.  .  .  . 
Whether  early  removal  of  the  exciting  eye  be  positively  useful 
in  staying  the  disease  or  no,  it  is  certainly  not  injurious,  as  no 
less  an  authority  than  Mauthner  has  asserted  that  it  is  when 
sympathetic  disease  is  of  the  'serous  form.'  .  .  .  Recovery 
of  the  sympathizer  after  early  removal  of  the  exciter  may  be  in 
part  ascribed  to  the  natural  mildness  of  the  disease  (in  both 
eyes).  .  .  .  Loss  of  the  sympathizer  when  exciter  is  not  re- 
moved may  in  part  be  ascribed  to  the  natural  severity  of  the 
disease  (in  both  eyes) .  On  the  other  hand  the  fact  that  sym- 
pathetic ophthalmitis,  when  it  sets  in  after  enucleation  of  the 
exciting  eye,  is  usually  mild  seems  to  show  that  early  removal 
of  the  cause  does  in  some  degree  check  the  disease." 

Schirmer  entertains  a  similar  opinion.  He  says :  "  If  sym- 
pathetic inflammation  has  already  broken  out,  the  exciting  eye, 
if  blind,  should  be  removed.  The  removal  of  the  exciting  eye 
has  never  been  proved  to  have  an  ill  effect  on  the  sympathetic 
inflammation,  but  has  on  the  other  hand  appeared  in  many 

1  "Sympath.  Dis.  of  the  Eye, "  pp.          s  Tr.   Oph.  Soc.  U.    K.,   vol.  vi., 
157,  159.  pp.  171-173. 


SYMPATHETIC   INFLAMMATION.  Ill 

cases  to  act  beneficially  in  this  respect,  although  the  improve- 
ment may  not  be  permanent.  It  is  rational  to  remove  the 
source  of  the  infection,  and  thereby  to  obviate  the  chance  of  a 
further  migration  of  germs  from  one  eye  to  the  other ;  moreover, 
the  enucleation  cuts  short  any  sympathetic  irritation  which 
may  be  present,  and  thereby,  in  all  probability,  favore  the  sub- 
sidence of  the  inflammation." ' 

IV.  CURATIVE  TREATMENT,  WHEN  THE  EXCITER  IB  NOT 
DESTROYED. — Given  a  case  of  sympathetic  inflammation  in 
which  the  exciter  retains  useful  vision,  should  enucleation  be 
performed?  Mauthner*  replies:  "  Every  one  will  admit  that  it 
is  a  crime,  in  a  case  of  pronounced  sympathetic  irido-cyclitis, 
to  enucleate  an  eye  which  still  possesses  vision,  or  in  which 
vision  might  at  a  later  date  be  restored."  Swanzy'says:  al 
would  not  enucleate  the  exciting  eye,  if  sympathetic  ophthalmitis 
had  already  appeared,  should  the  vision  of  the  exciting  eye  be 
fairly  good.  For  it  often  occurs  that  the  process  in  the  sympa- 
thizing eye  is  not  arrested  by  the  proceeding,  and  that,  when 
the  latter  is  not  undertaken,  the  exciting  eye  turns  out  in  the 
end  to  be  the  organ  with  the  better  vision." 

Nettleship4  advises  as  follows:  "The  exciting  eye,  if  quite 
blind  or  so  seriously  damaged  as  to  be  for  practical  purposes 
certainly  useless,  is  to  be  excised  at  once,  though  the  evidence 
of  benefit  from  this  course  is  slender.  But  it  is  not  to  be  re- 
moved if  there  is  reason  to  hope  for  restoration  of  useful  sight 
in  it;  if  there  is  simply  a  moderate  degree  of  subacute  iritis, 
with  or  without  traumatic  cataract,  and  with  sight  proportion- 
ate to  the  state  of  the  lens,  the  eye  is  to  be  carefully  treated, 
since  it  may  very  probably  in  the  end  be  the  better  of  the  two. " 

Finally,  Lawson  *  makes  the  following  observation :  "  On 
several  occasions,  when  the  injured  eye  has  retained  some  sight, 
I  have  seen  the  opposite  eye  destroyed  by  sympathetic  ophthal- 
mia, while  the  injured  eye  so  recovered  that  useful  sight  has 
been  restored,  and  the  patient  has  been  able  to  get  about  without 
assistance.  ...  If  sympathetic  ophthalmia  be  established,  the 
injured  eye  should  not  be  removed  if  it  retains  any  sight." 
When  the  sympathizer  is  lost,  it  may  be  enucleated  if  the  exciter 

1  Ophthalmic  Review,  London,        *  Op.  eit.,  p.  200. 
March,  1893,  pp.  97,  98.  4  Op.  eit..  p.  176. 

*  Op.  tit.,  p.  169.  •  R  L.  Oph.  Hosp.  Rep.,  vol.  x.,  p.  B. 


112  VISION   AND    AUDITION— WOODWARD. 

retain  some  vision.  For,  according  to  Berry,1  "cases  have 
been  met  with  when  there  seems  to  have  been  good  reason  to 
think  it  has  reacted  on  the  first  or  original  exciter." 

In  the  present  state  of  our  knowledge,  enucleation  must  be 
ranked  superior  to  any  of  its  substitutes  in  sympathetic  disease. 
The  most  noteworthy  of  the  substitutes  are  evisceration,  Mules' 
operation,  and  optico-ciliary  neurectomy.  Evisceration  is  es- 
pecially favored  by  Graefe  of  Halle.  The  objections  to  it  are, 
the  wound  heals  more  slowly  than  in  the  case  after  enucleation, 
and  the  local  reaction  is  more  intense.  Moreover,  the  posterior 
one-half  of  the  solera  of  the  displaced  organ  is  permitted  to  re- 
main to  form  the  stump.  The  operation  of  inserting  a  glass  sphere 
into  the  scooped-out  sclera  (Mules'  operation)  is  open  to  the  same 
criticism.  Optico-ciliary  neurectomy,  championed  by  DeWecker 
and  performed  also  by  Schweigger,  consists  in  the  abscission  of 
a  segment  of  the  optic  and  ciliary  nerves,  leaving  the  eyeball  in 
the  orbit.  The  focus  of  the  exciting  cause  therefore  is  not  re- 
moved ;  and,  since  the  mode  of  propagation  of  the  sympathetic 
disease  is  still  unknown,  this  operation  should  not  be  as  favor- 
ably regarded  as  the  others.8  Undoubtedly  there  are  cases  suita- 
ble for  each  of  these  operations.  The  question  whether,  in  a 
given  case,  one  or  the  other  should  have  been  performed  can  be 
answered  only  after  consideration  of  the  circumstances  which 
confronted  the  surgeon.  When  such  heroic  measures  are  indi- 
cated, enucleation  will  give  the  patient  the  best  chance  of  a  fa- 
vorable result;  and  an  operator,  who  elects  a  procedure  other 
than  that  in  a  case  of  sympathetic  inflammation,  should  be  pre- 
pared to  give  a  sufficient  reason  for  his  choice. 

1  "Dis.  of  the  Eye,"  1893,  p.  348.          2  Compare  Berry,  op.  cit.,  p.  350. 


CHAPTER  VIII. 

INJURIES  OF  THE 


INJURIES  OP  THE  EXTERNAL  EAR. 

CONTUSIONS,  contused  wounds,  incised,  punctured,  and  lac- 
erated wounds,  gunshot  wounds,  and  burns  of  the  external  ear 
are  occasionally  observed.  The  cartilages  may  be  fractured  by 
a  contusion.  Destruction  of  tissue  by  wounds  may  be  extensive 
or  it  maybe  trifling;  it  maybe  an  immediate  consequence  of 
the  injury,  or  the  greatest  loss  of  tissue  may  ensue  from  inflam- 
mation and  gangrene  of  the  affected  structures.  The  auricle 
has  been  completely  severed  from  the  head. 

Even  severe  wounds  of  the  auricle  show  a  marked  tendency 
to  heal  kindly.  Completely  severed  parts  will  occasionally 
unite  if  brought  into  proper  coaptation  with  the  wounded  mem- 
ber and  held  there  by  sutures  and  carefully  applied  dressings. 
Of  course  this  extraordinary  result  will  not  be  attained  if  the 
wound  be  not  thoroughly  disinfected  and  the  entrance  of  mi- 
crobes into  it  be  not  prevented  by  appropriate  antiseptic  precau- 
tions. On  the  other  hand,  not  all  wounds  of  the  auricle  run  a 
favorable  course.  Inflammation  with  suppuration  sometimes 
sets  in,  causing  swelling  of  the  ear  and  adjacent  parts,  destroy- 
ing the  cartilages  to  a  greater  or  less  extent,  and  resulting  in 
prolonged  annoyance  and  permanent  deformity. 

Contusions  of  the  auricle  give  rise  to  inflammation  of  the 
investing  membrane  of  the  cartilages,  —  the  peri  chondri  urn. 
Such  inflammation  may  be  productive  of  abscess  and  subse- 
quent deformity  of  the  ear.  In  other  cases,  contusions  are  fol- 
lowed by  the  appearance  of  a  blood  tumor  of  the  auricle,  known 
as  othcematoma.  This  tumor  is  duo  to  extravasation  of  blood 
between  the  perichondrium  and  the  cartilage,  or  between  the 
perichondrium  and  the  skin,  or  to  extravasations  into  the  sub 
stance  of  the  cartilage.  Experiments  on  animals  '  indicate  that 

1  HQttig.  Viertelsjahrsschrift  fQr  gericht.  Metl.  u.  rtffentlirh.  Sanitate 
wesen,  Oct.,  1893,  221. 

III.—  8  113 


114  VISION   AND   AUDITION — WOODWARD. 

the  extravasation  may  not  set  in  for  twenty-four  hours,  or  a 
longer  time.  Otha3matoma  occurs  also  as  a  spontaneous  or 
idiopathic  affection.  In  both  the  traumatic  and  the  idiopathic 
cases,  the  left  ear  is  commonly  the  site  of  the  trouble ;  and  in  both, 
the  tumor  is  observed  almost  invariably  upon  the  anterior  aspect 
of  the  concha.  But  it  has  been  found  on  the  back  side  of  the  ex- 
ternal ear.  Idiopathic  cases  are  observed  among  the  insane; 
rare  exceptions  to  this  rule  have  been  reported  as  occurring  in 
sane,  but  debilitated  subjects. 

Gruber '  describes  the  appearance  of  idiopathic  othsematoma 
as  follows :  It  "  commences  most  commonly  in  the  upper  part, 
in  the  fossa  triangularis  (fork  of  the  antihelix) ,  or  in  the  upper 
half  of  the  concha;  appearing  as  a  larger  or  smaller,  more  or 
less  distinctly  fluctuating,  circumscribed  tumor;  the  skin  cov- 
ering it  being  either  normal  or  of  a  livid  red  color.  The  sur- 
face is  regular  and  smooth,  if  the  blood  has  been  effused  into  the 
subcutaneous  areolar  tissue;  or  if,  as  is  often  the  case,  the  ex- 
travasation has  taken  place  into  the  substance  of  the  cartilage 
itself,  or  between  this  and  the  perichondrium,  the  external  sur- 
face exhibits  more  or  less  definitely  the  ordinary  elevations  and 
depressions  of  the  auricle."  In  traumatic  cases  there  is  no  char- 
acteristic hemorrhage,  but  the  appearances  may  be  identical 
with  those  of  the  idiopathic  variety.  Other  evidence  of  injury 
may  be  found.  Fracture  of  the  cartilages  may  be  noted.  But, 
inasmuch  as  the  cartilages  are  softened  in  some  idiopathic  cases, 
and  fragments  of  them  may  be  felt  beneath  the  fluctuating 
swelling,  the  signs  of  fracture  of  the  cartilages  do  not  necessa- 
rily indicate  the  nature  of  the  cause  of  the  extravasation. 

The  subjective  symptoms  of  idiopathic  otha3matoma  are  a 
feeling  of  fulness  and  burning  in  the  auricle.  Traumatic  cases 
may  give  more  marked  symptoms,  especially  pain,  tenderness, 
and  heat.  An  abscess  forms  occasionally.  Should  the  tumor 
rupture,  septica3mia  may  follow.  Cases  of  that  nature  have 
been  reported.  Both  traumatic  and  idiopathic  othsematomata 
cause  permanent,  unsightly  deformity  of  the  auricle. 

Burns  of  the  external  ear  by  heat  or  corrosive  agents  present 

considerable  variety  as  regards  the  extent  of  surface  involved 

and  the  degree  of  destruction  of  tissue.     Superficial  burns  of  the 

auricle  heal  very  satisfactorily,  leaving  inconspicuous  traces 

1  "Dis.  of  the  Ear,"  N.  Y.,  1890,  p.  221. 


INJURIES  OF  THE   EXTERNAL   AUDITORY   CANAL.          115 

behind.  Deep  burns,  however,  deform  the  auricle.  The  entire 
external  ear  may  be  burned  away.  When  the  bum  involves 
the  parts  surrounding  the  orifice  of  the  external  auditory  canal, 
the  resulting  cicatrix  will  close  the  ear.  Such  a  result  will 
cause  deafness.  Considerable  difficulty  would  be  experienced 
in  attempting  to  re-establish  the  opening  of  the  external  audi- 
tory canal  if  the  cicatrix  were  not  very  thin.  In  some  cases, 
failure  would  follow  every  such  attempt. 

Spontaneous  gangrene  of  the  auricle  has  been  observed  by 
Eitelberg,1  who  has  reported  two  cases  of  it:  that  of  a  boy  thir- 
teen months  old,  who  suffered  also  from  suppuration  of  the  mid- 
dle ear  and  died  on  the  fifth  day  of  exhaustion ;  and  that  of  a 
badly  nourished  girl,  three  weeks  old,  in  whom  the  lobule  and 
concha  became  dark  brown,  shrunken,  and  cold  (a  similar 
spot  was  found  at  the  umbilicus) . 

INJURIES  OF  THE  EXTERNAL  AUDITORY  CANAL. 

The  external  auditory  canal  is  anatomically  divided  into  two 
portions,  a  cartilaginous  and  a  bony.  Either,  or  both,  may  be 
injured  by  direct  violence.  Lesions  of  the  cartilaginous  por- 
tion of  the  canal  are  of  minor  importance.  They  may  excite 
inflammation  which  will  temporarily  diminish  the  acuteness  of 
hearing.  Healing  occurs,  however,  in  the  greater  number  of 
cases,  with  no  permanent  impairment  of  the  organ.  Burns 
may  close  the  canal  permanently  by  cicatricial  contraction,  if 
the  lesion  be  a  severe  one.  Knapp  *  has  reported  one  such  case 
from  sulphuric  acid.  Permanent  atresia  resulted. 

Lesions  of  the  bony  portion  of  the  external  auditory  canal 
are  the  result  of  either  direct  or  of  indirect  violence.  They  may 
be  complicated  by  direct  injury  to  the  drum -head  and  middle 
ear.  Or,  injury  to  the  canal  may  excite  an  inflammation  of  the 
drum-head  which  will  lead  to  perforation  of  the  latter  and  sup- 
puration in  the  middle  ear.  Hiittig'  asserts  that  this  result  is 
most  common  after  injury  to  the  superior  wall  of  the  canal. 
The  mastoid  process  may  be  invaded  by  inflammation,  which 
sometimes  extends  to  the  drum,  when  the  posterior  or  posterior- 
superior  wall  is  injured.  When  the  anterior  wall  is  injured, 
the  parotid  gland  may  become  inflamed. 

1  HQttig,  op.  tit.,  p.  221.  *  Ibid.,  p.  224.  » Ibid.,  p.  228. 


11G  VISION   AND    AUDITION — WOODWARD. 

Diffuse  inflammation  of  the  canal  occurs  in  consequence  of 
direct  injury ;  but,  in  general,  resolution  is  perfect,  leaving  no 
permanent  effects.  In  other  cases,  subjective  noises  and.  deaf- 
ness remain.  In  still  other  cases,  the  canal  is  partially  or  com- 
pletely closed  by  the  results  of  the  inflammatory  process,  there- 
by affecting  the  hearing  to  a  marked  degree. 

Intense  inflammation  of  the  external  auditory  canal  has  been 
excited  by  introducing  into  it  cotton  moistened  with  creosote. 
Trautmann '  reported  two  such  cases ;  in  both  hearing  was 
temporarily  affected.  Christinneck2  reported  a  case  of  inflam- 
mation following  the  introduction  of  concentrated  carbolic  acid 
into  the  canal;  healing  was  complete  in  two  weeks. 

Injuries  of  the  external  auditory  canal  occur  in  consequence 
of  indirect  violence.  The  soft  parts  have  been  injured  by  pull- 
ing the  ears.  The  bony  walls  have  been  fractured  by  a  blow  or 
a  fall  upon  the  head,  or  by  a  blow,  or  a  fall  upon  the  chin  or 
lower  jaw.  When  the  force  is  transmitted  through  the  lower 
jaw,  the  anterior  wall  of  the  canal  is  fractured,  and  the  lesion 
may  occur  in  both  ears  at  the  same  time.  Baudrimont3  ob- 
served such  a  case  in  which  the  lower  jaw  was  dislocated  back- 
ward. After  the  dislocation  was  reduced  the  right  drum-head 
was  found  badly  lacerated ;  some  splinters  of  the  anterior  wall 
were  removed,  and  recovery  took  place. 

When  the  fracture  of  the  bony  walls  is  simple,  hemorrhage 
takes  place  beneath  the  soft  parts,  and  blood  does  not  come  from 
the  ear.  A  subcutaneous  blood-tumor  may  form  and  close  the 
canal.  In  the  case  of  compound  fracture  of  the  bony  walls  the 
ear  bleeds.  The  hemorrhage  may  be  moderately  copious,  but 
soon  ceases  spontaneously.  If,  however,  there  is  also  a  fracture 
of  the  base  of  the  skull,  the  hemorrhage  is  more  persistent,  and 
may  become  serious  enough  to  require  treatment.  The  jugular 
vein  and  the  carotid  artery  may  be  injured  by  the  fracture.  In 
such  cases  the  bleeding  is  profuse.  When  the  hemorrhage 
comes  from  the  carotid,  it  will  prove  fatal. 

In  compound  fractures,  the  lesion  may  be  diagnosticated 
with  the  sound  before  inflammation  and  swelling  set  in.  Mas- 
tication will  be  painful  or  impossible  in  fractures  of  the  anterior 
wall  of  the  canal. 

1  "Handbuch     der    gerichtlichen          2  Hiittig,  op.  cit.,  p.  224;  Archiv 
Medicin,"    von   Dr.    J.      Maschka,       f.  Ohrenheilk.,  Bd.  18,  S.  291. 
Tubingen,  1881,  i.,  386.  3  Hiittig,  op.  tit.,  227. 


INJURIES   UP   THE    DRUM-HEAD.  117 

Uncomplicated  fractures  of  the  canal  do  not,  in  general, 
leave  any  permanent  evil  consequences.  Protracted  inflamma- 
tion, or  caries  or  necrosis  of  the  bones  ensues,  in  a  certain  num- 
ber of  cases. 

INJURIES  OP  THE  DRUM-HEAD. 

Ruptures  or  perforations  of  the  drum-head  are  caused  by 
direct  or  by  indirect  violence.  Direct  violence  to  the  drum-head 
is  done  by  penetration  of  objects  thrust  into  the  ear;  by  shot 
wounds;  by  violently  syringing  the  ear;  by  surf  bathing;  by 
entrance  into  the  ear  of  molten  metals,  steam,  scalding  water,  or 
corrosive  agents.  Indirect  violence  to  the  drum-head  is  caused  by 
blows  upon  the  ear  with  the  open  hand,  fist,  or  missiles;  by 
falls  upon  the  ear ;  by  severe  concussion  transmitted  through 
the  bones  of  the  skull ;  by  intense  sounds  (explosion  of  projec- 
tiles, great  guns,  long-continued  musketry  fire,  machine  guns, 
steam  whistles,  loud  voice) ;  by  violent  traction  on  the  auricle; 
by  sudden  condensation  of  air  in  the  drum  as  when  the  ear  is 
inflated  with  the  air  douche;  by  rarefaction  of  air  external  to 
the  drum-head  as  in  diving;  by  entering  caissons;  by  fracture 
of  the  temporal  bone.1 

A  great  variety  of  things  may  be  thrust  into  the  ear  and 
perforate  or  rupture  the  membrana  tympani.  The  membrana 
may  be  simply  contused  by  such  foreign  bodies,  and  subse- 
quently a  perforation  result  from  the  inflammation  excited 
thereby. 

Destruction  of  the  membrana  tympani,  together  with  other 
serious  lesions  in  the  auditory  apparatus,  has  been  criminally  pro- 
duced by  pouring  corrosive  liquids  or  molten  metal  into  the  ex- 
ternal auditory  canal.  Even  the  entrance  of  cold  water  into  the 
external  auditory  canal  may  excite  inflammation  and  consecutive 
perforation  of  the  membrana  and  suppuration  in  the  middle  ear. 

Indirect  violence  by  blows  upon  the  ear  with  the  open  hand 
or  fist  has  often  resulted  in  rupture  of  the  membrana  tympani. 
Trautmann"  cites  11  such  cases;  Sexton*  refers  to  51  cases 
among  his  records;  other  writers  refer  to  similar  cases.  The 
violence  may  be  comparatively  slight  and  yet  cause  rupture  of 

1  Vide  Sexton,  "The  Enr  ami  its          »  Op.  cit.,  p.  400  et  scq. 
Diseases,"  1888.  p.  ITfi:  nlsoTruu;  3  Op.  cit.,  p.  177. 

inann,  op.  cit.,  1,  p.  392. 


118  VISION   AND   AUDITION — WOODWARD. 

the  drum-head.     Gruber '  refers  to  two  cases  observed  by  him 
in  which  the  rupture  was  caused  by  a  kiss  on  the  ear  (rarefac- 
tion of  the  air  in  the  external  auditory  canal). 
The  following  cases  are  cited   from    Sexton:8 

"That  of  a  young  man,  aged  22,  whose  father  had  given  him  a 
blow  upon  the  left  ear  six  years  previously.  Severe  inflammation  of 
the  middle  ear  followed,  lasting  for  two  years,  during  which  time  the 
air  whistled  through  a  perforation  in  the  drum-head  whenever  he  blew 
his  nose.  When  seen  the  drum-head  was  found  thickened,  irregular, 
and  otherwise  changed  almost  beyond  recognition.  Hearing  very 
much  impaired. 

"  A  young  man  was  slapped  upon  the  left  ear  by  his  father.  There 
was  immediate  pain  and  deafness,  followed  in  a  few  hours  by  a 
watery  discharge,  which  afterward  was  tinged  with  blood.  Two  days 
after  the  boxing,  a  perforation  in  the  lower  segments  of  the  drum-head 
was  giving  vent  to  a  free  discharge  and  the  middle-ear  inflammation 
was  complicated  with  periostitis  externa — the  mastoid  cortex  being 
swollen,  red,  and  tender  to  the  touch.  Autophonia,  noises  in  the  head, 
and  pain  occurred  at  the  beginning,  and  were  very  distressing  for  a 
long  time,  recovery  not  taking  place  for  three  months. 

' '  The  grave  consequences  of  pounding  the  ear  are  well  shown  in 
the  case  of  a  woman  addicted  to  drink,  aged  38,  who  was  struck 
violently  by  a  man  upon  the  right  ear.  The  immediate  result  was 
severe  dizziness,  and  she  had  to  hold  on  to  a  stair-railing  to  keep  from 
falling.  Vertiginous  symptoms  became  more  severe,  and  the  pain  and 
autophonia  with  this  alarmed  her  very  much.  She  was  taken  to  a 
dispensary,  where  an  energetic  attendant,  feeling  that  something  must 
be  done,  vigorously  inflated  the  ear  by  Politzer's  method,  causing 
extreme  pain  in  the  ear,  and  afterward  introduced  some  irritating  medic- 
ament on  cotton-wool  with  instructions  to  keep  it  in  the  ear.  After 
this  the  pain  became  more  severe,  and  she  came  to  the  Eye  and  Ear 
Infirmary,  where  the  drum-head  was  examined.  This  was  found  to 
be  ruptured.  An  enormous  quantity  of  serous  fluid  was  escaping  from 
the  ear,  which  was  believed  to  consist  largely  of  the  water  of  the 
labyrinth,  thus  indicating  that  the  round  window  had  also  been  rup- 
tured by  the  blow.  She  had  now  become  extremely  nervous  and  ex- 
perienced insane  hallucinations,  as  was  confirmed  by  the  physician 
who  saw  the  case.  She  was  admitted  to  the  wards  of  the  infirmary, 
and  purulent  inflammation  of  the  middle  ear  soon  set  in.  The  cerebral 
symptoms — pain,  vertigo,  hallucinations,  etc. — became  more  grave. 
They  seemed  due  in  part  to  the  concussion  of  the  blow;  but  on  review- 
ing the  case  the  author  is  convinced  that  there  was  also  transmission 
of  a  septic  irritant  through  the  cerebro-spinal  fluid  into  the  cranial 

1  Op.  cit.,  257.  2  Op.  cit.,  pp.  178,  179. 


INJURIES   OF  THE   DRUM-HEAD.  119 

cavity,  inducing  leptomeningitis.  The  patient  left  the  infirmary  be- 
fore she  was  well,  and  when  last  heard  from,  a  mouth  after  the  injury, 
had  not  recovered." 

Falls  upon  the  ear  and  blows  upon  the  ear  with  missiles  pro- 
duce ruptures  of  the  membrana  similar  to  those  caused  by  box- 
ing the  ears. 

Pulling  the  ears  in  a  violent  manner  has  ruptured  the  drum- 
head. The  following  cases  are  quoted  from  Sexton : ' 

"Female,  11  years  of  age.  "While  playing  with  some  other  children 
in  front  of  a  shop,  the  proprietor  ran  out  and  seized  the  j»tieut  by  the 
left  auricle,  and,  during  her  struggles  to  escape,  the  organ  was  vio- 
lently wrung  and  pulled.  She  cried  out  with  pain,  which  continued 
for  some  time;  a  discharge  appeared  the  next  day,  and  she  was  brought 
a  few  days  afterward,  July  14th,  1884,  to  the  New  York  Eye  and  Ear 
Infirmary  for  relief.  An  examination  of  the  ear  showed  that  the 
integument  covering  the  superior  wall  of  the  canal  and  the  upper  por- 
tion of  the  drum-head  was  inflamed  and  exfoliating,  and,  furthermore, 
that  the  membrane  was  lacerated  in  several  places  about  the  umbo. 
There  was  a  discharge  through  the  perforations  from  the  drum;  also 
deafness  and  autophonia. 

' '  The  patient  was  under  observation  for  about  seven  weeks,  after 
which  she  failed  to  return.  The  drum-head  had  not  then  healed,  and  a 
purulent  discharge  from  the  ear  still  existed.  There  was  also  consid- 
erable deafness.  On  December  4th,  1887,  three  and  a  half  years  after 
the  injury,  this  patient  called  on  the  author,  stating  that  for  two  or  three 
weeks  she  had  had  a  good  deal  of  pain  and  discharge  in  the  right  ear. 
On  examining  the  left  (injured)  ear,  it  was  found  that  the  drum-head  was 
adherent  to  the  inner  wall  of  the  drum;  furthermore,  that  a  white  cica- 
trix  was  present  behind  the  handle  of  the  hammer,  which  was  drawn 
backward  somewhat.  The  malleus  was  displaced  downward.  Ante- 
riorly the  drum-head  had  a  little  brilliancy.  Loud  ordinary  voice  could 
be  heard  in  the  left  ear  at  twenty  feet  distance.  She  stated  that  the 
left  ear  had  discharged  off  and  on  until  four  months  ago;  that  there 
was  tinnitus  resembling  musical  sounds  and  intermittent  pain  in  the 
same  ear.  She  left  off  going  to  school  six  months  since,  as  she  was  so 
deaf  that  she  could  not  understand  what  the  teacher  said  to  her. 
Patient  has  many  decayed  teeth.  She  works  at  present  in  a  cigarette 
factory. 

"Male,  aged  14  years.  Three  months  ago  his  brother  caught  him 
by  the  lobule  of  the  left  ear,  pulling  it  until  some  blood  escaped  from 
the  canal.  The  ear  has  discharged  ever  since,  and  he  only  hears 
shouting  voice  in  that  ear.  The  left  drum-head  is  hypersemic;  the 

1  Op.  tit.,  p.  223. 


120  VISION  AND   AUDITION— WOODWARD. 

inner  end  of  the  canal,  which  is  large,  is  red,  dry,  and  exfoliating.     A 
month  later,  when  patient  was  last  seen,  the  drum-head  had  healed. 

"Male,  23  years  old.  Two  days  ago  left  auricle  was  seized  by  the 
teeth  of  a  man  during  a  fight.  The  lobule  was  much  torn,  and  the 
traction  made  on  the  auricle  lacerated  the  superior  membranous  wall 
of  the  canal,  where  it  enters  the  bony  portion.  The  membrana  flaccida 
was  also  lacerated  at  its  anterior  insertion.  The  parts  were  still  bleed- 
ing, and  the  neighborhood  very  much  injected.  There  was  no  deaf- 
ness. Patient  seen  but  once." 

The  following  case  quoted  from  Gruber1  exhibits  other 
consequences  of  a  blow  upon  the  ear  than  rupture  of  the  drum- 
head : 

"As  an  example  of  injury  to  the  ear  from  a  blow,  without  rupture 
of  the  drum-head  resulting,  a  case  of  Biirkner's 2  may  be  cited.  The 
patient  was  knocked  down  and  rendered  senseless  by  a  blow  from  the 
fist  over  the  ear.  On  recovering  consciousness,  two  hours  later,  he 
had  a  loud  buzzing  in  the  ear,  with  pain  on  moving  his  head  to  the 
same  side,  uncertainty  in  walking,  and  dizziness,  increased  on  closure 
of  the  meatus.  The  tympanic  membrane  was  depressed,  but  otherwise 
uninjured.  All  the  symptoms  disappeared  in  ten  days  under  treatment 
by  the  Politzer  process.  Biirkner  ascribes  the  symptoms  to  displace- 
ment inward  of  the  membrane  and  auditory  ossicles,  especially  the 
stapes,  subsequently  remedied  by  inflation." 

The  following  case  of  rupture  of  the  drum-head  by  contre- 
coup  is  taken  from  Gruber : 3 

"Ruptures  of  the  membrane,  brought  about  by  so-called  contre- 
coup,  are  particularly  noteworthy.  The  author  has  seen  several  such 
cases  in  Vienna.  A  young  lady,  leaving  the  room,  struck  her  fore- 
head against  the  door-post,  and  ruptured  her  left  tympanic  membrane  ; 
it  healed  in  the  course  of  a  week.  A  young  man,  while  diving,  struck 
his  forehead  against  the  bottom  of  the  bath,  and  ruptured  the  left  drum- 
head ;  a  severe  inflammation  was  set  up,  and  it  was  some  weeks  before 
it  had  quite  disappeared.  Williams 4  oberved  a  fracture  through  the 
external  auditory  canal,  with  rupture  of  the  membrane,  in  a  boy  who 
fell  on  the  back  of  his  head.  Eitelberg 5  reports  a  case  in  which  a  per- 
foration below  the  malleus,  with  fracture  of  its  handle,  were  said  to 

1  Op.  cit.,  p.  258.  seren  Gehorganges    durch    Contre- 

2  "Zur  Casuistik    der    traumati-  coup  mit  Zerreissung  des  Trommel  - 
schen   und    entziindlichen    Mittel-  felles,"    Zeitschrift  fur  Ohrenheil- 
ohraffectionen,"  Archiv  fur  Ohren-  kunde,  Bd.   xiv. 

heilkunde,  Bd.  xv.  5  "BruchdesHammergriffesdurch 

3  Op.  cit.,  p.  259.  Schlag  auf'sOhr, "  Separatabdruck 

4  "Eiu  Fall  von  Fractur  des  aus-      aus  der  Wiener  med.  Presse. 


INJURIES  OF  THE   DRUM-HEAD.  U'l 

have  resulted  from  a  blow  upon  the  ear  with  the  fwt;  both  lesion* 
healed.  Kirchner'  saw  several  cases  of  this  kind.  In  a  man  of  CO, 
who  fell  with  the  side  of  his  head  against  a  beam,  fracture  of  the 
osseous  portion  of  the  auditory  canal,  with  rupture  of  the  membrane 
and  fracture  of  the  handle  of  the  malleus,  took  place.  In  another  case 
there  was  fracture  of  the  temporal  bone  and  of  the  hammer ;  in  thia 
instance  the  patient  had  been  run  over  by  an  engine.  He  also  observed 
*  case  where  the  os  tympaiiicum  was  broken  by  the  force  of  the  lower 
jaw  in  a  fall  from  a  considerable  height.  On  recovery,  a  deep  furrow 
WM  seen  on  the  anterior  and  lower  surface  of  the  osseous  |>art  of  the 
auditory  canal,  extending  as  far  as  the  membrane,  and  a  fissure  on  the 
posterior  wall  1|  mm.  long;  the  membrane  also  was  ruptured.  Kra- 
kauer  saw  a  fracture  of  the  handle  of  the  malleus  which  was  due  to 
examination  of  the  ear  with  a  sound  under  a  bad  light.  In  the  author's 
collection  is  a  preparation  in  which,  besides  a  fissure  i>arallel  to  the 
long  axis  of  the  i>etrous  bone  through  the  whole  of  the  legmen  tympani, 
there  is  a  tear  through  the  tympanic  membrane,  with  fracture  of  the 
handle  of  the  malleus;  the  head  of  the  malleus  is  likewise  dislocated 
from  the  crown  of  the  incus,  the  latter  being  untouched.  The  case 
was  that  of  a  man  who  fell  upon  his  head  from  a  third-iloor  Mat." 

Objective  Symptoms. — The  position  ami  form  of  the  rup- 
ture produced  by  direct  violence  vary  with  the  shape  and  size  of 
the  offending  body  and  the  direction  it  takes  in  traversing  the 
external  auditory  canal.  Punctures  and  small  wounds  may  not 
be  visible,  only  a  scanty  extravasation  of  blood  being  found  at 
the  site  of  the  lesion.  In  other  cases  of  direct  violence  to  the 
drum-head  a  more  or  less  ragged  aperture  will  be  found,  having, 
according  to  circumstances,  greater  or  less  dimensions,  arid 
either  free  or  filled  with  coagulated  blood.  Fissures  resulting 
from  indirect  violence  have,  as  a  rule,  smooth  margins  and  their 
form  is  more  or  less  oval.  Their  edges  are  white  or  covered 
with  coagulated  blood.  After  twenty-four  hours,  the  margins 
become  red  and  swollen,  thus  narrowing  the  aperture. 

Hemorrhage  in  these  cases  is  very  slight— a  few  drops  only 
of  blood  being  the  limit.  If  more  copious  hemorrhage  occur, 
other  parts  have  probably  been  invaded  by  the  traumatism. 
Copious  hemorrhage  is  a  rare  incident. 

Air  may  be  forced  through  the  fissure  by  the  Valsalvian 
method  with  a  sharp  piping  sound.  A  snapping  noise  is  beard 

1  Jahresbericht  der  WurKburger  Sertion  dt-r  59  VenumilunK  d«-ut- 
otiatrischen  Poliklinik.  1*84-8.1 ;  sober  Naturforechet  und  Aerst* 
ferner,  Bericht  aus  dor  otiatrisrben  Berlin, 


122  VISION   AND   AUDITION — WOODWARD. 

at  the  time  of  injury  when  the  membrana  tympani  is  broken 
through  by  direct  violence. 

Subjective  Symptoms. — Pain,  especially  severe  in  cases 
of  direct  injury,  is  usually  experienced,  but  it  may  not  be  noted. 
As  a  rule,  it  subsides  in  a  few  hours,  but  will  continue  if  in- 
flammation supervene.  Loss  of  consciousness  for  a  few  minutes 
commonly  ensues  from  direct  violence.  Attacks  of  fainting 
may  be  repeated ;  and  convulsions  sometimes  occur.  Vertigo, 
autophonia,  tinnitus  aurium,  and  deafness  are  quite  constant. 
Hearing,  instead  of  being  dulled,  may  be  rendered  abnormally 
acute,  so  that  certain  sounds  are  distressing  to  the  patient.  The 
perception  of  the  direction  of  sounds  is  lost.  The  tuning-fork 
is  heard  best  by  bone  conduction  on  the  injured  side. 

Healing  of  uncomplicated  fissures,  due  to  indirect  violence, 
occurs  early — in  from  three  to  seventeen  days,  but  may  be  pro- 
longed to  six  weeks.1  Those  due  to  direct  violence  heal  more 
slowly,  according  to  the  size  and  characteristics  of  the  rupture. 
According  to  Trautmann,  fissures  do  not  leave  a  visible  scar. 
Inflammation,  suppuration  in  the  lesion,  and  invasion  of  the 
middle  ear  by  suppurative  inflammation  complicate  some  cases. 
The  shape  of  the  fissure  wiU  become  more  rounded  if  suppuration 
occur.  Syringing  and  inflating  such  injured  ears  will  retard  the 
reparative  process,  and  excite  suppurative  inflammation.  Cold 
air  blowing  into  the  ear  will  produce  the  same  effect.  The  aper- 
ture does  not  always  close;  especially  is  this  true  if  suppurative 
inflammation  have  occurred.  Relapses  of  this  inflammation 
are  often  observed.  And  so  long  as  the  ear  is  discharging  pus, 
the  life  of  the  patient  is  endangered,  by  virtue  of  the  possible 
occurrence  of  meningitis,  or  of  abscess  of  the  brain,  or  of  septic 
thrombosis  of  one  of  the  sinuses. 

Hearing  is  commonly  restored  when  healing  is  complete; 
but  in  some  cases  it  remains  more  or  less  impaired.  An  aper- 
ture through  the  drum-head  does  not  necessarily  diminish  the 
acuteness  of  hearing. 

Imprudence  on  the  part  of  the  patient  will  have  an  evil 
influence  on  the  healing  of  the  injured  drum-head.  And  pre- 
existing disease  of  the  ear  will  operate  as  a  predisposition  to 
protracted  healing  and  complicating  inflammatory  distur- 
bances. 

1  Trautmann,  op.  tit. 


INJURIES  OF  THE   DRUM.  123 

The  question  arises,  naturally,  whether  the  rupture  of  the 
drum-head  or  the  suppurative  inflammation  of  the  middle 
ear  is  due  to  traumatism  or  not.  It  is  well  known  that  both 
occur  without  injury  of  any  sort.  As  regards  the  causation 
of  rupture,  it  can  only  be  certainly  attributed  to  injury 
when  extravasations  of  blood  are  discovered  in  the  drum-head, 
or  when  there  is  found  evidence  of  hemorrhage  in  the  mar- 
gins of  the  fissure  or  in  their  immediate  vicinity.1  A  prob- 
able diagnosis  of  the  causation  of  the  conditions  may  be 
made,  however,  in  other  cases.  The  relationship  between  an 
injury  and  suppurative  inflammation  involving  the  middle  ear 
may  be  pronounced  upon  with  certainty  only,  when  the  de- 
velopment of  the  various  stages  of  the  ear  trouble  has  taken 
place  under  the  eye  of  a  competent  observer.  If  the  examina- 
tion have  been  made  first  after  the  suppuration  has  set  in,  and 
if  other  traces  of  an  injury  be  discovered,  it  is  probable  that  the 
injury  was  the  cause  of  the  ear  disease,  and,  indirectly,  of  the 
death  of  the  patient.  If,  however,  other  traces  of  injury  are 
wanting,  it  is  not  possible,  after  suppuration  has  set  in,  to  state 
positively,  on  the  strength  of  the  objective  evidence,  that  trauma 
and  suppuration  bear  to  one  another  the  relationship  of  cause 
and  effect.1 

INJURIES  OF  THE  DRUM. 

The  structures  in  the  middle  ear,  e.  g. ,  the  ossicles  of  the  ear, 
the  chorda  tympani  and  the  facial  nerve,  the  intrinsic  muscles 
of  the  ear,  the  mucous  lining  of  the  cavities  and  their  bony 
walls,  may  be  directly  injured  by  the  entrance  of  such  objects 
as  have  caused  rupture  of  the  drum-head  by  direct  violence. 
Being  the  most  exposed  of  the  ossicles,  the  malleus,  especially 
the  handle  of  the  malleus,  is  most  frequently  injured.  Frac- 
ture of  the  handle  of  the  malleus  has  been  reported  by  a  num- 
ber of  observers.  In  Meniere's  case '  the  twig  of  a  tree  entered 
the  external  auditory  canal,  ruptured  the  membrana  and  frac- 
tured the  malleus.  Healing  occurred  without  treatment.  Von 
Troltsch 4  saw  the  case  reported  by  him  after  the  fracture  had 
united.  The  injury  was  done  by  a  penholder  which  was  driven 

1  HQttig.  op.  tit.,  p.  43.  <Trautmann.tfciVJ.;  von  T. . "  Lehr 

*  Ibid.,  p.  203.  buch  der  Ohrenheilkunde,"  1877,  p. 

*  Trautmann,    op.    tit.,   405,    M.  149. 
Qaz.  nu'-ilicah-  de  Paris,  1856,  No.  50. 


124  VISION  AND    AUDITION — WOODWARD. 

into  the  ear  accidentally.  Hearing  was  blunted  and  the  patient 
complained  of  noises  in  the  ear.  In  Weir's  case,  the  fracture 
of  the  handle  of  the  malleus  had  not  united  four  months  after 
injury.  The  patient  gave  a  history  of  having  fallen  into  an 
open  areaway  about  fifteen  feet.  He  was  unconscious  about 
sixteen  hours.  He  had  been  informed  that  the  right  ear  had 
bled  for  about  an  hour.  He  experienced  pain  in  the  right  ear, 
forehead,  and  other  ear  for  about  a  month ;  and  great  tinnitus, 
which  remained  unabated  since  the  injury.  There  was  no  his- 
tory of  entrance  of  a  foreign  body  into  the  ear.  The  watch  was 
heard  on  affected  side  when  pressed  upon  the  ear.  The  drum- 
head was  normal  in  color;  there  was  an  irregularity  in  the 
handle  of  the  malleus.  The  bone  was  found  to  be  fractured  a 
short  distance  below  the  short  process.  The  broken  ends  were 
completely  and  transversely  displaced.  Reposition  of  the  ends 
of  the  fragments  took  place  when  the  ear  was  inflated  by  Val- 
salva's  method,  but  soon  became  displaced  again.  Two  of  Dr. 
Weir's  colleagues  were  of  the  opinion  that  a  faint,  whitish  line 
posterior  to  the  malleus  might  be  a  cicatrix  from  a  laceration 
of  the  drum-head.  Patient  was  not  seen  again. '  Hepburn  re- 
ported a  case  of  rupture  of  the  drum-head  and  of  fracture  of  the 
handle  of  the  malleus  due  to  thrusting  a  hair-pin  into  the  ear. 
Hearing-distance,  watch,  one-half  inch.  Seven  months  later, 
necrosis  of  the  fragments  was  observed.4 

Severe  injury  to  the  ear,  and  other  more  serious  consequences, 
have  been  produced  by  pouring  corrosive  liquids  and  molten 
metals  into  the  ear.  Trautmann 3  cites  the  following  cases  of 
that  nature: 

Morrison's 4  case,  of  a  man  who  poured  nitric  acid  into  his 
wife's  right  ear  while  she  was  lying  in  a  drunken  slumber. 
Hemorrhage,  violent  inflammation,  paralysis  of  the  right  side 
of  the  body,  and  death  in  six  weeks,  were  the  consequences. 
Caries  of  the  petrous  portion  of  the  temporal  bone  and  menin- 
gitis were  found  at  the  autopsy. 

Rau's  5  case,  in  which  melted  lead  was  poured  into  the  right 
ear  of  a  drunken  man;  causing  deafness,  purulent  discharge, 

1  Roosa,  "Dis.  of  the  Ear,"  N.  Y.,          3  Op.  cit.,  p.  387. 

1891,  p.  277.  4  Dublin  Journal  of  Medical  Sci- 

2  Burnett,    "Dis.  Ear,  Nose,   and      ence,  vol.  ix.,  No.  15. 

Throat,"   vol.     i.,    p.    266;   Trans.  s  Med. -chirurg.  Zeitung,  1852,  39. 

Amer.  Otol.  Soc. ,  vol.  i. ,  1870. 


INJURIES   OP  THE  DRUM.  125 

paralysis  of  the  corresponding  half  of  the  face.  The  lead  was 
so  firmly  embedded  that  seventeen  months  later  it  could  not  be 
removed. 

Ostander's '  case,  of  an  English  woman  who  murdered  six 
husbands  by  pouring  molten  lead  into  the  ear.  She  was  de- 
tected in  the  seventh  attempt. 

Taylor's  *  case,  in  which  a  mother  poured  molten  metal  (seven 
parts  tin  and  three  parts  lead)  into  the  right  ear  of  her  idiotic 
son  to  destroy  his  life.  Violent  pain  and  great  inflammation  en- 
sued, but  finally  recovery  took  place. 

Toynbee's '  case  exhibits  the  results  of  a  traumatism  of  the 
middle  ear  involving  the  chorda  tympani.  The  twig  of  a  tree 
penetrated  the  patient's  right  ear.  There  was  very  severe  pain, 
some  bleeding  (blood  is  said  to  have  run  from  the  ear),  subjective 
noises,  deafness,  and,  when  the  ear  was  inflated  by  the  Valsal- 
vian  method,  air  passed  through  the  drum-head.  Seven  days 
later  some  clotted  blood  was  found  in  the  external  auditory 
canal.  A  fissure  was  found  in  the  drum-head  behind  and  par- 
allel with  the  handle  of  the  malleus.  Its  margins  were  red  and 
swollen.  Nine  days  later  the  fissure  was  healed,  the  subjective 
noises  had  diminished,  and,  the  hearing  had  improved.  Four 
days  after  the  injury  the  patient  had  the  feeling  that  a  cold 
body  had  been  rubbed  over  the  right  half  of  his  tongue,  and  the 
sense  of  taste  was  diminished  on  the  affected  side.  Klaatsch 
had  also  observed  the  sensation  of  cold  in  the  tip  of  the  tongue. 

Commenting  on  this  case  Trautmann  states  that "  patients  in 
whom  he  has  accidentally  severed  the  chorda  tympani  in  punc- 
turing the  drum-head  give  different  replies:  some  state  that 
they  experience  a  sticking,  prickling  sensation  with  a  metallic 
or  sour  taste  on  the  affected  half  of  the  tongue,  especially  along 
its  edge.  Von  Troltsch,  Neumann,  and  others  have  noted  the 
prickling  sensation  on  the  edge  of  the  tongue.  In  another 
case  a  sense  of  smoothness  on  the  affected  half  of  the  tongue 
lasted  six  days.  The  sensation  had  been  experienced  imme- 
diately after  division  of  the  nerve,  and  disappeared  absolutely, 
leaving  nothing  abnormal  behind.  Blunting  of  the  sense  of 
taste  and  anomalies  of  the  secretion  of  saliva  are  frequently  ob- 

1  "UeberdenSelbstmord,"  S.  895.  *  Trautmann.  op.    cit. ,  405.  a  Dio 

*  "Mecl.  Jurisprudence,"  London,       Krankli<>it«*n     dw      (J«>homrgans, 
1861.  a!*™,  von  Moss,  1863.  S    180. 


126  VISION   AND    AUDITION — WOODWARD. 

served.  In  many  cases,  these  characteristic  symptoms  of  in- 
jury to  the  chorda  tympani  were  accompanied  by  a  sudden,  al- 
most lightning-like  movement  of  the  head,  mouth,  and  tongue. 
The  head,  affected  as  it  were  by  electric  shocks,  is  drawn  slightly 
toward  the  affected  side,  as  are  also  the  corner  of  the  mouth  and 
the  tongue,  which  is  slightly  protruded.  In  large  perforations 
of  the  membrana  which  lay  bare  the  chorda  tympani,  these 
symptoms  may  be  induced  by  touching  the  nerve  with  a  sound." 

Direct  violence  to  the  middle  ear  has  been  done  by  the  at- 
tending physician  in  attempting  to  extract  a  foreign  body  from 
the  external  auditory  canal.  The  foreign  body  has  been  forced 
into  the  middle  ear  through  a  drum-head  lacerated  by  the  un- 
skilful manipulations.  A  foreign  body  lodged  in  the  middle 
ear  causes  suppurative  inflammation,  and  may  excite  grave  com- 
plications in  the  brain — meningitis,  abscess,  and  thrombosis  of 
the  sinuses.  Headache,  vertigo,  epilepsy,  and  mental  disturb- 
ances of  a  serious  nature  sometimes  occur  in  the  non-fatal  cases. 
Not  only  have  foreign  bodies  lodged  in  the  external  auditory 
canal  been  forced  into  the  middle  ear,  but  methods  adopted  for 
their  extraction  have  led  to  perforation  of  the  skull,  laceration 
of  the  brain,  and  death  of  the  victim.  Worse  than  this  has  hap- 
pened. Misguided  by  the  statements  of  the  patient  or  his 
friends  regarding  the  presence  of  a  foreign  body  in  the  external 
auditory  canal,  physicians  have  searched  so  unskilfully  that 
not  only  has  the  drum-head  been  lacerated  and  removed,  but 
the  ossicles  of  the  ear  have  been  torn  out,  and  even  the  walls 
of  the  middle  ear  have  been  perforated  and  the  brain  injured  in 
the  vain  hunt  for  a  thing  that  did  not  exist.  Ordinarily,  re- 
moval of  foreign  bodies  from  the  ear  may  be  accomplished  with- 
out injury  to  the  organ,  by  simply  syringing  the  ear.  When- 
ever it  becomes  necessary  to  resort  to  other  measures  than  that, 
it  is  best  for  the  patient  that  the  case  be  referred  to  a  competent 
specialist  in  aural  surgery,  or  that  the  foreign  body  be  allowed 
to  remain  in  the  ear.  In  a  certain  number  of  cases  it  may  do 
no  harm  if  allowed  to  remain  in  its  bed  unmolested. 

Injury  to  the  middle  ear  by  indirect  violence  occurs  by 
virtue  of  shocks  to,  or  blows  upon,  the  head,  falls  upon  the  knees, 
gunshot  wounds  in  the  immediate  vicinity  of  the  ear,  violent 
vomiting  and  coughing,  forcible  inflation  of  the  ear,  and  falls 
upon  the  chin.  In  consequence  of  such  injuries,  hemorrhage 


INJURIES   OF  THE   DRUM.  127 

into  the  drum  has  taken  place  to  an  extent  sufficient  to  cause 
deafness,  noises  and  pressure  sensations  in  the  ear,  and  vertigo. 
Loss  of  consciousness  and  vomiting  signify  the  coexistence  of 
concussion  of  the  brain.  Eventually — after  some  weeks  or 
months — the  effused  blood  will  be  absorbed  and  the  function  of 
the  organ  restored.  Sometimes  suppuration,  with  perforation 
of  the  drum-head,  occurs.  In  other  cases,  inflammation  of  the 
middle  ear  without  suppuration  ensues.  When  inflammation 
of  the  middle  ear  ensues,  whether  suppuration  occur  or  no*  the 
probability  that  the  function  of  the  organ  will  ever  be  restored 
is  proportionately  lessened;  but  it  is  not  always  impossible  to 
restore  such  organs  to  their  normal  function. 

The  drum  is  injured  indirectly  by  such  causes  as  effect  a 
fracture  of  the  base  of  the  skull.  The  characteristic  symptoms 
are  those  of  fracture  of  the  base  of  the  skull,  viz.,  marked  hem- 
orrhage from  the  ear,  escape  of  cerebro-spinal  fluid  from  the 
ear,  and,  in  exceptional  cases,  escape  of  brain  matter  through 
the  external  auditory  canal.  Even  in  such  cases,  death  is  not 
inevitable. 

The  mastoid  process  is  occasionally  injured  by  heavy  blows 
and  gunshot  wounds.  Dupuytren  '  reported  a  case  in  which  the 
mastoid  was  torn  away  from  the  skull.  As  a  rule,  the  injuries 
cause  fissure  or  splintering  of  the  bone.  They  heal  kindly,  in 
some  cases;  in  others,  necrosis  of  the  bone  occurs;  in  still  other 
cases,  death  follows  from  consecutive  meningitis. 

"  In  gunshot  wounds,  which  involve  the  mastoid  only,  or 
the  adjacent  bones  and  soft  parts  also,  the  ball  may  become 
encapsulated  and  excite  no  further  disturbance;  yet  in  other 
cases,  if  the  missile  press  upon  the  sterno-cleido  muscle,  neu- 
ralgia and  interference  with  the  movements  of  the  neck  may 
bother  the  patient,"  '  Absolute  deafness  is  the  consequence  <-f 
gunshot  wounds  of  this  region,  in  nearly  all  cases. 

Injuries  of  the  internal  ear  and  auditory  nerve  are  due 
either  to  direct  or  to  indirect  violence.  In  the  former  set  of  cases, 
the  direct  injury  involves,  almost  without  exception,  other 
structures  within  the  cranium  and  terminates  fatally.  In  the 
latter,  when  the  internal  ear  and  the  auditory  nerve  only  are 
indirectly  injured,  the  objective  symptoms  are  not  sufficiently 
positive  to  base  a  diagnosis  upon  them.  Thus  is  afforded  a 
1  Httttig,  op.  tit.,  Jan.,  1894,  p.  25.  f  Ibid.,  p.  25. 


128  VISION   AND   AUDITION — WOODWARD. 

favorable  opportunity  for  malingering.  And,  inasmuch  as  it 
is  not  possible  objectively  to  differentiate  between  a  malingerer 
and  a  truthful  patient  in  this  class  of  cases,  on  account  of  the 
absence  of  objective  evidence,  discussion  of  the  subject  is  post- 
poned until  our  knowledge  of  these  injuries  is  more  satisfactory. 
The  reader  is  referred,  however,  to  the  writings  of  Trautmann 
and  Hiittig  for  a  discussion  of  that  class  of  injuries. 


THE  MEDICO-LEGAL  RELATIONS 

OP 

INSURANCE. 

BY 
ALFRED   L.  BECKER,  A.B.,  LL.B., 

Of  the  Buffalo,  A'.  1*.,  Ikir. 


III. 


THE  MEDICO-LEGAL  RELATIONS 
OF  INSURANCE. 

Scope  of  the  Article. — Only  a  small  number  of  questions 
indistinctive  insurance  law  involve  any  essential  relat  ion  to  medi- 
cine, and  these  concern  exclusively  life,  health,  and  accident  iu- 
surance.  The  following  subjects  will  be  treated  in  this  article: 
Powers  and  Duties  of  Medical  Examiners  for  Life  Insurance; 
Proofs  of  Death ;  Definitions  of  Terms  of  Medico-legal  Wigniti- 
cance  Used  in  Insurance  Policies. 

The  trials  of  insurance  causes  frequently  require  expert  med- 
ical testimony.  The  subject  of  medical  expert  testimony  in  gen- 
eral is  considered  elsewhere  in  this  treatise.1  For  discussions  of 
the  causes  of  death,  often  an  issue  in  insurance  cases,  and  for 
the  effects  of  insanity  on  insurance,  consult  the  respective  arti- 
cles in  this  work.2 

POWERS  AND  DUTIES  OF  MEDICAL  EXAMINERS  FOR  LIFE 

INSURANCE. 

The  universal  life  insurance  practice  requires  an  examination 
of  the  person  of  an  applicant  for  insurance  by  a  physician  em- 
ployed by  the  insurer.  Generally  the  medical  examiner  also 
puts  to  the  applicant  certain  questions  contained  in  a  blank  form 
furnished  by  the  company,  designed  to  test  the  applicant's  de- 
sirability as  a  risk,  and  he  records  the  answers  on  the  blank, 
which  the  applicant  signs.  Very  frequently  these  answers  are 
made  a  part  of  the  policy  and  declared  to  be  warranties,  and  tin- 
courts  construe  them  as  having  the  force  of  warranties,  for  the 
truth  of  which  the  insured  is  wholly  responsible.3 

1  Vol.  I.,  pages  49-72.  insurance  cases;    also  the  KfTecta  of 

'Medico-Legal    Autopsies,  Vol.  I.,  Insanity  on  Insurance,  Vol.  III.,  page 

page  831;    Personal  Identity,  Vol.  I.,  373;    and    the   subject   of    Poisons, 

page    865;      Determination    of    the  treated  in  Vol.  IV. 

Time  of  Death,  Vol.  I.,    page   919;  •See    the   excellent   dwrumnon   of 

Death   by  Heat  and  Cold,  Vol.   I.,  this  subject  in  Cooley's  Brief*  on  the 

page  939;     Death  from  Starvation,  Law  of  Insurance.  Vol.  III.,  pp.  11W1- 

Vol.   I.,  page  975;    etc.,  etc.,  all  of  HMW.     It  falls  outside  the  scope  of 

which  may  be  of  great  assistance  in  this  treatise. 

131 


132  INSURANCE — A.    L.    BECKER. 

The  relation  of  physician  and  patient  of  course  does  not  arise 
between  the  medical  examiner  and  the  applicant  for  insurance. 
Hence  no  legal  privilege  or  rule  of  confidential  communications 
binds  the  examiner  not  to  testify  as  to  facts  learned  from 
the  examination.  Sound  professional  ethics  doubtless  incul- 
cates, however,  discreet  silence  as  to  the  circumstances  of  an 
examination  for  insurance ;  they  should  remain  confidential  with 
the  physician,  the  insured,  and  the  insuring  company.1 

Medical  Examiner  the  Agent  of  the  Insurer. — In 
the  very  nature  of  things 2  the  medical  examiner  is  the  agent  of 
the  insurer. 

The  fact  that  he  has  been  employed  by  the  company  to  make 
the  examination  and  to  take  down  the  answers  to  the  questions 
controls  the  legal  relations  between  him,  the  company,  and  the 
applicant.3  Some  companies  in  drawing  their  policies  have  in- 
cluded a  stipulation,  repeated  in  the  application,  that  for  the 
purpose  of  recording  the  answers  the  medical  examiner  shall  be 
the  agent  of  the  insured.  But  the  courts  have  held  quite  uni- 
formly to  what  may  be  called  a  doctrine  of  immutable  agency. 
Such  a  stipulation  is  of  no  effect  because  it  agrees  to  a  legal 
impossibility ;  the  facts  unalterably  establish  an  agency  between 
the  company  and  the  examiner.4 

It  follows  from  such  agency  that  the  company  is  responsible 
for  the  acts  of  its  medical  examiner  in  taking  down  the  answers 
of  the  applicant,  and  if  a  mistake,  misinterpretation,  or  inten- 
tional error  be  made  in  recording  them,  provided  the  insured 
stated  the  truth 5  and  did  not  read  over  the  answers  as  written, 
thus  making  the  rnisstatement  his  own,6  the  policy  issued  is 

1  Cf.   Sullings  v.   Shakespeare,   46  *  Cases  last  cited;   also  Providence 
Mich.,  408,  41  Am.  Rep.,  166,  9  N.  W.  Savings  Life  As.  Soc.  v.  Reutlinger, 
R.    451;     Loudoun   v.    8th   Avenue  58  Ark.,  528,  25  S.  W.  R.,  835. 
Railway  Co.,  16  App.  Div.  (N.  Y.),  5  Mutual  Reserve  Fund  Life  Ass'n 
152,    44    Supp.,    742;     Roberson   v.  v.  Farner,  65  Ark.,  581;  47  S.  W.  R., 
The  Rochester  Folding  Box  Co.,  171  850;    Michigan  Mut.  Life  Ins.  Co.  v. 
N.  Y.,  538.  Leon,   138  Ind.,  636;  37  N.  E.  R., 

2  Sternaman  v.   Metropolitan  Life  584;     Marston    v.    Kennebec    Mut. 
Insurance  Co.,  170  N.  Y.,  13,  62  N.  E.  Life  Ins.  Co.,  89  Me.,  266,  36  All.  R., 
R.,  763,  88  Am.  St.  Rep.,  625,  67  389,   56  Am.   St.   R.,   412;    Otte  v. 
L.  R.  A.,  318;   Franklin  Life  Ins.  Co.  Hartford  Life  Ins.  Co.,  88  Minn.,  423, 
v.  Galligan,  71  Ark.,  295,  73  S.  W.  R.,  93  N.  W.  R.,  608,  97  Am.  St.  R.,  532; 
102,  100  Am.  St.  R.,  73.  Grattan    v.    Metropolitan    Life    Ins. 

3  Sternaman  v.  Metropolitan  L.  I.  Co.,  92  N.  Y.,  274,  44  Am.  Rep.,  372. 
Co.,  supra  ;  Howe  v.  Provident  Fund  '  Pottsville  Mut.  Fire  Ins.  Co.  v. 
Soc.,  7  Ind.  App.,  586,  34  N.  E.  R.,  Fromm,   100  Pa.,  347;    Mattson   v. 
830;    Coles  v.  Jefferson  Ins.  Co.,  4  Modern  Samaritans,  91  Minn.,  434, 
W.  Va.,  261,  23  S.  E.  R.,  732.  98  N.  W.  R.,  330;    but  see  Phenix 


MEDICAL   EXAMINERS.  133 

nevertheless  binding  on  the  company.1  Decisions  vary  as  to  the 
degree  of  care  required  of  the  insured  to  see  that  his  answers 
are  correctly  set  down.3  But  it  seems  to  be  well  settled  that 
where  the  applicant  is  not  required  to  read  over  the  blank  when 
filled  out,  and  merely  signs  it,  he  is  not  bound  by  inaccurate 
transcriptions  of  his  truthful  answers;  at  least,  not  unless  the 
errors  are  afterward  included  hi  the  policy  when  delivered, 
and  moreover  are  in  some  sufficient  manner  called  to  his  atten- 
tion.3 It  will  thus  be  seen  that  the  law  fastens  complete  respon- 
sibility upon  the  medical  examiner  to  state  fairly  and  accurately 
the  substance  of  an  applicant's  statements  concerning  his  health 
and  health  history.  If,  however,  the  insured  connives  with  the 
examiner  to  make  an  untrue  report  of  his  answers,  this  fraud  is 
of  course  a  defence  to  an  action  on  the  policy.4 

Another  question  which  sometimes  arises  concerns  the  effect 
of  knowledge  on  the  part  of  the  company's  agent,  as  its  medical 
examiner,  that  statements  contained  in  an  application  are  un- 
true. If  these  statements  are  in  a  given  case  mere  representa- 
tions and  the  medical  examiner  knows  facts  to  the  contrary  of 
them,  there  is  no  doubt  that  the  company  waives  the  untruth  of 

Ins.  Co.  of  Brooklyn  v.  Weeks,  45  an  action  in  equity,  Martin  v.  In- 

Kan.,  751,  26  Pac.,  410.  surance  Co.,  57  N.  J.  Law,  623,  31 

'Cases  cited  in  last  three  notes;  Atl.  R.,  213. 

also  Leonard  v.   State  Mutual   Life  *  Ryan  v.  World  Mut.  Life  Ins.  Co., 

Ins.  Co.,  24  R.  I.,  7,  51  At.  R.,  1049,  41  Conn.,    168,    19  Am.    Rep..   490; 

96  Am.   St.   Rep.,   698;    Mut.   Life  Otte  v.  Hartford  Ufe  Ins.  Co.,  88 

Ins.  Co.  v.  Selby,  72  Fed.,  980,   19  Minn.,  423,  93  N.  W.  R.,  608,  97  Am. 

C.  C.  A.,  331,  44  U.  S.  App.,  282;  St.  Rep.,  532;   Uowling  r.  Merchants' 

Mutual  Reserve  Fund  Life  Ass.  Co.  v.  Ins.  Co..   168  Pa.,  234,  37  Atl.   R., 

Farner,  65  Ark.,  581,  47  S.  W.   R.,  988;     Hartford    Life    and    Annuity 

850;    Prudential  Ins.  Co.  v.  Haley,  Ins.  Co.  r.  Gray,  91  III.,  159;   Qiiinn 

91  111.  App.,  363;    Shotliff  v.  Modern  v.  Metropolitan  Life  Ins.  Co.,  10  App. 

Woodmen  of  Am.,  100  Mo.  App.,  138,  Div.  (N.  Y.),  483,  41    Supp.,  1060; 

73  S.  W.  R.,  326;  Connecticut  Gen.  Keystone  Mut.  Ben.  Ass'n   r.  Jonen. 

Life  Ins.  Co.   v.  McMurdy,  89  Pa.,  72  Md.,  363,  20  Atl.  R.,  195;    Vir- 

363;     Equitable    Life    Ins.    Co.    v.  ginia   Fire  and   Marine    Ins.   Co.   r. 

Hazlewood, 75 Texas, 338, 12  S.  W.  R.,  Morgan,  90  Va.,  290,  18  S.  K.  R..  191. 

621,  16  Am.  St.  Rep.,  893,  7  L.  R.  A..  *  New  York  Life  Ins.  Co.  r.  Fletcher. 

217.     But   see,    holding   that   parol  117  t'.  S.,  519,  6  Sup.  Ct.  R.,   837, 

evidence  is  not  admissible,  that  the  29  Lawyers'  Kd.,  934;    Leonard   r. 

application,  made  part  of  the  con-  State  Mutual  IJfe  Ass.  Co.,  24  R.  I., 

tract,   does  not  correctly  show  the  7,  51  Atl.  R.,  1049,  96  Am.  St.  R., 

answers,     McCoy     v.     Metropolitan  698. 

Life  Ins.  Co.,  133  Mass.,  82;    Thomas  *  Reynolds  r.  Iowa  and  X.  In*.  Co.. 

v.  Commercial   Union   Ass.  Co.,  162  80   Iowa   5<>3.    46   \.    W.    R..    159; 

Haas.,  29,  37  N.  E.  R.,  672,  44  Am.  Speiser  r.  Phoenix  Mut.  IJfe  Ins.  Co., 

St.  Rep.,  323;   and  holding   that  the  119  Wis..   530,   97    N.  W.    R.,   2O7 

application,  when  made  part  of  the  Rockford  Ins.  Co.  r.  Nelson,  65  111., 

contract,  must  first  be  reformed  in  415. 


134 


INSURANCE — A.    L.    BECKER. 


the  statements.  It  cannot  be  said  that  it  relies  on  them,  and 
hence  their  falsity  will  be  no  defence  to  the  policy.1  When  the 
statements,  by  the  clear  intention  of  the  contract,  amount  to  war- 
ranties, a  more  difficult  question  arises ;  on  the  whole,  the  weight 
of  authority  appears  to  be  that  the  same  rule  does  not  apply.  A 
company  can  accept  the  premium  payment  from  an  applicant 
for  insurance  and  insure  him  without  waiving  the  defence  of 
false  warranty,  although  its  agent  knows  the  falsity  of  the  war- 
ranty at  the  time.2  And  such  knowledge  is  not  in  any  case  ini- 
putable  to  the  company  unless  it  exists  at  the  time  in  the  mind 
of  the  particular  agent  whose  business  it  is  to  obtain  the  war- 
ranties or  to  deliver  the  policy.  "It  is  a  fundamental  principle 
in  the  law  of  agency  that  for  information  given  an  agent  to  be 
attributable  to  his  principal  the  information  must  be  imparted 
to  the  agent  in  the  course  of  his  agency. " 3 

The  medical  examiner  must,  if  the  questions  on  the  applica- 
tion blank  are  worded  inadequately  to  draw  out  all  the  informa- 
tion desired,  supplement  them  with  further  inquiries.  Thus 


1  Endowment  Rank,  K.  of  P.,  v. 
Cogbill,  99  Tenn.,  28,  41  S.  W.  R., 
340;  National  Fraternity  v.  Karnes, 
24  Tex.  Civ.  App.,  607,  60  S.  W.  R., 
576  (only  facts  learned  on  the 
examination). 

*  Any  discussion  of  the  nature  of 
warranties  in  insurance  lies  beyond 
the  scope  of  this  article.  The  state- 
ment in  the  text  is  borne  out  by: 
Kenyon  v.  Knights  Templar  and 
M.  M.  A.  Ass'n,  122  N.  Y.,  247,  257: 
"The  cases  in  which  knowledge  of 
the  agent  through  whom  insurance 
is  taken  may  operate  to  defeat  the 
right  of  the  company  to  avail  itself 
of  the  fact  so  known,  at  the  time  it 
is  taken,  are  those  in  which  there  is 
no  application  (warranty)  signed  by 
the  assured  stating  to  the  contrary 
of  such  existing  fact,  but  rests  upon 
a  condition  expressed  in  the  policy 
merely.  Then  it  may  be  presumed 
that  the  statement  of  it  in  the  policy 
as  required  by  the  condition  was 
omitted  by  mistake  or  waived." 
And  see  Foot  v.  Aetna  Life  Ins.  Co., 
61  N.  Y.,  571.  But  the  following 
language  from  Sternaman  v.  Metro- 
politan Life  Ins.  Co.,  170  N.  Y.,  13, 
23,  62  N.  E.  R.,  763,  88  Am.  St.  R., 
625,  67  L.  R.  A.,  318,  a  case  relating 


to  statements  negligently  taken 
down  by  the  medical  examiner, 
certainly  is  broad  enough  to  cover 
knowledge  contrary  to  a  warranty: 
[The  Company]  "could  not  take  the 
money  of  the  insured  while  he  lived, 
and,  when  he  was  dead,  claim  a 
forfeiture  on  account  of  what  it 
knew  at  the  time  it  made  the  con- 
tract of  insurance,  for  that  would  be 
fraud."  And  indeed,  if  knowledge 
of  the  medical  examiner  or  other 
agent  is  ever  to  be  imputed  to  the 
company  at  all,  it  would  seem  that 
it  ought  to  be  imputed  in  the  con- 
ceivable case  where  a  medical  ex- 
aminer knows  facts  about  the  appli- 
cant's health  directly  contrary  to  his 
innocently  made  warranties.  Per- 
haps the  law  will  be  held  ultimately 
to  be  that  where  a  warranty  is  inno- 
cently false,  the  agent's  knowledge 
will  be  imputed;  but  if  knowingly 
false,  the  courts  will  not  aid  the 
insured  even  though  the  agent  knew 
its  falsity;  collusion  of  the  agent 
with  the  insured  might  then  almost 
be  presumed. 

3  Butler  v.  Michigan  Mutual  Life 
Ins.  Co.,  184  N.  Y.,  337,  340;  Caru- 
thers  v.  Kansas  Mutual  Life  Ins. 
Co.,  108  Fed.,  487. 


PROOFS   OF    DEATH.  135 

where  the  question  was  asked  whet  her  the  applicant  had  had  any 
sickness  or  disease  during  the  last  ten  years  and  he  replied  that 
he  had  hud  typhoid  fever  nine  years  before,  it  was  held  that  if 
information  of  other  diseases  or  of  all  the  diseases  from  which 
the  applicant  had  suffered  was  desired,  the  medical  examiner 
was  bound  to  ask  for  it.1  The  duty  of  the  applicant  is  in  gen- 
eral satisfied  by  his  giving  frauk  answers  to  the  questions  as  put 
to  him.2 

PROOFS   OF   DEATH. 

The  physician  who  attended  the  last  illness  of  a  JHTSOII  de- 
ceased frequently  is  called  upon  to  make  proof  of  the  death,  in 
the  form  of  an  affidavit  or  certificate  to  be  submitted  to  the  in- 
surance company,  or  in  the  form  of  testimony  on  the  trial  of  a 
contested  insurance  case.  The  method  of  making  proof  to  be 
submitted  to  the  insurer  is  ordinarily  determined  by  the  policy 
itself,  which  should  always  be  consulted.  Proofs  of  death  so 
prepared  in  accordance  with  the  policy  are  admissible  on  the 
trial  of  a  case  as  some  evidence  of  the  cause  of  death,  but  they 
are  not  conclusive.3  As  a  rule  the  beneficiary  may  on  the  trial 
show  by  parol  testimony  that  the  proofs  submitted  were  erro- 
neous.4 

The  family  physician's  certificate  of  death,  adhered  to  by 
him  in  his  testimony,  is  entitled  to  just  the  weight  which  the 
jury  concludes  should  be  given  to  the  opinion  of  a  learned  phy- 
sician, who  saw  deceased  shortly  before  his  death,  and  had  j>er- 
sonal  knowledge  of  him  for  some  time  before.* 

1  Dillcber  v.  Home  Life  Insurance  missible  in  In-half  of  beneficiary  in 

Co.,  69  N.  Y.,  256,  25  Am.  Rep.,  182;  Aetna  Life  Ins.  Co.   r.   Kaiser.    115 

Mutual  Res.  Fund  Life  Asso.  r.  S.illi-  Ky.,  539;    Cook  r.  Standard  Life  and 

van  (Tex. Civ.  Apn.),29  S.  W.  R.,  190.  Ace.  Ins.  Co.,  84  Mich.,  12,  47  X.  \V. 

'Mutual  Benefit  Life   Ins.  Co.  v.  R.,  568.     Otherwise  as  to  the   vital 

Wise,  34  Md.,  582;    Rawls  v.  Ameri-  statistics   of   the    Board   of    Health, 

can  Mutual  Life  Ins.  Co.,  27  N.  Y.,  Buffalo  Loan,  Trust  and  Safe  ivpiwit 

287.  84  Am.  Dec.,  280.  Co.  v.  Knights  Templar  and  M.  M.  A. 

1  Hanna    v.    Connecticut    Mutual  Ass'n,  126  N*.  Y.,  450,  4.">8,  27  X.  K. 

Life  Ins.  Co.,  150  X.  Y.,  526.  44  X.  K.  R.,  942.  22  Am.  St.  R..  839;    or  the 

R.,    1099;     Knights   Templars    and  minutes  of  a  coroner's  inquest.  I/ouia 

Masonic  Life  Indemnity  Co.  r.  Cray-  v.  Conn.  Mut.  L.  Ins.  Co.,  58  A  pp. 

ton,  209  111.,  550,  70  X.  K.  R..  10M:  Div.  (X.  Y.),  137. 

Mutual  Life   Ins.  Co.  v.   Stibl>e,  46  'Cases  cited   and   John    Hancock 

Md.,    302;      Modern     Woodmen     r.  Mut.  Life  Ins.  Co.  r.  Dick.  1 17  Mich., 

Kozak,  63  Neb.,   146,  88  X.  W.   R.,  518,  76  X.  W.  R..  9.  44  L.  R.  A..  S46; 

248;     Bentz    r.    Xorthwestern    Aid  Denver    Ufe    Ins.    Co.    t.    Price.    18 

Ass'n,  40  Minn.,  202,  41    X.  W.  R.,  Colo.  App.,  30.  69  Par.  R..  313. 

1037,  2  L.  R,  A.,  784.     Held  inad-  *  Aetna  Ufe  Ins.  Co.  r.  Ward,  140 


136  INSURANCE— A.    L.    BECKER. 

DEFINITIONS  OF  TERMS  OF  MEDICO-LEGAL  SIGNIFICANCE 
USED  IN  INSURANCE  POLICIES. 

Determinations  by  courts  of  law  of  such  purely  diagnostical 
questions  as  what  is  pneumonia,  or  what  is  a  disease  of  the  res- 
piratory organs,  made  upon  the  trial  of  insurance  causes,  need 
not  be  collated  in  this  article.  Some  other  terms,  however,  have 
a  more  distinctively  medico-legal  character,  either  in  view  of  the 
context  in  which  they  are  employed  in  policies  of  insurance,  or 
by  reason  of  the  fact  that  their  definition  involves  questions 
which  while  demanding  medical  knowledge  do  not  arise  except 
in  connection  with  the  law  of  insurance.  Policies  of  life  and 
accident  insurance  frequently  exempt  the  insurer  from  liability 
for  death  of  the  insured  from  certain  excepted  causes,  and  assume 
liability  for  certain  specified  risks.  Life  policies  are  also  invari- 
ably issued  upon  the  applicant's  representations  or  warranties  as 
to  his  health.  The  terms  defined  below  are  mainly  of  these 
classes.  The  citation  of  cases  is  intended  to  be  illustrative  and 
not  exhaustive.1 

Accident. — Usually  employed  in  accident  policies  in  the 
phrase,  death  or  injury  "by  external,  violent,  and  accidental 
means."  The  term  is  to  be  construed  as  meaning  an  event  which 
takes  place  without  one's  foresight  or  expectation.2  Unforeseen, 
unexpected,  and  unthought-of  occurrences  are  accidents.3  "An 
injury  may  be  said  objectively  to  be  accidental,  though  subject- 
ively it  is  not,  and  if  it  occurs  without  the  agency  of  the  in- 
sured, it  may  logically  be  termed  'accidental,'  though  it  was 
brought  about  designedly  by  another  person. "4  The  term  acci- 
dent itself  imports  an  external,  violent  agency.5  Injury  result- 
ing naturally  from  usual  and  ordinary  acts  of  the  insured  is  not 
an  accident;  e.g.,  rupture  from  closing  a  window;6  rupture  of  a 

U.  S.,  76,   11  Sup.  Ct.  R.,  720,  35  *  Fidelity    and    Casualty    Co.     v. 

Lawyers'  Ed.,  371.  Johnson,  72  Miss.,  333,  17  So.  R.,  2, 

1  See    the    excellent  encyclopaedia  3,  30  L.  R.  A.,  206,  citing  Biddle  on 
"Words  and  Phrases  Judicially  De-  Ins.,  Vol.  2,  p.  780.     But  see  Gaines 
fined,"    for    numerous    citations    of  v.  Fidelity  and  Casualty  Co.,  Ill  App. 
cases.  Div.  (N.  Y.),  386. 

2  Supreme  Council  Order  of  Chosen  6  Bacon  v.   United  States  Mutual 
Friends  v.  Garrigus,   104  Ind.,   133,  Ace.  Ass'n,  123  N.  Y.,  304,  25  N  E. 
3  N.  E.,  818,  54  Am.  R.,  298.  R.,  399,  20  Am.  St.  R.,  748,  9  L.  R. 

3  Breed   v.    Glasgow   Ins.    Co.,    92  A.,  617. 

Fed.,    760,    764;   cf.    United    States  8  Feder  v.  Iowa  State  Trav.  Men's 

Mut.  Ace.  Ass'n  v.  Barry,  131  U.  S.,  Ass'n,  107   Iowa,  538,  78  N.  W.  R., 

100,  9  Sup.  Ct.,  755,  33  Lawyers'  Ed.,  252,  70  Am.  St.  R.,  212,  43  L.  R.  A., 

60.  693. 


DEFINITIONS.  137 

blood  vessel  affected  with  arterial  sclerosis  caused  by  regular 
work  at  the  trade  of  carpenter;1  hemorrhage  of  a  consumptive 
caused  by  the  exertion  of  closing  a  railway  ear  window.3  Sun 
stroke  is  iiot  an  accident,  for  it  is  not  really  a ''stroke"  at  all 
but  a  disease  of  the  brain.  In  a  leading  English  c;use  so  decid- 
ing, Cockburu,  C.  J.,  well  said:3  "It  is  diflicult  to  define  the 
term  'accident,'  as  used  in  a  policy  of  this  nature,  so  as  to  draw 
with  perfect  accuracy  a  boundary -line  between  injury  or  death 
from  accident,  and  injury  or  death  from  natural  causes,  such  as 
shall  be  of  universal  application.  At  the  same  time  we  think 
we  may  safely  assume  that  in  the  term  accident  as  so  used,  some 
violence,  casualty,  or  vis  major  is  necessarily  involved.  We 
cannot  think  disease  produced  by  the  action  of  a  known  cause 
can  be  considered  as  accidental."4  The  distinction  is  clearly 
brought  out  in  a  border-line  case  in  the  United  States  (.'ircuit 
Court,5  in  which  death  resulted  from  the  bursting  of  a  blood-vessel 
during  exercise  with  Indian  clubs,  and  the  court  laid  down  as 
the  law  of  the  case  that  if  the  deceased  had  used  the  clubs  in  the 
ordinary  way  and  there  had  been  no  unusual  circumstances,  it 
was  not  an  accident;  but  if  there  occurred  any  unforeseen,  ab- 
normal, or  involuntary  movement  or  torsion  of  the  body,  then 
the  injury  was  an  accident.  In  a  singular  case  it  was  held  that 
inadvertently  resting  the  head  upon  the  hand  while  sleeping,  in 
such  a  way  as  to  cause  serious  inflammation  of  the  periosteum 
of  the  metacarpal  bones,  was  an  accidental  injury.8  Poisoning 
inadvertently,  as  by  swallowing  or  inhaling  a  toxic  substance, 
has  been  held  to  be,  and  not  to  be,  by  external,  violent,  and  acci- 
dental means.7  So  also  death  by  drowning  is  by  such  means,8 

•Niskern  v.   United   Brotherhood  Co.,  46  Fed.,  440.  13  L.  R.  A..  114. 

of    C.   and  J.  of   A.,  93    App.  Div.  581,    22    L.    R.    A.,    620;     Railway 

(N.  Y.),  364.     See  also  Southard  v.  Officials',  etc.,  Asso.  r.  Johnson,  I  Oil 

Railway   Passengers' Ass' n    Co.,   34  Ivy.,  26 1,  95  Am.  St.  R..  370. 

Conn    574.  s  McCarthy  r.  Travelers    In*.  Co.. 

*  Feder   v.    Iowa   State   Traveling  8  Bissel's  t *.  S.  C.  C.  Rep.,  MS.  Fed. 

Men's  Asso.,  107  Iowa,  538,  78  N.  W.  Cas.  No.  8.<iS2. 

R.,  252,  70  Am.  St.  R.,  212,  43  L.  R.  *  Aetna  Life  Ins  Co.  v.  1 

A.,  693.     But  see  Standard  Life  and  165  Ind.,  317,  75  X.  K.  R-,  262,  1  L. 

Acc.Ins.  Co.  v.  Schmaltz,  66  Ark.,  588,  R.  A.  (N.  S.).  422. 


4  Dozier  v.  Fidelity  and  Casualty          "  Winspear 


138  INSURANCE — A.    L.    BECKER. 

On  the  other  hand,  death  from  contact  with  putrid  substances 
containing  virulent  bacilli  was  held  to  be  from  disease  and  not 
from  accident.1 

Affection. — See  Disease. 

Attendance  by  Physician. — See  Medical  Treatment. 

Breaking  of  Limb. — This  has  been  judicially  denned  to 
mean  any  actual  fracture.  Where  a  policy  allowed  a  benefit  for 
the  breaking  of  the  shafts  of  both  bones  between  the  knee  and 
ankle-joints,  it  was  held  not  to  include  thereby  "Pott's  frac- 
ture," i.e.)  the  breaking  of  one  bone  between  the  knee  and  ankle 
and  the  dislocation  of  the  other.2 

Disease.— One  of  the  required  representations  or  warranties 
in  a  life  policy  is  whether  the  insured  has  had  certain  kinds  of 
diseases.  By  this  term  mere  temporary  ailments  are  not  in- 
tended.3 For  example,  "spitting  of  blood "  means  the  complaint 
of  spitting  blood,  not  a  mere  isolated  instance.4  Even  when  a 
warranty  is  made  that  the  insured  has  not  had  certain  diseases, 
it  usually  means,  according  to  the  strongest  authority,  not  to  his 
knowledge,  and  does  not  include  an  obscure  disease  undiscover- 
able  even  by  medical  diagnosis.5  For  the  distinction  between 
accident  and  disease  as  a  cause  of  death,  see  Accident. 

Epidemics. — •  Where  a  policy  excluded  the  risk  of  death 
from  an  epidemic,  the  word  was  held  to  have  "its  plain,  ordi- 
nary, and  popular  sense  as  a  familiar  word  in  our  language, " 
and  not  the  technical  medical  meaning  laid  down  in  Copeland's 
Medical  Dictionary,  title,  "Epidemics."  The  court  adopted  the 
Webster  definition — a  disease  generally  prevailing,  affecting 
great  numbers.  And  it  was  held  that  the  yellow  fever  was  not 
epidemic  in  Havana  when  there  were  only  the  usual  number  of 
cases,  viz.,  500  to  1,000  deaths  annually.6 

External,  Violent,  and  Accidental  Means. — See  Ac- 
cident. 

Co.    (Eng.),  L.  R.  6  Q.  B.    D.,    42;  Co.,  24  Fed.,  670;  Schmitt  v.  Michi- 

London  v.   Preferred  Ace.   Ins.  Co.,  gan  Mut.  Life  Ins.  Co.,  101  App.  Div. 

43  App.  Div.  (N.  Y.),  487.  (N.  Y.),   12.     Cf.  Connecticut  Mut. 

1  Bacon  v.  United  States  Mut.  Ace.  Life  Ins.  Co.  v.  Union  Trust  Co.,  112 
Ass'n,123  N.Y.,  304,  25  N.  E.  R.,  399,  U.  S.,  250,  5  Sup.  Ct.,  119,  28  Law- 
20  Am.  St.  R.,  748,  9  L.  R.  A.,  617.  yers'  Ed.,  708. 

2  Petersen  v.  Modern  Brotherhood  6  Moulor  v.  American  Life  Ins.  Co., 
of  Am.,  125  Iowa,  562,  101  N.  W.  R.,  Ill  U.  S.,  335,  4  Sup.  Ct.,  266,  28 
289,  67  L.  R.  A.,  631.  Lawyers'  Ed.,  447;  Grattan  v.  Metro- 

3  Cushman  v.   United  States  Life  politan  Life  Ins.  Co.,  92  N.  Y.,  275, 
Ins.  Co.,  70  N.  Y.,  72.  280. 

4  Dreier   v.   Continental   Life   Ins.  6  Pohalski  v.  Mutual  Life  Ins.  Co., 


DEFINITIONS.  139 

External  and  Visible  Sign  of  Injury.— When  this 
sign  has  been  required  as  the  condition  of  liability  under  a  policy 
the  courts  have  been  inclined  to  construe  slight  signs  as  suffi- 
cient. The  requirement  is  satisfied  by  the  death  of  the  insured ; » 
and  by  pallor;2  by  discoloration  of  a  member,  showing  within  a 
reasonable  time  after  the  accident ;  *  by  an  emanation  of  gas  from 
the  lungs  of  a  person  killed  by  the  inhalation  of  illuminating- 
gas.4  Cf.  Visible  Sign  of  Injury. 

Habits. — Policies  sometimes  require  the  insured  to  state 
whether  he  has  habits  of  using  intoxicants  or  narcotics,  and 
sometimes  also  restrict  the  liability  of  the  insurer  if  the  insured 
shall  thereafter  acquire  such  habits.  Habitually  excessive  or 
intemperate  use  of  an  intoxicant  or  drug  means  uncontrolled 
use,  daily  or  often;5  but  not  under  advice  of  a  physician  for 
medical  reasons.8 

Health. — See  Disease.  If  the  insured  states  that  he  is  in 
good  or  sound  health,  this  means  free  from  any  substantial  or 
chronic  malady  having  a  direct  bearing  on  the  general  health, 
expectation  of  life,  and  hence  on  the  risk.7 

Intemperance,  Death  Caused  by. — Where  this  risk  is 
excepted  it  has  been  held  to  include  death  caused  by  the  exces- 
sive use  of  liquor  for  a  short  period  of  time  only.8 

Intoxicating  Liquor  or  Narcotics,  Death  from 
Use  of. — Where  this  risk  is  excepted  it  has  been  held  to  intend 
voluntary  use,  not  when  prescribed  by  a  physician.9  And  it 
must  be  the  proximate  cause  of  death.  If  it  be  such  cause  it 
need  not  be  immoderate  or  intemperate  use  to  fall  within  the 
exception  of  such  a  risk  in  a  policy.10 

45  How.  Pr.,  504,  36  N.  Y.  Super.  U.  S.,  739,  8  Sup.  Ct.(  331,  31  Law- 

Ct.,  234,  aff'd  on  opinion  below,  56  yers'  Ed.,  315. 

N.  Y.,  640.  "Aetna  Life  Ins.  Co.  r.  Ward.  140 

1  Paul  v.    Travelers'  Ins.  Co.,  112  U.  S.,  76,  11  Sup.  Ct.,  720,  35  Law- 
N.  Y.,  472,  20  N.  E.  R.,  347,  8  Am.  yers'  Ed.,  371. 

St.  R.,  758,  3  L.  R.  A.,  443;   Beraays  7  Manhattan     Life     Ins.     Co.     v. 

v.  United  States  Mutual  Ace.  Ass'n,  Carder,  82  Foil.,  986.  27  C.  C.  A., 

45  Fed.,  455.  334;     Brown   r    Ins.  Co.,  65   Mirh., 

2  Root  v.   London  Guarantee  and  306,  32  N.  \V.   R.,  610;    (Jrattan  P. 
Accident  Co.,  92  App.  Div.  (N.  Y.),  Metropolitan  Life  Ins.  Co.,  92  N.  Y., 
578,  86  Supp.,  1055.  274,  44  Am.  R..  372. 

»  Thayer  v.  Standard  Life  and  Ace.  *  Aetna  Life  Ins.  Co.  r.  Davev,  12,1 

Ins.  Co.,  68  N.  H.,  577,  41  Atl.  R.  182.  U.  S.,  739,  8  Sup.  Ct.   R..  331.  31 

4  Menneily  v.  Employers'    Liability  lawyers'  Ed.,  315. 

Aflsur.  Corp.,  148  N.  V.,  596,  43  N.  •  Endowment    Hank    K.    of    I 

E.  R.,  54,  51  Am.  St.  R.,  716,  31  L.  Allen,  104  Twin.,  623.  58  S.  W.  It., 

R.  A.,  686.  241. 

1  Aetna  Life  Ins.  Co.,  v.  Davey,  123  I0  Mutual  Life  Ins.  Co.   r.   JMibbe, 


140  INSURANCE — A.    L.    BECKER. 

Loss  of  a  Member. — Where  an  accident  benefit  is  pro- 
vided for  the  loss  of  a  member,  the  question  has  arisen  whether 
only  the  complete  and  actual  amputation  of  the  member  is 
meant.  By  the  weight  of  authority,  if  the  testimony  shows  that 
the  insured  has  completely  and  permanently  lost  the  use  of  a 
limb,  as  by  paralysis,  he  has  suffered  the  "loss  "  of  it  within  the 
meaning  of  the  policy. 1 

Medical  Treatment. — Where  a  policy  requires  the  in- 
sured to  state  whether  he  has  received  medical  treatment  within 
a  given  time,  a  physician's  attention  for  some  actual  disease  is 
.intended,  not  for  some  trifling  or  imaginary  disorder.2 

Natural  Causes,  Death  from. — Where  liability  was 
measured  by  natural  causes  of  death,  it  was  held  that  intentional 
or  accidental  killing  was  excluded  thereby.3 

Over-Exertion. — Where  an  accident  policy  excludes  the 
risk  of  death  or  injury  from  over-exertion,  the  term  has  been 
defined  to  mean  a  voluntary  and  unnecessary  over-exertion,  not 
one  put  forth  in  an  emergency  of  danger  to  save  oneself  from 
injury,  as  from  being  crushed  by  a  great  weight.4  And  what  is 
over-exertion  for  one  man  may  not  be  for  another ;  thus,  riding 
a  bicycle  race,5  or  lifting  a  300-pound  weight  a  short  distance  by 
a  strong  man  accustomed  to  such  exertion.8 

Poison. — When  liability  under  a  policy  is  exempted  for 
death  or  injury  from  poisoning,  or  contact  with  poisonous  sub- 
stances, both  unintentional  and  intentional  poisoning  are  in- 
cluded.7 But  when  the  exemption  is  from  liability  for  death 

46  Md.,  302;    Hanna  v.  Conn.  Mut.  477;    Edington  v.  Mutual  Life  Ins. 

Life  Ins.  Co.,  8  Misc.  (N.  Y.),  431,  Co.,    67   N.    Y.,    185;     Valentine   v. 

28   Supp.,    661;     c/.    Miller   v.  Mut.  Metropolitan  Life  Ins.  Co.,  106  App. 

Ben.  Life  Ins.  Co.,  31  Iowa,  216,  7  Div.     (N.    Y.),    487;     Hubbard    v. 

Am.  R.,  122;    Union  Cent.  Life  Ins.  Mutual   Reserve   Fund   Life    Ass'n, 

Co.  v.  Hughes.  Adm.,  110  Ky.,  26  100  Fed.,  719,  40  C.  C   A.,  665. 

60  S.  W.  R.,  850.  3  Slevin  v.  Board  of  Police  Pension 

1  Sheanon  v.  Pacific  Mut.  Life  Ins.  Fund  Commr's,    123    Cal.,    130,   55 
Co.,  77  Wis.,  618,  46  N.  W.  R.,  799,  Pac.  R.,  785,  44  L.  R.  A.,  114. 

20  Am.  St.  R.,  151,  9  L.  R.  A.,  685,          4  Reynolds  v.  Equitable  Ace.  Ass'n, 

s.c.  83  Wis.,  507,  53  N.  W.  R.,  878;  59  Hun  (N.  Y.),  13. 

Sneck  v.  Travelers'  Ins.  Co.,  88  Hun          5  Keeffe  v.  Nat'l  Ace.  Soc.,  4  App. 

(N.  Y.),  94,  34  Supp.,  545;  Supreme  Div.  (N.  Y.),  392,  38  Supp.,  854. 

Court    of    Honor    v.  Turner,  99  111.          6  Rustin  v.  Standard  Life  and  Ace. 

App.,  310,  Sisson  v.  Supreme  Court  Ins.  Co.,  58  Neb.,  792,  79  N.  W.  R., 

of  Honor,  104  Mo.  App.,  54,  78  S.  W.  412,  76  Am.  St.  R.,  136,  46  L.  R.  A., 

R.,  297;  contra  (?),  Stever  v.  People's  253. 

Mut.  Ace.  Ins.  Asso.,    150  Pa.,  132,          7  McGlother    v.     Provident     Mut. 

24  Atl.  R.,  662;    16  L.  R.  A.,  446.  Ace.  Co.  of  Phila.,  89  Fed.,  685,  32 

2  Billings  v.  Met.  Ins.  Co.,  70  Vt.,  C.   C.   A.,   318;     Early  v.   Standard 


DEFINITIONS.  141 

caused  by  hiking  poison  or  inhaling  poisonous  gases  it  seems  to 
be  well  established  that  only  a  voluntary  taking  is  meant.1  The 
question  often  arises  as  to  what  are  poisons,  and  it  usually  in- 
volves expert  medical  or  chemical  testimony.  For  the  general 
classification  of  poisons  and  also  the  essential  differences  between 
toxicological,  i.e.,  chemical,  action  of  substances  upon  the  Ixnly, 
and  purely  mechanical  action,  such  as  burning,  suffocation,  or 
drowning,  see  Vol.  IV.  of  this  work  generally.2  The  following 
have  been  held  not "  poisons  ":  Substances  not  ordinarily  poison- 
ous, e.g.,  oysters;3  putrid  animal  matter;4  sting  of  insect.5  Hut 
carbolic  acid  thrown  in  the  face  is  "contact  with  a  poisonous 
substance,"6  and  contact  with  poison-ivy  has  been  held  the  same.7 
Whether  inhaling  coal-gas  is  poisoning  was  determined  in  an 
interesting  case  as  a  question  of  fact  depending  upon  the  weight 
to  be  given  by  the  jury  to  conflicting  expert  testimony.  Asa 
matter  of  curious,  rather  than  scientific  interest,  it  may  be  noted 
that  the  jury  found  that  the  result  was  suffocation,  not  poison- 
ing.8 

Proximate  Cause  of  Death. — Medical  testimony  is  often 
requisite  to  enable  the  court  to  determine  whether  the  injury  of 
an  insured  was  the  proximate,  or  only  the  remote  cause  of  death. 
The  questions  of  law  in  cases  where  proximate  cause  is  at  issue 
have  been  so  varied  and  have  involved  so  many  subtle  distinc- 
tions that  it  is  impracticable  to  examine  them  adequately  in  this 
article.  Any  standard  work  on  accident  insurance  discusses  a 
multitude  of  such  cases.  A  charge  of  United  States  District 
Judge  Dyer  to  the  jury9  states  the  law  in  atypical  case  succinctly 
and  accurately.  The  policy  in  suit  required  that  the  accident 

Life  and  Ace.  Ins.  Co.,  113  Mich.,  58,  97  Tex.,  124,  76  S.  W.  R.,  745,  64 

71  N.  W.  R.,  500,  67  Am.  St.  Rep.,  L.  R.  A.,  349. 

445,  and  cases  cited.  *  Bacon    t».    United    States    Mat. 

'Travelers'    Ino.    Co.  v.    Dunlap,  Ace.  Ass'n,  44   Hun  (N.  Y.),  509. 

160111.,  642,  43  N.E.  R,,  765,  52  Am.  •  Omtjrrg   r.    Tinted   StatcH   Nut. 

St.  R.,  355;    Menneily  v.  Employers'  Ass'n,   101    Ky.,  303,  40    S.  W.   R., 

Liability  Assur.   Corp.,    148  N.   Y.,  909,  72  Am.  St.  R.,  413. 

596,  43  N.  E.  R.,  54,  51  Am.  St.  R.,  •  Median  r.  Traders'  and  Travelers' 

716,  31  L.  R.  A.,  686.  Ace.  Co.,  34  Misc.  (N.  Y.),  158,08 

2  Cf.    on    this    point,    Boswell    v.  Sunn.,  821. 

State,  39  S.  E.  R.,  897,  898,  114  da.,  'Preferred  Arc.  Ins.  Co.  r.  Rolmi- 

40;     Dougherty  v.    People,    1   Colo.,  eon,  33  So.  R.  (Fla.),  1005,  61  L.  R. 

514,519;    United  States  Mutual  Ace.  A.,   145. 

Ass'n  v.    Newman,   84     Va.,    52,   3  "  United  States  Mut.  Ace.  A*«  n  r. 

S.  E    R    805  Newman,  81  Yu..  52.  3  S.  E.  R.,  805. 

•Maryland  Casualty  Co.  v.  Hudgins,  •  Barry  r.  IViU'd  States  Mut.  Aoc. 

Ass'n,  23  Fed.,  712. 


142  INSURANCE — A.    L.    BECKER. 

should  be  the  proximate  and  sole  cause  of  death.  Judge  Dyer 
charged:  "Interpreting  and  enforcing  the  policy  accord  ing  to  its 
letter  and  spirit,  it  must  be  held  that  if  any  other  cause  than  the 
alleged  injury  produced  death,  there  can  be  no  recovery.  In 
short,  to  entitle  the  plaintiff  to  recover  you  must  be  satisfied  that 
the  alleged  injury  was  the  proximate  cause  of  death.  Whether 
a  cause  is  proximate  or  remote  does  not  depend  alone  upon  the 
closeness  in  the  order  of  time  in  which  certain  things  occur.  An 
efficient,  adequate  cause  being  found,  must  be  deemed  the  true 
cause,  unless  some  other  cause,  not  incidental  to  it,  but  inde- 
pendent of  it,  is  shown  to  have  intervened  between  it  and  the 
result.  If,  for  example,  the  deceased  suffered  injury  to  an  in- 
ternal organ,  and  that  necessarily  produced  inflammation,  and 
that  produced  a  disordered  condition  of  the  injured  part  whereby 
other  organs  of  the  body  could  not  perform  their  natural  and 
usual  functions,  and  in  consequence  the  injured  person  died,  the 
death  could  be  properly  attributed  to  the  original  injury.  In 
other  words,  if  these  results  follow  the  injury  as  its  necessary 
consequence  and  would  not  have  taken  place  had  it  not  been  for 
the  injury,  then  I  think  the  injury  could  be  said  to  be  the  prox- 
imate or  sole  cause  of  death ;  but  if  an  independent  disease  or 
disorder  supervened  upon  the  injury,  ...  I  mean  a  disease  or 
derangement  of  parts  not  necessarily  produced  by  the  injury, 
or  if  the  alleged  inj  ury  merely  brought  into  activity  a  then  exist- 
ing but  dormant  disorder  or  disease,  and  the  death  of  the  deceased 
resulted  wholly  or  in  part  from  such  disease,  then  it  could  not  be 
said  that  the  injury  was  the  sole  or  proximate  cause  of  death." 

Pulmonary  Disease.-  Vv  here  an  insured  warranted  that 
he  had  had  no  pulmonary  dis  ase,  it  was  held  to  mean  no  chronic 
disease,  and  the  question  did  not  require  him  to  state  that  he  had 
had  pneumonia.1  This  seems  a  doubtful  decision.  Cf.  Disease. 

Serious  Illness. — When  an  applicant  for  insurance  is  re- 
quired to  state  whether  he  has  had  a  serious  illness,  only  those 
illnesses  which  commonly  affect  the  risk,  by  permanently  injur- 
ing the  system  and  tending  to  shorten  life,  are  meant.  It  is  not 
necessary  that  they  should  have  been  dangerous  illnesses.2 

1  Metropolitan  Life  Ins.  Co.  v.  Co.,  20  N.  Y.,  293;  Boyle  v.  North- 

Bergen,  64  111.  App.,  685;  Carson  western  Mutual  Life  Ins.  Co.,  95 

v.  Metropolitan  Life  Ins.  Co.,  1  Pa.  Wis.,  312,  70  N.  W.  R.,  351;  Illinois 

Super.  Ct.,  572.  Masons' Benefit  Soc.  v.  Winthrop,  85 

''Peacock  v.  New  York  Life  Ins.  111.,  537;    Continental  Life  Ins.  Co. 


DEFINITIONS.  143 

Spitting  Blood. — See  Disease. 

Suicide.— Seethe  article  in  this  volume  on  the  Medico-Legal 
Belations  of  Insanity,  Effect  of  Insanity  on  Insurance,  Vol.  III., 
page  373.  When  a  person  is  found  drowned,  there  is  in  general 
a  presumption  of  fact  that  he  did  not  commit  suicide,  based  on 
the  principle  that  every  man  tends  to  obey  the  instinct  of  self- 
preservation.  * 

Sunstroke. — See  Accident. 

Total  Disability. — Incapacity  for  work  or  business  is  gen- 
erally the  test  of  total  disability  within  the  meaning  of  accident 
policies.2  The  phrase  must  be  given  a  reasonable  meaning,  and 
if  what  the  insured  is  able  to  do  is  only  a  small  and  unsubstan- 
tial part  of  his  usual  work,  he  is  totally  disabled.8 

Vaccination,  Successful.— Where  made  a  condition  of 
the  policy  being  valid,  successful  vaccination  was  held  not  to 
require  vaccination  producing  absolute  immunity  from  small- 
pox, but  merely  producing  the  ordinary  symptoms;  it  was  suf- 
ficient if  the  vaccination  "took."4 

Visible  Marks  upon  the  Body. — See  External  and  Visible 
Sign  of  Injury.  When  an  accident  policy  requires  as  a  condi- 
tion of  a  recovery  under  it  that  there  shall  be  a  visible  mark 
upon  the  body  merely,  it  is  sufficient  if  some  internal  sign  is 
found,  as  a  localized  redness  of  the  tissues  of  the  brain  shown  by 
an  autopsy.5  And  it  has  been  held  that  the  mark  need  not  be 
visible  to  the  eye ;  if  a  physician  can  perceive  it  by  the  sense  of 
feeling  the  mark  is  sufficient  to  satisfy  the  requirement  of  the 
policy.8 

v.  Young,  113  Ind.,  159,  15  N.  E.  R.,  Ace.  Ins.  Asso.,    55  Hun     (X.  Y.), 

220,  3  Am.  St.  R.,  630;    Drakeford  98,  8  Supp.,  263;  Commercial  Trav- 

v.  Supreme  Conclave  K.  of  D.,  61  S.  elers'  Mut.  Ace.  Asso.  r.  Springsteen, 

C.,  338,  39  S.  E.  R.,  523;   Goucher  v.  23  Ind.  App.,  657.  55  N.  E.  R..  973; 

Northwestern  Traveling  Men's  Asso.,  Young  t'.  Travelers'  Ins.  Co.,  80  Me.. 

20  Fed.,   596;     Higbie  v.   Guardian  244,  13  All.  R.,  896;  Holm  r.  Inter- 

Mut.  Life  Ins.  Co.,  53  X.  Y.,  603,  state  Casualty   Co.   of   X.    Y.,    115 

605.  Mich.,  79,  72  X.  W.  R..  1105. 

1  Mallory  v.   The   Travelers'    Ins.  *  Sovereign    Camp    Woodmen    of 

Co     47  N    Y     52  the    World    r.    Woodruff,    80   Miss., 

'Mutual    Benefit    Asso.    v.    Nan-  546,  32  So.  R.,  4. 

carrow,   71    Pac.    R.,   423,    18  Colo.  *  Freeman  r.  Mercantile  Ace.  As*  n, 

App.,  274,  Lobdell  v.  Laboring  Men's  156  Mass.,  351,  30  X.  K.  R..  1013.  17 

Mut.  Aid.  Ass'n,  69  Minn.,  14,  71  N.  L.  R.  A.,  753;    t'nion  Casualty  and 

W.  R.,  696,  65  Am.  St.  R.,  542.  38  Surety  Co.  r.  Mondy.  18  Colo.  App., 

L.    R.    A.,    537;  Beaeh   r.    Supreme  395.  71  Pac.  R.,  07<. 

Tent  of  K.  of  T.  M.  of  the  World,  177  •Gale    r.    Mutual    Aid    and    Ace. 

N.  Y.,  100,  69  N.  E.  R.,  281.  Aas'n,    66   Hun    (N.    Y.).   COO.   21 

*  Wolcott    v.     United     Life    and  Supp.,  893 


MEDICAL    ASPECTS 
OP 

INSANITY 

IN   ITS 

RELATIONS  TO  MEDICAL  JURISPRUDENCE. 


BY 

EDWARD   D.    FISHER,    M.D., 

Professor  of  Mental  and  Nervous  Diseases.  University  of  the  City  of  Netr  York;  Medical 
Department;  Consulting  Physician  to  the  ,Veie  York  City  Insane  Asylum:  Neuro- 
logist to  Hospital  for  Incurable*.  B.  I.;     Visiting  Physiciatt  *o  Hospital 
for  Nervous  Diseases;    Assistant  Visiting  Physician  to  Helle- 
vue  Hospital;  President  of  the  New  York  Neurological 
Society,  etc.,  etc. 


ITS    RELATIONS    TO 
JURISPRUDENCE. 


INTRODUCTION. 

DIFFICULTIES  OF  THE  SUBJECT. 

AN  introduction  to  a  subject  of  this  nature  is  at  once  diffi- 
cult and  yet  important.  It  is  but  natural  that  difficulties  should 
surround  it,  as  the  action  of  the  mind  in  its  normal  condition  is 
as  yet  but  partly  understood.  The  position  of  the  public  to  this 
subject  has,  however,  materially  changed  from  that  which  it 
occupied  even  a  quarter  of  a  century  ago.  The  idea  of  dioooaQ 
of  the  brain  as  associated  with  mental  derangement  has  done 
much  to  remove  the  horror  and  mystery  associated  with  mental 
disease.  In  the  early  centuries  physicians  had  associated  in- 
sanity with  disease  of  the  brain,  and  all  through  the  literature 
of  this  period  we  find  descriptions  of  cases  of  insanity  ;  but  in 
the  Middle  Ages  superstition  and  ignorance  again  held  sway, 
and  the  intelligent  and  more  or  less  scientific  opinions  of  the 
past  were  lost  sight  of.  Under  the  direction  of  the  priest  the 
insane  were  regarded  as  possessed  by  spirits  or  under  the  dis- 
pleasure of  God.  The  consideration  that  morbid  changes  in 
the  organ  of  the  mind,  the  brain,  as  in  other  organs  of  the 
body,  must  necessarily  interfere  with  its  functional  activity, 
provides  a  material  basis  for  the  consideration  of  the  subject, 
which  alike  to  the  professional  and  lay  mind  has  had  the  effect 
of  removing  the  stigma  from  those  who  are  so  unfortunately 
affected.  This  conception  also  suggests  the  idea  that,  as  in 
Dther  diseases,  we  may  have  acute  and  chronic,  curable  and 
:ncurable  forms,  so  in  mental  disease,  like  conditions  may  exist, 
opening  up  in  this  way  a  solution  of  many  questions  of  the  re- 
lation of  the  insane  to  their  surroundings. 

The  study  of  psychology  from  n  physiological  standpoint 
has  done  much  to  bring  about  tliis  improved  condition.  It  in 

]47 


148  INSANITY — FISHER. 

not  possible  at  present,  and  probably  never  will  be,  to  establish 
a  material  basis  for  thought,  nor  in  my  opinion  would  much  be 
gained  thereby;  but  it  is  of  great  importance  to  have  arrived 
at  a  definite  conclusion  as  to  the  method  of  study  of  thought  or 
mental  action.  Proceeding  from  this  we  can  see  that  to  under- 
stand insanity  we  must  hold  some  conception  of  sanity.  No 
definition  can  be  made  to  apply  to  all  civilizations.  The  nor- 
mal mind  expresses  itself  through  the  feelings,  thought,  and 
volition,  in  accordance  with  the  accepted  customs  and  rulings 
of  its  surroundings,  and  departure  from  this  recognized  order 
of  action  constitutes  just  so  far  a  departure  from  the  normal. 
The  legal  aspect  of  the  question  only  arises  where  the  welfare 
of  the  individual  or  community  is  affected.  One  can  well 
understand  that  acts  by  savages,  cruel  and  inhuman  though 
they  may  be,  cannot  be  ascribed  to  mental  disease,  though  they 
would  be  classified  as  insane  acts  in  a  civilized  nation.  The 
great  advance  of  modern  times,  then,  is  the  consideration  of 
insanity  or  mental  derangement  as  a  disease  of  the  brain. 
The  term  "partial  insanity"  is  a  poor  one  and  open  to  criti- 
cism, for,  as  has  been  truly  said,  the  person  must  be  either  sane 
or  insane;  and  yet  as  all  the  other  organs  of  the  body  may  be 
more  or  less  completely  disorganized  and  still  functionate,  al- 
though imperfectly,  so  the  mind  may  be  able  to  act  although 
imperfectly.  The  principle  here  laid  down  is  of  great  impor- 
tance, and  if  applied  would  do  away  with  much  of  the  contra- 
diction of  expert  testimony ;  for,  after  all,  it  is  not  the  question 
of  insanity  that  is  most  often  in  dispute,  but  the  question  of 
responsibility  for  the  act  committed,  which  must  depend  on  the 
form  and  degree  of  mental  impairment.  The  absurd  travesty 
of  justice  and  common  sense  is  seen  too  often  in  our  courts,  by 
which  persons  are  declared  insane  and  irresponsible  at  the  time 
of  the  act,  although  sane  at  the  time  of  and  following  the  trial. 
Such  conditions  lead  juries,  from  fear  of  allowing  the  dangerous 
if  not  insane  man  his  liberty,  to  discard  the  plea  of  insanity. 
The  commission  of  certain  acts,  which  are  held  to  be  those  of 
an  irresponsible  person,  usually  also  mark  that  person  as  one 
who  sh6uld  remain  in  the  custody  of  the  State.  The  fact  that 
he  has  at  one  time  been  capable  of  irresponsible  action  of  a 
serious  character  makes  it  possible,  if  riot  probable,  that  he  will 
again  be  subject  to  a  like  impulse.  We  should  estimate  his 


DIFFICULTIES   OF   THE   SUBJECT.  149 

condition  from  his  past  hist  or  ij  as  well  as  from  his  present 
apparent  state. 

Cullen '  discusses  the  subject  of  partial  responsibility  or 
partial  insanity  very  fully.  Ho  says  in  substance  as  fol- 
lows : 

Considering  the  profound  and  complex  modifications  which 
the  moral  organism  of  the  individual  is  subject  to,  it  is  very 
difficult  for  the  physician  to  define  the  limits  within  which 
moral  liberty  remains  intact.  The  doctrine,  however,  of  partial 
or  attenuate  responsibility  is  admitted  by  a  certain  number  of 
physicians  and  legal  writers. 

Casper,  at  a  period  still  recent,  "considered  that  any  one, 
the  subject  of  a  delusion,  should  bo  held  resjwnsible,  if  the  act 
was  not  committed  under  the  influence  of  that  delusion."  This 
is  the  generally  accepted  ruling  in  civil  and  criminal  procedure. 
Legrand  du  Saulle'  admits  total  irresponsibility  only  in  cases  of 
general  insanity.  In  cases  of  partial  alienation  (a  term  unten- 
able from  a  medical  point  of  view)  the  individual  "should  not 
be  held  responsible  when  ho  has  acted  under  the  influence  of  the 
delusion,  but  should  be  so  considered,  when  the  impulse  tinder 
which  he  acted  is  foreign  to  the  sphere  of  his  maniacal  concep- 
tions." 

These  opinions,  however,  have  as  a  foundation  psychologi- 
cal considerations  not  consistent  with  medical  vieirs  and 
contrary  to  clinical  observation.  For  admitting  them,  it  is 
necessary  to  deny  the  solidarity  of  the  faculties  which  compose 
the  human  intelligence  and  to  admit,  for  instance,  that  the  in- 
dividual possessed  by  a  fixed  idea  is  sufficiently  master  of  his 
reason  to  resist  all  other  impulses.  To-day,  however,  there 
can  scarcely  be  found  a  clinical  expert,  who  does  not  admit 
that,  "  however  limited  the  circlo  in  which  the  delusion  moves, 
the  intelligence  is  altered  in  its  totality,  and  that  morbid  ideas 
can  germinate  and  develop  only  on  a  territory  previously  mor- 
bid ;  that  insanity,  if  different  in  its  manifestations,  is  a  unit 
in  its  nature,  and  that  monomaniacs  present  in  the  course  of 
their  existence  several  different  monomanias,  not  constituting, 
however,  different  forms  of  insanity  but  different  symptoms  of 
one  disease." 

1  -Maladitm   Men  tales."  3d    part:         *  "TraiU-    dt-    Medeciue 
Legal  Mt  dicim  and  Legislation.  Paris, 


150  INSANITY — FISHER. 

"  How  can  it  be  affirmed,"  says  J.  Falret,1  "that  a  given  act, 
accomplished  at-  a  certain  moment,  is  totally  foreign  to  the 
maniacal  conceptions  of  the  individual,  while  another  act,  com- 
mitted at  the  same  moment,  must  be  ascribed  to  a  morbid  im- 
pulse?" 

The  whole  question  often  hinges  on  the  idea  so  common, 
with  judge  and  jury,  that  insane  persons  must  at  all  times 
show  evidence  of  insanity,  so  that,  if  they  exhibit  any  natu- 
ral desires  and  motives,  or  show  any  lucidity  in  their  speech 
and  actions,  it  is  assumed  at  once  that  they  are  of  sound 
mind  and  responsible  for  their  acts.  This  is  especially  seen 
where  the  person  after  the  act  uses  methods  to  escape  the  result 
of  his  act,  or  has  shown  skill  in  planning  its  accomplishment. 
Another  element,  which,  while  of  great  importance  indeed  in 
deciding  these  questions,  namely,  that  of  a  motive  for  the  deed, 
is  given  too  great  weight,  for  motive  is  often  present  in  the 
insane.  A  delusion,  perhaps  a  concealed  one,  may  be  back 
of  it,  but  except  in  the  violently  maniacal  cases,  where  great 
mental  confusion  exists,  there  is  frequently  a  motive,  more  or 
less  well  defined,  present. 

The  tendency  of  modern  times  to  give  more  weight  to  the 
testimony  of  physicians,  trained  in  mental  diseases  and  accus- 
tomed to  observe  the  method  of  thought  in  the  insane,  is  to  be 
encouraged.  The  two  aspects  of  view,  i.e.,  the  medical  and 
legal,  are  necessarily  different,  but  at  the  same  time  cannot  be 
absolutely  divorced.  It  cannot  be  the  province  of  the  expert  to 
render  a  decision  as  to  the  responsibility  of  the  person  in  ques- 
tion, nor  can  he  define  insanity  in  a  way  which  can  always  be 
of  practical  use  for  the  courts,  but  he  can  and  should  state  how 
far  the  mental  condition  depends  on  disease  and  to  what  extent 
the  individual  has  been  deprived  of  the  free  exercise  and  con- 
trol of  his  will,  either  by  reason  of  overpowering  false  ideas  or 
by  general  impairment  of  his  mental  faculties. 

The  object  of  all  law  is  the  protection  of  the  public. 
Punishment  of  the  criminal  is  only  a  means  to  that  end. 
In  the  principle,  laid  down  by  all  civilized  nations,  for  the 
protection  of  those  who  are  considered  mentally  unsound,  from 
the  consequences  of  their  acts,  this  idea  is  present.  Any  diffi- 
culty in  this  respect  arises  only  where  the  question  of  fact  as 
1  "  Diet.  Encyclop.  des  Sciences  Medicales, "  3"  aerie,  t.  iii. 


DIFFICULTIES   OK   THE   SUBJECT.  151 

to  the  insanity  of  the  accused  exists,  especially  in  the  no-called 
borderland  cases  or  when  again  the  mental  disorder  manifest* 
itself  either  intermittently  or  periodically. 

Practically,  however,  another  phase  of  the  question  arises, 
especially  in  criminal  cases — that  is,  whether  the  mental  disor- 
der is  of  such  a  character  as  to  deprive  the  individual  of  the 
knowledge  of  the  moral  character  of  his  acts,  as  to  whether  they 
are  right  or  wrong,  and  as  to  whether  he  knew  they  were  con- 
trary also  to  the  law  of  the  land.  A  person  migot  understand 
the  character  of  his  acts,  while  from  a  medical  standpoint  he 
might  be  considered  insane.  The  English  and  American  law 
follows  this  method  of  procedure,  while  the  German  courts 
give  greater  weight  to  the  medical  testimony,  and  have  special, 
so-called  court  physicians,  who  are  called  upon  to  state  the 
mental  condition  of  the  accused.  As  a  result  there  is  more 
frequently  partial  responsibility  for  the  act  allowed  than  with 
us.  The  question  of  partial  insanity  can  in  this  way  be  eluded. 
Casper,  the  great  German  authority,  in  the  last  edition  by  Li- 
man  takes  this  ground  very  positively. 

While  agreeing  with  most  of  the  authorities,  as  Griesinger, 
Krafft-Ebing,  Kirch hoff,  and  others,  flint  ice  must  regard  the 
mind  as  a  whole,  and  not  as  consisting  of  independent  fac- 
ulties, or  functions,  which  can  be  individually  and  indejien- 
dently  diseased,  he  holds  for  this  very  reason  that  disease  espe- 
cially affecting  one  of  these  divisions  of  the  mind  must  involve 
the  integrity  of  the  whole.  If  these  views  can  be  accepted,  it 
is  reasonable  to  consider  degrees  of  responsibility — without  ac- 
cepting the  idea  of  partial  insanity. 

A  delusion  which  does  not  affect  the  act  committed  or  has 
no  bearing  on  it,  or  again  if  true  would  not  justify  the  act  in  a 
sane  person,  is  not  accepted  by  the  courts  as  a  defence.  While 
this  is  right  in  so  far  as  it  should  not  preclude  the  accused  from 
all  responsibility  for  his  act,  the  fact  that  the  individual  is  so 
far  mentally  affected  that  he  has  delusions,  should  have  ite 
weight  in  respect  to  the  kind  of  punishment  to  be  meted  out. 

These  remarks  have  especially  to  do  with  criminal  eases. 
In  civil  cases,  indeed,  as  in  matter  of  contracts,  wills,  torts,  etc., 
the  presence  of  delusions  having  no  bearing  on  the  subject- 
matter  are  justly  excluded  from  rendering  the  acts  void. 

In  no  way  can  the  great  difference  between  the  iwdieal  and 
III.— 12 


152  INSANITY — FISHER. 

legal  estimate  of  the  fact  of  insanity  and  its  relations  be  better 
shown  than  in  the  degree  of  responsibility  ascribed  to  those  of 
unsound  mind,  in  civil  or  criminal  procedure. 

An  individual  might  be  held  responsible  for  his  civil  act, 
who,  however,  would  not  be  held  criminally  responsible. 

It  is  impossible,  therefore,  for  the  law  ever  to  establish 
lasting  or  permanent  principles.  Each  case  must  be  studied 
by  itself,  and  changes  in  opinions  on  social  questions  will  always 
modify  with  time  present  rulings. 

MECHANISM  OF  THOUGHT,  OR  THE  SCIENCE  OF  MIND. 

In  order  to  properly  consider  the  subject  of  mental  disease, 
we  must  in  a  brief  manner  consider  the  subject  of  the  mind 
itself.  Mind  is  represented  by  mental  action,  which  is  only 
the  psychical  function  of  the  brain,  as  distinguished  from 
its  physical  function.  Mental  action  can  only  be  understood  or 
appreciated  by  its  expression  in  the  feelings  generally  and  their 
subdivisions,  the  various  emotions;  and  by  thought,  which  is 
represented  by  perceptions  dependent  in  every  case  on  the  spe- 
cial sense  impressions  received  into  consciousness.  Under  the 
head  of  thought,  therefore,  must  come  ideation,  which  depends 
on  the  reception  of  perceptions,  their  retention  or  memory,  and 
their  comparison  and  association,  or  judgment.  The  knowledge 
whether  or  not  thought  exists  in  the  individual  depends  on  its 
expression,  either  in  language  or  action,  in  other  words  in 
volition.  The  combination  of  the  three  general  faculties  of 
the  mind  constitutes  the  psychical  function  of  the  brain.  Voli- 
tion must,  therefore,  represent  thought,  as  action  must  be  pur- 
posive in  normal  mental  function.  It  is  under  this  considera- 
tion that  we  are  able  to  recognize  the  great  difference  between 
sanity  and  insanity. 

In  considering  the  various  faculties  of  the  mind,  their  activ- 
ity implies  consciousness  on  the  part  of  the  individual — a  spe- 
cial consciousness,  in  which  the  individual  or  Ego  is  cognizant 
of  the  impressions  which  are  being  perceived. 

We  have  to  do  with,  in  fact,  self -consciousness,  which  has 
been  defined  as  the  recognition  of  one's  own  personality.  Self- 
consciousness  differs  from  consciousness  in  general;  it  is 
what  makes  the  individual. 


MECHANISM   OK   TIIOl'UIIT.  ]5j 

111  a  child  impressions  are  received,  painful  ones  resulting  in 
reflex  expressions  of  painful  feeling  or  emotion,  and  rice  versa. 
Mere  excitation  of  the  special  senses  of  sight  or  hearing  are 
usually  pleasurable.  Repetition  of  these  impressions  create* 
permanent  mental  perceptions,  which  are  recalled  by  similar 
impressions,  by  which  means  memory,  so-called,  is  established. 
At  first  a  new  impression  of  a  similar  character  is  required  to 
recall  the  former  perception ;  later  this  may  arise  of  itself.  The 
comparison  of  these  various  perceptions  results  in  an  idea  or 
conception ;  this  implies  memory,  that  is,  the  recalling  of  former 
perceptions,  or,  as  it  is  called,  apperception.  It  is  now  that  a 
higher  grade  of  feeling  manifests  itself  in  the  form  of  desire; 
this  is  not  at  first  present,  all  the  responses  of  the  cerebro-spinal 
system  being  reflex.  Following  close  upon  ideation  and  desire 
comes  judgment  or  comparison  of  the  various  conceptions,  and 
this  is  associated  with  volition.  It  is  some  time  before  the  in- 
fiint  can  dissociate  himself  from  his  environment,  or  in  other 
words  establish  the  Ego  as  distinct  from  his  surroundings;  self- 
consciousness  is  not  acquired  until  that  is  accomplished. 

In  our  brief  study  of  the  development  of  mind  in  the  infant, 
the  close  and  almost  indissoluble  relation  or  connection  of  the 
three  faculties  of  mind  is  plainly  seen.  Another  fact  should  be 
commented  on,  and  that  is,  that  the  first  evidence  of  mental 
function  is  in  the  field  of  the  feelings.  Thi^  seems  the  first  to 
be  evolved  and  in  fact  always  accompanies  the  further  devel- 
opment of  the  mental  function.  As  it  is  the  first  to  appear  in 
the  evolution  of  the  mind,  so,  following  a  well-observed  law 
of  the  nervous  system,  it  is  the  first  to  be  affected  in  its  dis- 
solution. 

It  is  only  ivith  the  evolution  of  the  Ego  into  the  con- 
sciousness, that  desire  can  be  said  to  be  fully  established  and 
that  the  individual  is  able  to  discriminate  what  is  for  his  own 
personal  good  or  injury.  Up  to  this  jxnnt  none  of  the  higher 
qualities  of  man  have  shown  themselves.  The  ethical  side  has 
not  been  developed;  his  relations  have  only  been  those  which 
have  concerned  his  own  good  or  pleasure— the  last  stone  to  be 
laid  on  the  edifice  is  regard  for  the  good  of  others,  under  which 
head  comes  love  of  family,  of  country,  and  as  the  top  stone  love 
of  mankind. 

Feelings,  as  we  have  said,  represent  the  emotions.     In  gon- 


154  INSANITY — FISHER. 

eral  they  are  divided  into  pleasurable  and  painful.  All  mental 
action  is  accompanied  by  one  or  the  other  in  some  degree. 

Subdivisions  or  forms  of  emotion  are  joy,  sorrow,  anger, 
fear,  etc. 

Perceptions  are  received  through  the  special  senses  of  sight, 
hearing,  taste,  and  smell  and  general  sensibility,  under  which 
we  will  include  touch,  pain,  and  temperature. 

The  intensity  of  these  perceptions  depends  on  the  character 
of  the  irritation  of  the  special  sense  and  on  the  manner  of  re- 
ception into  the  sentient  consciousness,  that  is,  on  the  degree  of 
attention.  On  these  two  conditions  will  depend  the  ability  to 
correctly  recall  the  perception.  It  is  imperfect  recollection  in 
this  regard  which  leads  to  phantasy.  Where  the  attention  has 
not  been  intense  or  active,  or  in  cases  where  several  impressions 
or  presentations  are  taking  place  at  the  same  time,  or  again 
where  the  impression  in  itself  is  not  sharp  and  defined,  errone- 
ous, perceptions  may  result ;  this  is  recognized  in  the  form  of 
hallucinations  or  illusions,  or  again  in  delusion. 

A  certain  duration  of  time  is  also  necessary  for  the  com- 
plete recognition  or  reception  of  impressions;  there  must  also  be 
a  certain  degree  of  feeling  accompanying  it,  else  no  attention  is 
given.  When  impressions  are  rapidly  received,  there  is  usu- 
ally a  pleasurable  condition  resulting ;  when,  however,  one  per- 
ception remains  long  in  the  consciousness,  a  sense  of  fatigue  or 
pain  results. 

Intellection  or  thought  implies  the  presence  of  perceptions, 
which  by  association  of  previous  perceptions  has  led  to  a  com- 
parison of  the  various  attributes  of  an  object  as  received 
through  the  special  senses.  This  recalling  of  former  perceptions 
is  memory,  and  any  defect  in  it  interferes  with  ideation  or 
thought. 

This  can  be  studied  from  a  psychological  standpoint  very  well 
in  the  insane,  where  either  a  false  perception,  or  the  failure  to 
recall  all  in  regard  to  an  object,  results  in  a  delusion  or  wrong 
conception. 

In  judgment  we  have  the  same  mental  process  going  on, 
only  now  conceptions  or  ideas  are  reached  by  memory  and  com- 
pared, their  resemblances  and  differences  noted.  Here  again, 
attention  is  of  great  importance,  associated  as  it  is  also  with 
feeling. 


MEDICO-LEGAL  ASPECT.  15o 

There  cannot  be  thought  or  intellection  without  its  expres- 
sion in  action  or  speech;  in  fact,  speech  is,  probably,  the  agent 
or  means  by  which  thought  takes  place. 

Speech  was  no  doubt  later  evolved;  nevertheless,  by  long 
hereditary  influences,  it  has  become  a  part  of  ratiocination. 
I  do  not  mean  by  this  that  speech  is  necessarily  articulate  in 
the  mental  process.  In  our  consideration  so  far  we  see  the  close 
relation  of  the  various  processes  employed  in  mental  action.  It 
seems  psychologically  impossible  to  consider  one  as  being  af- 
fected, without  involving  the  action  of  the  others.  Excessive 
pain  or  sorrow,  pleasure  or  joy,  can  entirely  prevent  thought 
from  taking  place;  again,  the  continued  presence  of  certain 
ideas  which  cannot  be  removed  can  establish  emotional  condi- 
tions of  pleasure  or  pain. 

Just  such  conditions  occur  in  the  insane ;  the  self-conscious- 
ness or  the  Ego  being  so  changed  or  affected  that  the  usual 
response  to  impressions  no  longer  takes  place,  leading  thus  in  a 
logical  way  to  abnormal  feeling,  thought,  and  volition. 

MEDICO-LEGAL  ASPECT. 

Our  conception  of  mental  disease  depends  entirely  on  whether 
we  look  at  it  from  a  medical  or  legal  standpoint!  Ordroneaux, 
quoting  Ray,  says :  "  Insanity  in  medicine  has  to  do  with  a 
prolonged  departure  of  the  individual  from  his  natural  mental 
state  arising  from  bodily  disease."  "Insanity  in  law  covers 
nothing  more  than  the  relation  of  the  person  and  the  particular 
act  which  is  the  subject  of  judicial  investigation.  The  legal 
problem  must  resolve  itself  into  the  inquiry,  whether  there 
was  mental  capacity  and  moral  freedom  to  do  or  abstain  from 
doing  the  particular  act." 

Legally,  the  question  of  civil  and  criminal  responsibility 
arises,  making  it  necessary  that  we  should  consider  not  so  much 
the  form  and  character  of  the  disease,  as  the  mental  soundness 
of  the  person  affected,  and  also  as  to  whether  there  can  be  any 
motive  for  simulation. 

All  countries  agree  in  absolving  from  responsibility  for 
criminal  acts  any  one  who  is  mentally  unsound.  According  to 
the  German  law,  a  crime  is  not  counted  such  when  the  doer  at 
the  time  is  unconscious,  or  is  deprived  of  his  free  will  by  disease 


156  INSANITY — FISHER. 

of  the  mind.  Austrian  law  defines  an  act  as  not  criminal  when 
the  doer  is  unconscious  or  when  his  will  is  affected,  or  the  char- 
acter of  the  act  not  perceived.  The  French  law  is  virtually  the 
same. 1 

WHAT  is  INSANITY  ? 

Synonyms. — Insania,  Folie,  Alienation  mentale,  Insania 
Folia,  Irrsinn,  Irresein,  Wahnsinn,  Verriicktheit.  It  is 
hardly  possible  to  give  a  succinct  definition  of  insanity.  So  long 
as  the  mental  processes  arise  from  natural  causes  and  correspond 
to  the  condition  of  the  surroundings,  so  long  is  the  mind  sound ; 
when  the  feelings,  ideas,  and  acts  arise  without  cause,  but 
rather  from  cerebral  disease,  we  have  the  reverse.  Mental  dis- 
ease is  brain  disease,  but  the  reverse  is  not  true.  The  organ  of 
the  mind  has  its  basis  in  the  cortex  of  the  brain.2  "  Insanity  is 
a  matter  of  fact,  and  is  not  amenable  to  any  legal  test.  It  is 
for  the  jury  or  experts  to  determine  the  fact  of  insanity ;  for 
the  courts  to  determine  its  effect  on  civil  rights."  The  general 
meaning  of  insanity  at  laiv  is  ''  a  permanently  disordered  state 
of  the  mind  beyond  the  control  of  the  individual,  produced  by 
disease.  This  must  be  proved,  the  burden  of  proof  resting  on 
the  party  alleging  it.  As  mind  is  represented  by  feeling, 
thought,  and  volition,  any  departure  from  their  normal  relation 
must  represent  mental  disorder.  Persons  may,  however,  be  in- 
sane medically,  but  not  in  the  eye  of  the  law,  and  vice  versa."  3 

"  It  is  a  trite  but  a  most  important  observation,  that  in  the 
question  of  what  constitutes  insanity,  the  members  of  the  two 
great  and  learned  professions  of  law  and  medicine  entertain 
essentially  different  and  seemingly  irreconcilable  views,  and 
that  on  the  question  of  the  irresponsibility  of  criminals,  who 
are  supposed  to  be  insane,  there  is  still  a  wide  chasm  of  differ- 
ence of  opinion  between  them.  To  a  certain  extent  this  is  true, 
and  perhaps  inevitable,  and  the  reason  of  it  is  not  difficult  to 
find — that  the  two  professions  have  to  regard  insanity  and  to 
deal  with  the  insane  with  different  aims  and  purposes.  The 
physician  has  to  prevent  or  cure  it,  and  to  him,  therefore,  the 
whole  and  especialty  the  early  histor}-  of  the  patient,  embracing 
the  causes  and  the  development  of  the  changes,  bodily  and  men- 

1  Krafft  -  Ebing  :       "Gerichtliche         '-  Ibid. 
Psycho-Pathologie, "  edition  of  1875.          3  Ordronaux. 


WHAT    IS    INSANITY?  157 

tal,  and  affording  perhaps  some  insight  into  the  pathology,  is 
of  preponderating  importance.  With  him  the  main  question  is 
to  prevent  its  interference  with  the  enjoyment  and  duration  of 
the  life  of  the  patient. 

"  To  the  lawyer  it  matters  not  how  the  seed  of  insanity  was 
sown,  nor  the  growth  of  the  plant,  except  as  confirmatory  evi- 
dence that  the  plant  is  there.  With  him  the  sole  question  is, 
its  existence,  its  degree,  and  its  influence  on  the  conduct,  not 
therefore  a  medical  but  a  moral  one;  and  if  the  same  mental 
states  were  capable  of  being  produced  by  other  conditions  than 
disease,  the  same  amount  of  irresponsibility  would,  I  think, 
be  recognized,  as  indeed  is  the  case  for  children  under  seven 
years  of  age,  in  whom  the  law  refuses  to  recognize  the  responsi- 
ble knowledge  of  right  and  wrong." 

While  indeed,  as  the  writer  just  quoted  states,  the  standpoint 
of  law  and  medicine  is  different  in  the  view  of  what  insanity 
is,  there  are  many  points  which  they  must  investigate  in  com- 
mon, especially  heredity,  injuries,  etc.,  as  causative  agents,  and 
again  "the  bodily  and  mental  changes"  are  fully  as  important 
for  the  lawyer  to  study  as  for  the  physician.  In  fact  it  is 
impossible  for  the  law  to  do  without  the  knowledge  which 
belongs  to  the  medical  expert,  for  the  question  of  responsibility 
is  determined  by  the  fact,  whether  or  not  the  disease  of  the 
brain  is  of  such  a  character  as  to  fall  under  the  rulings  of  the 
courts,  as  to  what  constitutes  insanity.  This  cannot  lx»  left  to 
laymen  to  decide,  and  therefore,  despite  the  somewhat  con- 
temptuous reference  to  medical  experts  by  some  judges,  they 
are  forced  to  make  use  of  their  knowledge. 

"No  doubt  the  extension  of  the  meaning  of  insanity,  as  un- 
derstood by  medical  men,  has  been  due  in  a  great  measure  to 
more  laborious  and  accurate  methods  of  observation,  resulting 
in  actual  discovery  and  increase  of  knowledge,  and  also  to  a 
more  enlightened  estimate  of  the  correlation  of  insanity  with 
other  nervous  diseases;  but  also  it  seems  to  me  it  lias  gained  an 
impulse  from  the  adoption  of  hypotheses  which  have  no  dinvt 
relation  with  the  actual  existence  of  mental  disease,  and  which, 
however  useful  and  admissible  in  the  theoretical  conception 
and  in  the  practical  study  of  other  causation  of  insanity,  nn» 
completely  out  of  place  in  the  investigation  of  such  practical 
1  Bucknill  :  "Insanity  in  its  l>>j;al  IMntions." 


1 58  INSANITY — FISHER. 

questions  as  whether  a  criminal  is  or  is  not  insane.  As  a  type 
of  this  kind  of  hypothesis  I  may  cite  what  is  called  the  insane 
neurosis,  being,  if  I  understand  it  aright,  the  condition  of  a 
man  who  is  more  liable  than  other  men  to  become  insane,  but 
who  has  hitherto  shown  no  signs  of  the  presence  of  the  disease 
itself.  No  doubt  there  is  such  a  condition  as  an  insane  neuro- 
sis. And  there  is  also  such  a  condition  as  a  criminal  neurosis. 
It  is  the  Hegelian  theory  of  becoming,  and  we  are  all  becoming, 
something  which  we  are  not.  But  the  inquiries  of  criminal 
courts  are  restricted  to  actual  events  of  the  past ;  and  if  these 
forty-fold  forms  of  insanity,  this  tendency,  to  comprehend  all 
nervous  disease  within  the  pale  of  insanity,  these  speculative 
views  as  to  the  existence  of  inherited  insanity  which  shows  no 
signs,  are  in  any  way  reflected  in  the  evidence  of  medical  wit- 
nesses, no  wonder  if  our  legal  fellow-laborers,  in  the  interest  of 
truth  and  justice  and  the  welfare  of  society,  should  take  a  stand 
which  may  be  nothing  more  than  the  conservatism  of  common 
sense. " l 

One  observes  perhaps  primarily,  in  all  mental  disease, 
a  change  in  the  feelings  or  the  emotions,  and  therefore  in 
the  personality.  There  may  be  excitement  or  apathy,  but  in 
either  case  a  concentration  upon  the  ego  or  individual  who  be- 
comes the  central  figure  amid  disordered  perceptions  and  con- 
ceptions. As  all  mental  action  is  carried  on  through  perception, 
we  expect  and  find  disorders  of  the  various  perceptions,  as  rep- 
resented in  hallucinations  and  illusions.  While  these  latter 
conditions  are  not  necessary  for  our  diagnosis  of  insanity,  still 
in  conjunction  with  other  symptoms  they  are  perhaps  the 
strongest  and  most  common  evidence  we  have  of  mental  dis- 
ease. Delusions,  either  primary  or  secondary  to  hallucination 
and  illusion,  are  the  best  proof  we  possess  of  mental  aberration, 
but  they  are  not  absolutely  necessary,  and  in  many  cases  are 
not  present  in  well-recognized  forms  of  insanity.  As  a  neces- 
sary part  of  the  normal  mental  activity,  consciousness  must  be 
present,  and  the  recognition  of  one's  own  personality,  by  which 
we  mean  self-consciousness.  We  observe  then,  in  the  insane, 
first  some  change  in  this  entit}~ — self-consciousness. 

J.  Battey  Tuke  defined  insanity  as  consisting  "  in  morbid 
conditions  of  the  brain,  the  result  of  defective  formation  or 
1  Bucknill :  "Insanity  in  its  Legal  Relations." 


WHAT    IS    INSANITY? 


159 


altered  nutrition  of  its  substance,  induced  by  local  or  gen- 
eral morbid  processes,  and  characterized  especially  by  non- 
development,  obliteration,  impairment,  or  perversion  of  one 
or  more  of  its  psychological  functions."  Bucknill '  defines* 
insanity  as  u  a  condition  of  the  mind  in  which  a  false  action  of 
perception  or  judgment,  a  defective  power  of  the  will,  or  an  un- 
controllable violence  of  the  emotions  and  instincts  have  sepa- 
rately or  conjointly  been  produced  by  disease."  The  legal 
question  must  always  involve  the  extent  of  impairment  of  the 
will,  and  the  consequent  irresponsibility.  As  Ray  has  well 
said,  "  certain  it  is  that  as  we  have  become  better  acquainted 
with  the  anatomy  of  the  brain,  and  have  become  more  thor- 
ough and  persevering  in  our  examinations,  the  more  rarely  do 
we  find  a  case  of  insanity  presenting  no  organic  changes  after 
death." 

Clinically,  insanity  is  a  disturbance  of  self-consciousness, 
and  is  dependent  upon  disease  of  the  cerebro-spinal  system .  The 
object  of  the  study  of  insanity  is  to  discover  the  conditions 
under  which  psychical  function  or  mental  action  departs  from 
the  normal,  and  to  learn  the  method  by  which  this  function 
may  be  restored. 

Brain  affections  with  predominating  disturbance  of  mental 
function  are  called  diseases  of  the  mind.  The  question  neces- 
sarily arises,  however,  as  to  where  the  seat  of  the  psychical  or 
mental  function  lies.  The  cortex  of  the  cerebrum  is  the  organ 
of  all  mentality,  the  rest  of  the  nervous  system  acting  only  as  a 
conductor.  Here  are  grouped  the  result  of  former  feelings,  per- 
ception, and  volition.  Mental  action  springs  from,  and  depends 
upon,  conscious  perception  in  the  cortex.  There  alone  is  the 
seat  of  thought.  By  comparative  study  of  the  hemispheres  of 
the  various  grades  of  mammalians  it  is  noted  that  the  anterior 
brain,  and  the  convolutions  around  the  fissure  of  Sylvius,  which 
pathology  and  physiology  designate  as  the  centre  for  speech, 
are  especially  developed  in  man.  The  significance  of  the  an- 
terior brain  for  the  intellect  is  also  shown  by  its  proportionate  in- 
crease in  the  more  intelligent  races,  its  loss  in  weight  (Meynert) 
in  mental  disease.  The  convolutions  become  more  complicated 
and  increase  as  we  ascend  in  the  species.  The  significance  of 
these  fissures  and  convolutions  lies  in  the  fact  of  the  increased 
1  "Unsoundness  of  Mind  in  Relation  to  Criminal  Acta." 


160  INSANITY—FISHER. 

surface  they  present  for  the  gray  matter,  which  is  proportional 
to  the  intelligence. 

Mental  action  consists  in  perceptions  and  their  action  one 
on  the  other.  In  general,  the  three  principal  functions  or 
faculties  of  the  mind — the  feelings,  thoughts,  and  will — must 
act  in  harmony.  We  cannot  separate  them  before  the  law. 
The  fact  of  mental  unsoundness  is  the  important  thing.1  Men- 
tal disease  must  then  affect  these  different  factors  of  the  mind, 
manifesting  itself  by  anomalies  of  the  feelings,  and  disturbances 
of  the  perceptions  and  conceptions. 

"  Any  one  or  more  of  numerous  causes  may  produce  disease 
of  the  brain  or  nervous  system,  which  interferes  more  or  less 
with  the  feeling,  will,  or  intellect  of  the  person  affected.  Com- 
monly the  disease,  if  it  runs  its  full  course,  affects  the  emo- 
tions first,  and  afterward  the  intellect  and  the  will.  It  may 
affect  the  emotions,  either  by  producing  morbid  depression, 
or  by  producing  morbid  excitement  or  feeling.  In  the  first, 
which  is  much  the  commoner  of  the  two  cases,  it  is  called 
melancholia,  and  in  the  second  mania.  Melancholia  often 
passes  into  mania.  Both  melancholia  and  mania  commonly 
cause  false  opinions  as  to  existing  facts,  which  suggest  them- 
selves to  the  mind  of  the  sufferer  as  explanations  of  its  mor- 
bid feelings.  These  delusions  are  often  accompanied  by  hallu- 
cinations which  are  deceptions  of  the  senses.  Melancholia, 
mania,  and  the  delusions  arising  from  them  often  supply 
powerful  motives  to  do  destructive  and  mischievous  acts, 
and  cases  occur  in  which  an  earnest  and  passionate  desire  to  do 
such  acts  is  the  first  and  perhaps  the  only  marked  symptom  of 
mental  disease.  It  is  probable  that  in  such  cases  some  morbid 
state  of  the  brain  produces  a  vague  craving  for  a  relief  by  some 
form  of  passionate  action,  the  special  form  of  which  is  deter- 
mined by  accidental  circumstances,  so  that  such  impulses  may 
differ  in  their  nature  and  mode  of  operation  from  the  motives 
which  operate  on  the  sane  and  insane  persons  alike.  The  differ- 
ence may  be  compared  to  the  difference  between  hunger  prompt- 
ing a  man  to  eat.  and  the  impulse  which,  when  he  suffers 
violent  pain,  prompts  him  to  relieve  himself  by  screaming.  In- 
sanity affecting  the  emotions  in  the  forms  of  melancholia  and 
mania  is  often  succeeded  by  insanity  affecting  the  intellect  and 
1  Neuman's  "Lehrbuch  der  Psychiatric. " 


ANALOGOUS   CONDITION    IN    HEALTH.  161 

the  will.  In  this  stage  of  the  disease,  the  characteristic  symp- 
tom is  the  existence  of  permanent  incurable  delusions,  commonly 
called  monomania.  The  existence  of  any  such  delusion  indi- 
cates disorganization  of  all  the  mental  powers,  not  only  the 
power  of  thinking  correctly,  but  the  power  of  keeping  l*»fore 
the  mind  and  applying  to  particular  cases  the  general  principles 
of  conduct.  The  last  stage  of  insanity  is  one  of  utter  fwbU'- 
ness,  in  which  all  the  intellectual  powers  are  so  much  prostrated 
as  to  reduce  the  sufferer  to  a  state  of  imbecility.  lastly,  paral- 
ysis and  epilepsy  are  so  closely  allied  with  insanity,  that  insan- 
ity frequently  forms  a  symptom  of  each.  In  all  the  cases  above 
referred  to,  the  sufferer  is  supposed  to  have  been  originally  sane, 
but  sanity  may  never  be  enjoyed  at  all.  This  happens  in  cases 
of  idiocy."1 

English  law  recognizes  two  states  of  mental  disease :  (1)  De- 
mentia naturalis;  and  (2)  dementia  adrentitia,  under  which 
general  insanity  is  included.  To  this  the  term  "  lunacy"  is  usu- 
ally applied.  In  New  York,  Massachusetts,  and  several  other 
of  the  States  statutes  have  been  passed  defining  the  term  "  in- 
sane person,"  "lunatic,"  "non  compos,"  and  "insane,"  so  as  to 
embrace  all  forms  of  insanity  except  idiocy.  In  many  of  the 
States,  the  law  has  made  the  words  "lunatic,"  "  insane,"  and 
"non  compos  mentis"  synonymous  and  convertible  terms.1 
There  is  no  distinction  between  the  terms  insanity  and  un- 
soundness  of  mind. 

ANALOGOUS   CONDITION    IN    HEALTH. 

Mental  disturbance  as  represented  by  hallucinations,  illu- 
sions, and  delusions  is  not  confined  to  the  insane,  but  analo- 
gous conditions  are  not  infrequently  seen  in  health  and  in  vari- 
ous diseases,  or  in  persons  under  the  influence  of  drugs,  such  as 
alcohol,  morphine,  hasheesh,  etc.  A  most  typical  example  of 
this  is  seen  in  delirium  tremens,  which  may  l»  taken  as  a  fair 
representation  of  mania.  In  it  we  find  great  excitement,  hal- 
lucinations, especially  of  sight  and  hearing,  marked  volubility, 
and  the  accompanying  mental  confusion  which  is  usually  pres- 
ent to  a  greater  or  less  degree  in  all  mania.  The  distinction, 

1  Stephen's  "History  of  Criminal         'Taylor's     "Medical     Jurispru 
Law  of  England,"  vol.  ii.  deuce." 


1U2  INSANITY — FISHER. 

however,  is  easily  made  between  this  condition  and  mental 
disease,  in  that  we  are  acquainted  with  its  cause  and  also  with 
the  fact  that  clinically  we  can  define  its  course  and  duration. 
But  even  in  these  cases,  the  truth  of  its  close  alliance  with 
mental  aberration  is  proven  by  the  fact  that  in  chronic  alco- 
holism we  have  a  well-defined  chronic,  and  generally  incurable, 
form  of  insanity. 

With  morphine,  we  find  hallucinations  and  delusions,  usu- 
ally of  a  pleasant  character,  which,  however,  the  subject  is  able, 
when  aroused  to  full  consciousness,  to  recognize  as  merely 
such,  giving  therefore  one  of  the  cardinal  distinctions  between 
the  so-called  hallucinations  of  the  insane  and  of  the  sane.  The 
brief  duration  of  these  conditions  also,  of  whatever  nature,  is 
opposed  to  the  idea  of  their  dependence  upon  disease  of  the  brain 
structure. 

We  find  in  the  dreams  accompanying  sleep  an  almost  typical 
reproduction  of  the  mental  condition  of  the  insane,  as  in  both 
instances  self-consciousness  is  never  fully  in  the  ascendency. 
In  both  cases,  not  infrequently,  a  dual  existence  may  be  par- 
tially recognized;  or,  again,  the  two  existences,  accompanied 
frequently  by  a  change  of  personality,  remain  distinct  and  apart, 
so  that  in  the  insane,  at  least,  acts  committed  or  persons  met 
during  one  state  are  not  recollected  in  the  other. 

Krafft-Ebing  puts  this  very  clearly : 

The  physiological  function  of  the  brain,  on  its  mental 
side,  is  the  production  of  feelings,  thought,  and  volition. 

The  spontaneous  origin  of  mental  action  without  adequate 
cause  is,  in  general,  a  sign  of  internal  irritative  processes, 
its  pathological  nature  manifesting  itself  by  its  duration,  in- 
tensity, and  general  disproportion.  Only  when  we  know  the 
source  and  motive  of  the  mental  action,  can  we  decide  whether 
it  is  that  of  a  sane  or  insane  person.  In  the  majority  of  cases, 
in  the  early  stages  of  insanity,  the  most  marked  symptom  is 
emotional,  not  intellectual,  and  apparently  has  arisen  without 
cause.  It  is  similar,  however,  to  the  normal  physiological 
reaction ;  the  course  of  the  feelings  can  be  tumultuous  or  de- 
pressive, corresponding  to  melancholia  or  mania.  If  we  com- 
pare physiological  or  normal  depression  with  melancholia  we 
notice  no  substantial  difference;  in  both  individuals  there  is 
evidence  of  psychical  pain,  both  are  depressed,  and  given  over 


ETIOLOGY.  JQ;J 

to  their  painful  impressions,  interesting  themselves  in  nothing 
else,  i.e.,  their  usual  duties  or  pleasures.  Physically  they  ex- 
hibit similar  states:  they  are  sleepless,  the  appetite  is  poor,  the 
intestinal  action  is  sluggish,  and  there  is  general  malnutrition. 

The  difference  is,  that  in  the  first  the  mental  pain  and  de- 
pression have  an  adequate  cause  in  some  previous  occurrence, 
and  are  the  physiological  reaction  from  it,  while  in  the  other 
there  has  been  no  external  cause,  or  at  least  not  a  sufficient 
one,  but  it  has  arisen  from  an  internal  process,  the  result  of  a 
diseased  brain.  The  self-consciousness  is  too  much  affected  to 
distinguish  the  true  from  the  false. 

The  laity  rarely  make  this  distinction,  especially  when 
some  cause  exists,  and  try  vainly  to  arouse  the  patient  by  change 
and  occupation.  The  analogy  is  the  same  for  mania :  it  is  only 
a  permanent  state  of  the  joy  following,  for  instance,  a  good 
piece  of  news ;  observe  also  the  slight  line  between  genius  and 
insanity. 

ETIOLOGY. 

The  causes  of  insanity  are  predisposing  and  exciting. 

Predisposing. — The  predisposing  causes  are  those  which 
come  under  a  general  head,  as  civilization  and  race;  the  latter, 
however,  except  where  races  have  isolated  themselves  from 
others,  has  very  little  influence.  Among  the  Chinese  there  is 
very  little  mental  disease.  This  may  be  due  to  their  methodi- 
cal habits  of  living  and  temperate  use  of  alcohol.  Age,  with 
its  transitional  periods — e.g.,  childhood,  puberty,  senility— sub- 
ject the  individual  to  special  danger.  It  is  difficult  to  say 
whether  celibacy  has  an  influence  in  this  disease,  although  the 
proportion  of  those  admitted  into  asylums,  as  given  in  the  re- 
port of  the  Lunacy  Commission  in  England,  shows  a  much 
larger  number  among  the  unmarried.  Occupation,  where  men- 
tal worry  or  monotony  is  present,  as  in  sailors,  teachers,  prison- 
ers, etc.,  has  a  deleterious  influence. 

Inhabitants  of  cities  are  more  liable  to  mental  disease. 
This  is  probably  the  result  of  the  increased  demands  on  the 
energy  of  the  individual  to  maintain  his  social  position  or  in 
the  greater  struggle  for  mere  existence;  there  is  also  greater 
dissipation  of  all  kinds. 

There  is  one  form  of  insanity  which  is  peculiar  to  modern 


1 64  INSANITY — FISHER. 

life — that  which  Kirn  has  termed  the  characteristic  psy- 
chosis of  the  nineteenth  century,  namely,  general  paresis. 

This  disease  does  not  seem  peculiar  to  any  race,  but  depends 
on  the  surroundings  of  the  individual  and  the  vicissitudes  and 
anxieties  of  life. 

Before  slavery  in  the  United  States  was  abolished,  the  negro 
was  never  affected  with  this  form  of  insanity ;  it  is  now  com- 
mon among  those  who  have  flocked  to  the  cities  and  who  have 
been  compelled  to  assume  the  responsibilities  of  supporting 
themselves. 

This  can  also  be  said  of  the  Irish,  that  is,  after  leaving  their 
agricultural  pursuits,  and  being  exposed  to  the  vicissitudes  and 
excitement  of  large  cities. 

The  Chinese  in  this  country  also  supply  their  quota,  several 
cases  having  come  under  my  observation.  We  observe  no 
change  in  the  class  of  symptoms  from  mere  difference  of  race : 
there  are  the  same  delusions  of  grandeur,  the  feeling  of  power, 
and  the  ideas  of  great  wealth,  associated  with  the  physical  signs 
of  tremor  and  disturbance  of  articulation. 

HEREDITY. 

A  most  important  element  among  the  individual  predis- 
posing causes  is  heredity.  It  is  more  often  the  inheritance  of 
an  unstable  nervous  organization  than  any  special  form  of  insan- 
ity. The  effect  of  predisposition  to  insanity  is  seen  in  its  rela- 
tions to  all  the  direct  and  exciting  causes. 

Injuries,  fevers,  grief,  stress  of  any  severe  form,  with  the 
hereditary  tendency  to  mental  disease  in  the  individual,  result  in 
insanity,  where  in  other  persons  the  tendency  would  be  slight. 

This  predisposition  by  inheritance  may  be  due  to  various 
nervous  disorders  in  the  progenitors,  as  epilepsy,  dipsomania, 
neuralgia,  hysteria,  etc.,  all  producing  alike  an  unstable  nerv- 
ous organization.  The  reverse  of  this  is  also  true,  nervous  dis- 
orders being  the  result  in  the  descendants  of  insanity  in  the 
antecedents. 

Marriage  between  persons  either  too  similar  in  mental 
characteristics  or  tastes,  or  again  too  dissimilar,  not  unfrequently 
results  in  insanity,  especially  if  there  is  any  consanguinity. 

The  tendency  to  inheritance  of  insanity  depends  largely  on 


PREDISPOSING   CAUSES.  JU5 

the  condition  of  the  parent  at  the  time  of  procreation.  If  the 
insanity  developed  after  the  hirth  of  the  child  the  influence  of 
heredity  is  not  so  great.  In  regard  to  the  special  form  of 
disease  inherited,  it  may  be  of  the  same  kind.  Especially  is  this 
seen  in  suicidal  tendencies,  occurring  not  infrequently  at  the 
same  age,  or  again  the  occurrence  of  insanity  at  the  puorjieral 
and  climacteric  periods  when  it  has  been  directly  inherited. 

Certain  forms,  as  general  paralysis,  are  rarely  directly  in- 
herited, although  the  children  may  be  idiotic  or  subject  to  the 
various  neuroses  (Savage). 

INDIVIDUAL  PREDISPOSING  CAUSES-.— OCCUPATION. 

Prisoners. — Among  those  confined  in  institutions,  mental 
disease  is  not  uncommon.  Here  it  is  also  that  the  different 
forms  of  insanity  are  often  feigned  in  order  to  avoid  work  or  to 
procure  hospital  treatment.  In  the  older  method  of  treating 
criminals,  where  punishment  by  separation  from  others  was 
common,  mental  disease  was  very  frequent.  The  monotony  of 
work  without  mental  exercise  ma}'  result  in  delusions  common 
to  various  forms  of  mental  disease,  especially  those  of  persecu- 
tion. Epilepsy  may  also  result.  Mania  is  not  common,  but 
impulses,  homicidal  and  suicidal,  are  frequent.  Masturbation 
with  its  accompanying  result,  dementia,  is  frequent;  but  where 
a  system  of  occupation  is  carried  out,  all  these  conditions  are 
much  lessened.  Perhaps  the  mental  disturbance  most  often 
feigned  among  prisoners  is  that  of  dementia.  It  is  also  the 
easiest  and  the  least  liable  to  detection.  Still  epilepsy  is  not 
infrequently  assumed,  as  in  the  case  of  the  so-called  "  dummy 
chucker"  in  Sing  Sing  prison.  This  patient  had  deceived 
many  expert  examiners,  and  was  only  detected  after  many 
years.  The  opposite  condition  of  attempt  at  concealment  of  in- 
sanity is  more  rarely  present.  It  is  olraerved  sometimes  on 
examining  the  patient,  especially  in  the  degenerative  type  of 
disease.  Where  the  symptoms  can  be  restrained,  it  implies  a 
certain  amount  of  control;  however,  under  provocation,  or 
when  the  patient  is  taken  unawares,  the  true  condition  can 
usually  be  determined.  It  is  only  by  frequent  examinations,  or 
allusions  to  the  special  delusion  of  such  cases,  that  the  true 
mental  condition  can  be  discovered.  In  melancholia  we  find 


166  INSANITY — FISHER. 

this  tendency  to  concealment  of  the  condition,  where  it  is  of  a 
mild  type.  After  partial  recovery  from  acute  attacks,  care  is 
necessary  to  discover  whether  the  delusions  and  hallucinations 
are  still  present.  Our  only  method  of  estimating  the  sanity  or 
insanity  must  ultimately  rest  on  the  conduct,  whether  expressed 
in  speech  or  act. 

There  is  little  difference  noted  in  the  various  business  occu- 
pations. Those,  however,  whose  life  is  more  solitary  or  confined, 
as  sailors,  soldiers,  governesses,  teachers,  etc.,  show  greater 
tendency  to  mental  disease.  Professional  beggars  and  prosti- 
tutes are  especially  liable ;  this  is  probably  the  result  of  sexual 
excess,  drunkenness,  and  general  privation. 

Kirn  finds  that  prisoners,  probably  through  the  physical 
weakness  induced  by  imprisonment,  and  the  influence  of  re- 
morse, especially  when  solitary  confinement  has  been  carried 
out,  are  liable  to  melancholia  with  delusions  of  persecution 
and  hallucinations  of  the  special  senses. 

It  has  not  been  found  that  those  engaged  in  the  care  of 
the  insane  are  much  affected.  Certainly  imitation  is  rare 
of  the  same  form  of  disease.  The  social  conditions  do  not  seem 
to  have  any  especial  influence,  except  in  so  far  as  poverty  and 
bad  hygienical  surroundings  have  in  a  general  way  a  deleterious 
effect. 

RELIGION. 

According  to  Kirn  religious  formalism  favors  the  occurrence 
of  (primary)  religious  paranoia;  this  may  even  become  epidemic 
under  favorable  circumstances.  Investigation  generally  proves, 
however,  that  its  effects  are  shown  mainly  in  those  predisposed 
to  mental  disorder  by  heredity  or  a  neurotic  disposition,  or  again 
at  special  periods  of  life,  as  puberty,  the  puerperal  period, 
and  during  the  climacteric.  In  regard  to  this  latter  class,  also, 
it  may  be  observed  that  the  condition  is  not  usually  a  perma- 
nent one,  recovery  taking  place,  while  in  true  paranoia,  which 
is  itself  a  chronic  delusional  state,  the  religious  excitement  has 
acted  simply  as  an  exciting  cause,  and  has  given  direction  to  the 
form  of  mental  disturbance.  Anxiety  in  regard  to  success  in 
any  special  department,  as  in  art  or  politics,  especially  when 
failure  results,  or  even,  though  more  rarely,  great  success,  may 


EXCITING    CAUSES. 


107 


give  rise  to  paranoia,  though  of  a  different  type,  as,  for  instance, 
with  delusions  of  persecution. 

During  revivals  mental  disorder  is  common.  The  term  a  re- 
ligious insanity"  is  misleading,  and  is  to  be  deprecated.  Where 
the  delusions  are  of  a  religious  character  it  is  not  infrequent 
to  find  associated  with  them  an  element  of  eroticism,  so  that 
those  addicted  to  sexual  abuse  are  frequently  subject  to  such 
delusions.  Communications  with  God  are  frequent,  either 
through  hallucinations  of  sight  or  hearing,  leading  to  de- 
lusions in  which  special  commands  are  received  or  in  which 
a  change  of  personality  occurs.  The  character  of  God  himself, 
or  of  some  prophet  is  assumed.  We  find  these  conditions  not 
infrequently  among  the  uneducated,  or  among  those  of  a  low 
type  of  mental  development.  We  often  find  among  this  dass 
those  who  subject  themselves  to  self-mutilation  in  their  desire 
perhaps  to  atone  for  some  crime,  imaginary  or  otherwise.  It 
is  really  a  type  of  paranoia.  Epileptics  are  especially  in- 
clined to  religiosity,  taking  great  pleasure  in  all  exercises 
of  a  religious  character.  This,  however,  has  little  or  no  effect 
on  their  action,  nor  is  true  remorse  likely  to  follow  acts  of  the 
most  extreme  violence.  Depression  or  self -condemnation  is 
felt  most  often  for  imaginary  acts  of  disobedience  to  God, 
especially  in  relation  to  self -abuse  rather  than  to  actual  pres- 
ent wrong-doing. 

EXCITING  CAUSES. 

In  those  predisposed  by  heredity  or  a  neurotic  disposition, 
physical  causes,  as  injuries,  fevers,  physiological  states  a* 
pregnancy,  lactation,  etc.,  may  induce  mental  disorder,  but 
these  causes  may  be  the  primary  ones  themselves. 

The  varioitft  inflammation  of  the  meninges,  and  the  cor- 
tex of  the  brain,  rarely  result  in  insanity.  We  may  indeed 
have  delirium  and  mania,  but  these  symptoms  are  usually  of 
comparatively  short  duration,  and  with  the  subsidence  of  the 
provoking  cause  they  also  subside. 

We  exclude  from  these  remarks  the  specific  characteristic 
affection  of  the  brain  peculiar  to  certain  diseases,  as  general 
paralysis,  as  they  are  the  pathological  changes  observed  in  the 

disease  and  not  the  cause. 
III.— is 


168  INSANITY — FISHER. 

Cerebral  hemorrhage,  tumors,  multiple  sclerosis  impair 
the  functional  activity  of  the  brain  and  tend  to  dementia  rather 
than  any  well-defined  psychosis.  Here  again  we  must  not  in- 
clude in  the  list  of  causes  what  is  a  symptom  of  the  disease, 
as  apoplectic  seizures  in  general  paralysis. 

Injuries  to  the  skull  may  not  manifest  themselves  in  a  dele- 
terious way  for  years,  but  no  doubt  have  an  influence  even  after 
a  long  period,  either  directly  or  indirectly,  in  causing  insanity. 
While  we  cannot  consider  it  a  predisposing  cause  to  general 
paralysis  it  may  be  an  exciting  one. 

Insanity  may  result  from  various  diseases  of  the  nerv- 
ous system,  as  Basedow's  disease,  or  exophthalmic  goitre, 
hysteria,  epilepsy,  chorea,  etc.,  tabes,  multiple  sclerosis. 
With  the  exception  of  tabes  no  special  form  is  the  result;  here 
perhaps  general  paralysis  not  infrequently  results.  There  are 
many  allied  and  similar  symptoms  in  these  two  diseases. 

Following  Griesinger  we  find  that  constitutional  disease  may 
result  in  insanity.  General  anemic  states  following  exhaus- 
tive disease,  repeated  loss  of  blood,  special  conditions  as  lacta- 
tion, exposure  as  in  the  states  of  inanition  following  in  ship- 
wrecks, produce  those  forms  of  insanity  which  come  under  the 
head  of  functional  psychoses,  i.e.,  mania,  melancholia,  hallu- 
cinatory and  delusional  insanity,  and  primary  dementia. 

Tuberculosis  is  very  common  among  the  insane,  the  mor- 
tality from  this  disease  being  large.  I  can  scarcely  agree  that 
it  is  very  frequently  a  direct  cause  of  it,  or  that  we  are  justified 
in  establishing  a  special  form  under  the  name  of  phthisical 
insanity.  Tuberculosis  of  the  brain  substance,  or  tubercular 
meningitis  rarely  terminates  in  insanity;  the  course  of  these  dis- 
eases is  usually  a  rapid  and  fatal  one,  and  while  such  cases  not 
infrequently  are  brought  to  the  as3Tlum,  they  cannot  properly 
be  considered  as  examples  of  insanity.  The  delusions  and 
hallucinations  may  be  excessive  and  the  patient  require  re- 
straint, the  course  of  the  disease  resembling  acute  mania  or 
delirium  grave.  In  such  a  patient  under  my  observation, 
careful  examination  showed  no  physical  signs  of  tuberculosis, 
either  abdominal  or  cerebral.  The  temperature  had  suggested 
tuberculosis,  and  special  attention  had  been  given  to  these  symp- 
toms. Death  ensued  from  exhaustion,  and  the  post-mortem  re- 
vealed a  general  miliary  tuberculosis,  involving  the  abdominal 


EXCITING   CAUSES.  16«> 

region  and  the  convex  surface  of  the  brain,  the  bane  not  being 
affected. 

The  direct  cause  of  the  delirium  and  hallucination  was  the 
cerebral  irritation  by  the  miliary  tubercles. 

There  was  nothing  characteristic  to  differentiate  it  from 
similar  states  occurring  in  acute  mania,  or  in  meningitis  oc- 
curring in  the  course  of  acute  inflammatory  rheumatism. 

Tuberculosis  may  run  its  course  in  the  insane  without  being 
observed,  the  mental  symptoms  obscuring  it,  especially  as  the 
patients  themselves  frequently  offer  no  complaint.  The  course 
of  the  disease  is  apt  to  be  rapid,  owing  to  the  generally  impaired 
nutrition. 

Mj*  experience  would  not  indicate  that  melancholia  is  more 
frequent  than  mania.  Suicidal  mania  is  not  uncommon. 

Syphilis  stands  in  an  important  relation  to  insanity,  asso- 
ciated as  it  is  with  disease  of  the  meninges  and  the  blood-vessels, 
as  well  as  the  brain  substance  itself.  We  frequently  find  acute 
conditions  present. 

Cerebral  syphilis  not  infrequently  passes  into  general  paral- 
ysis of  the  insane.  This  implies  organic  changes  in  the  men- 
inges and  cortex,  secondary  usually  to  the  eudarteritis,  which 
are  incurable.  The  estimate  of  the  proportion  of  these  latter 
cases  due  to  syphilis  varies  with  the  author,  some  writers  going 
so  far  as  to  say  that  it  is  the  basis  of  general  paresis  in  all 
cases  with  few  exceptions.  The  initial  stages  in  both  may  be 
very  similar;  in  general  paralysis,  however,  the  fatal  course  of 
the  disease  is  not  affected  by  specific  treatment,  while  cerebral 
syphilis  not  infrequently  entirely  clears  up  under  the  iodides 
and  mercury. 

Fevers,  especially  the  infectious,  may  during  their  course 
cause  insanity ;  this  can  be  ascribed  often  to  the  high  tempera- 
ture or  to  the  overwhelming  of  the  brain  by  the  dirt»ct  poison. 
These  states  are  rarely  protracted,  although  at  times  they  pass 
into  chronic  incurable  forms.  It  is  usual  to  find  an  hereditary 
history  if  that  is  the  result,  the  constitutional  condition  acting 
only  as  the  exciting  cause. 

Another  cause  for  these  mental  states  is  the  exhaustion  and 
cerebral  anremia,  which  may  result  in  hallucinatory  mania  or 
melancholia.  This  occurs  in  the  course  of  all  the  fevers,  as 
typhus,  typhoid,  small-pox,  pneumonia,  scarlet  fever,  etc. 


170  INSANITY— FISHER. 

Griesinger  speaks  especially  of  psychoses  occurring  in  the 
course  of  intermittent  fever,  in  regions  where  intermittent 
fever  is  endemic,  the  regular  quartan  or  tertian  attacks  of  fever 
being  superseded  by  attacks  of  insanity  (violent  mania,  sui- 
cidal impulse)  without  fever.  This  may  terminate  in  chronic 
disease. 

Influenza  is  not  an  infrequent  cause  of  the  functional  type 
of  the  psychoses.  The  recent  epidemic  of  the  past  few  years 
has  given  occasion  to  many  observations.  While  apparently 
melancholia  is  more  common,  mania  of  a  violent  character  may 
follow.  It  would  seem  to  be  largely  due  to  the  exhaustion. 

Rheumatism,  when  acute,  causes  meningeal  irritation,  the 
symptoms  being  usually  acute  and  marked  by  delirium  and 
hallucination.  Clouston,  Savage,  and  others  speak  of  rheu- 
matic insanity,  but  this  is  hardly  a  proper  term.  However,  the 
close  connection  between  the  mental  disturbances  and  the  rheu- 
matic attack  can  be  noted  by  the  fact  that  not  infrequently  a 
total  disappearance  of  articular  inflammation  may  be  marked 
by  the  appearance  of  the  mental  symptoms,  and  vice  versa. 

Gout  may  be  mentioned  in  the  same  relation  and  as  follow- 
ing the  same  course. 

The  cause  in  both  instances  seems  to  be  an  overwhelming 
of  the  system  with  a  distinct  poison,  and  not  to  be  due  to  the 
temperature  changes.  It  can  be  compared  to  cases  of  metallic 
poisoning,  as  especially  observed  in  lead  and  mercury,  or  again 
with  ursemic  conditions.  The  system  can  absorb  slowly  a  large 
amount  of  these  poisons,  but  if  for  any  cause  they  are  thrown 
suddenly  into  the  system  cerebral  symptoms  manifest  them- 
selves. 

Alcohol,  morphine,  cocaine,  quinine  in  excessive  amounts 
show  a  similar  class  of  mental  symptoms,  characterized  by  ex- 
citement or  depression  with  various  illusions  and  hallucinations 
of  the  special  senses. 

These  acute  conditions  are  to  be  distinguished  from  the 
chronic  forms  of  mental  disease,  dependent  principally  upon  ar- 
terial degeneration  with  its  consequent  malnutrition. 

Too  much  weight  is  often  placed  on  malaria  in  the  produc- 
tion of  mental  disorder.  Where  mental  disturbance  has  fol- 
lowed, it  occurs  in  those  previously  disposed  by  a  neurotic  tem- 
perament or  other  hereditary  forms  of  disease.  Its  occurrence 


GENITO-URINARY    IRRITATION.  171 

in  the  insane  cannot  be  said  to  have  any  marked  effect,  exo»«pt 
in  a  general  way,  upon  the  course  of  the  disease. 


ANAESTHETICS   AND   MENTAL  DISEASE. 

Many  cases  of  mental  disturbance  have  been  recorded  as 
following  the  administration  of  anaesthetics,  whether  chloro- 
form, ether,  or  nitrous  oxide.  This  has  often  been  ob«erved 
in  very  slight  operations,  such  as  the  extraction  of  the  teeth 
while  under  the  influence  of  nitrous  oxide.  It  may  take  the 
form  of  maniacal  excitement,  or  of  marked  stupor,  or  of  acute 
dementia.  It  is,  however,  not  as  a  rule  of  long  duration. 
Dr.  T.  G.  Thomas  reports  several  cases  following  operations 
in  which  acute  dementia  followed,  and  several  have  come 
under  the  author's  own  observation.  The  most  usual  form  in 
his  experience  has  been  of  that  type,  or  of  a  condition  of  stupor- 
ous  insanity ;  rarely  has  it  been  of  a  maniacal  character.  It 
is  probable  that  thd  nervous  condition  of  anticipation  is  the 
effective  cause  of  this  mental  disturbance  rather  than  the  use 
of  the  anaesthetic.  It  seems  hardly  possible  that  it  alone  would 
be  effective,  except  in  those  who  by  their  habits,  as  by  the 
excessive  use  of  alcohol,  etc.,  are  specially  predisposed. 

GENITO-URINARY  IRRITATION  AND  INSANITY. 

Irritation  of  the  sexual  apparatus,  whether  due  to  disease 
or  the  practice  of  masturbation,  not  infrequently  causes  ner- 
vous and  mental  disorders;  but  these  are  more  often  of  a  func- 
tional than  an  organic  type.  They  occur  especially  in  those 
predisposed  to  nervous  disorder  by  hereditary  or  acquired  in- 
stability of  organization.  It  is  rare  in  my  experience  to  find 
insanity  per  se  due  to  masturbation,  whether  in  the  male  or  in 
the  female.  In  all  forms  of  insanity,  especially  in  the  later 
stages,  as  in  dementia,  where  the  higher  powers  of  the  mind 
have  been  affected,  this  practice  is  very  frequent,  but  a  true 
masturbational  insanity  probably  does  not  exist.  The  effect  of 
operations  on  the  diseased  organs  is,  as  a  rule,  unsuccessful  in 
producing  recovery  from  mental  disease  if  the  hereditary  pre- 
disposition is  of  the  degenerative  type.  In  other  cases,  it  may 


172  INSANITY — FISHER. 

be  favorable.     In  any  case  where  disease  is  present,  an  opera- 
tion for  the  removal  of  the  abnormal  condition  is  indicated. 


INSOLATION  AND   INSANITY. 

The  influence  of  the  sun,  except  in  so  far  as  it  may  cause 
inflammatory  disease  affecting  the  meninges,  is  not  an  impor- 
tant factor  in  insanity,  but  in  connection  with  exhaustion, 
anxiety,  and  alcoholism  it  is  of  importance  as  a  causative  agent. 

The  heat  of  summer  does  not  apparently  influence  the  oc- 
currence of  mental  disease,  according  to  Krafft-Ebing,  although 
Esquirol  considered  that  more  insane  were  received  into  asy- 
lums during  the  months  of  May  and  June.  Arndt,  Schiile, 
and  Kraepelin  think  that  great  heat  favors  the  outbreak  of 
mental  disease,  especially  mania.  It  is  difficult,  however,  as  has 
been  remarked,  to  state  when  the  disease  commenced.  The 
old  idea  that  suicide  due  to  insanity  occurs  in  the  gloomy  month 
of  November  seems  disproved  and  to  be  without  foundation. 

Change  of  climate  seems  to  have  some  influence.  Among 
those  coming  to  a  new  country,  especially  among  female  domes- 
tics, I  have  observed  a  general  impairment  of  nutrition,  with 
amenorrhcea,  associated  with  mental  disease  usually  in  the 
form  of  melancholia,  either  simple  or  with  stupor. 

Moral  causes  may  act  directly  as  the  exciting  agent.  Espe- 
cially is  this  seen  following  loss  of  relations,  or  business  reverses, 
or  any  intense  emotional  disturbance,  as  disappointment  in  love, 
or  the  strain  of  great  poverty,  where  the  necessaries  of  life  even 
are  impossible  of  procurement.  The  mother  in  her  despair  may 
even  be  led  to  destroy  herself  and  offspring  to  relieve  them  from 
suffering.  Fear  or  terror  following  a  criminal  assault,  or  the 
shock  from  exposure  to  some  great  danger,  as  a  railroad  ac- 
cident or  fire,  or  the  fear  arising  from  epidemic  disease — indeed, 
excessive  anger  itself — may  cause  insanity ;  but  as  has  been  said 
in  reference  to  all  these  exciting  causes,  they  fall  most  heavily 
on  those  already  predisposed  to  mental  disease. 

CRETINISM. 

This  is  commonly  a  congenital  condition,  or  commences 
early  in  life.  The  congenital  type  manifests  itself  by  the  stunted 


GENERAL   INDICATIONS   OF    INSANITY. 


173 


appearance  of  the  child,  the  thickness  of  the  skin,  and  an  ap- 
pearance not  unlike  that  of  myxcedema.  The  intelligence  is 
usually  low,  and  the  subsequent  development  is  slow  and  im- 
perfect. Speech  is  often,  but  not  always,  defective.  The  spe- 
cial senses  are  not  infrequently  affected,  especially  the  senses 
of  smell  and  hearing. 

Table  showing  causes  of  insanity  in  patients  admitted  into 
the  asylums  and  registered  in  hospitals  in  England  and  Wales 
during  the  ten  years  from  1878  to  1887: ' 

Moral. 

Domestic  trouble  (loss of  relatives). 
Adverse     circumstances    (business 

losses,  etc.). 

Mental  anxiety  and  worry. 
Love  affairs  (including  seduction) . 


Physical. 

Intemperance  in  drink. 
Intemperance  (sexual). 
Venereal  disease. 
Self-abuse. 
Over-exertion. 
Sunstroke. 
Accident  or  injury. 


Pregnancy. 

Parturition  and  the  puerpural  state. 

Lactation. 

Uterine  and  ovarian  diseaw. 

Puberty. 

Changes  of  life. 

Fevers. 

Privations  and  starvation. 

Old  age. 

Other  bodily  diseases  or  disorders. 

Previous  attacks. 

Hereditary  influence  ascertained. 

Congenital  defect  ascertained. 

Other  ascertained  causes. 

Unknown. 


GENERAL  INDICATIONS  OF  INSANITY. 

"The  diagnosis  of  insanity  presents  itself  to  the  physician 
in  a  purely  medical  or  in  a  medico-legal  point  of  view.  In  both 
cases,  the  grounds  of  the  diagnosis  must  be  the  same.  For 
although,  in  criminal  trials,  the  nature  of  the  crime  itself  and 
the  manner  in  which  it  has  been  effected  must  often  l>e  allowed 
to  have  no  inconsiderable  weight  in  the  formation  of  the  judg- 
ment, yet  these  circumstances  are  essentially  no  other  than  a  part 
of  the  conduct  of  the  patient;  and  the  conduct  must  be  carefully 
estimated  even  when  the  question  is  not  purely  medical." 

"The  conduct  of  the  alleged  lunatic  himself  «/,  In-fore,  and 
immediately  after,  the  critical  transaction,  is  relevant  evidence 
of  lunacy."1 


1  Tuke  :  "Dictionary  of  Psycholo- 
gical Medicine." 

*  Hucknill  and  Tuke:  "Psycholo- 
gical Medicine." 


»  Beavan  r.  McDonnell.  10  Ex. 
184;  Lovatt  r.  Tribe,  3  F.  and  F., 
9. 


174  INSANITY — FISHER. 

Mere  eccentricity  of  dress  and  behavior,  though  admissible 
as  evidence,  goes  but  a  little  way  to  establish  lunacy.1 

The  clinical  phenomena  and  pathological  changes  do  not 
stand  in  such  close  relation  as  in  other  diseases  of  the  body. 
As  Krafft-Ebing  has  well  said :  "  We  have  not  auscultation  and 
percussion  to  help  us  in  making  our  diagnosis;  we  have  only 
psychological  phenomena  to  deal  with."  From  the  disturbances 
of  the  ego,  of  the  consciousness,  of  the  memory  (quantitatively 
and  qualitatively),  of  the  feelings,  conceptions,  and  volition 
we  must  determine  the  nature  of  the  cerebral  disease.  This 
special  character  is,  however,  only  an  apparent  one;  for  if 
insanity  is  a  disease  of  the  brain,  its  symptoms  must  follow 
the  laws  of  physiology  and  pathology  which  'obtain  in  the  nerv- 
ous system.  We  must  have  the  latency  and  the  intermissions 
of  disease;  the  exacerbations,  the  remissions,  periodicity,  and 
relapses ;  the  response  to  irritation ;  the  loss  of  response,  the  re- 
flex action,  etc. ,  as  in  all  nervous  diseases.  We  can  best  under- 
stand this  when  we  deal  with  it  in  the  language  used  in  disease. 
So  we  can  speak  in  a  certain  sense  of  psychical  or  mental  hyper- 
sesthesia  and  anesthesia;  psychical  convulsions  or  paralysis; 
increased  or  decreased  reflex  action  or  resistance  to  action.  We 
must  always  remember  that  insanity  is  a  disease,  and  that  dis- 
ease is  life  under  abnormal  conditions.  Disease  and  health  are 
not  necessarily  opposite;  analogies  and  a  neutral  ground  exist 
for  both.  The  elements  out  of  which  diseased  mental  action 
results  are  the  same  for  healthy  mental  action;  the  only  differ- 
ences are  the  conditions  of  their  origin.  The  conditions  for 
the  process  of  psychical  function  in  normal  mental  life  are  ex- 
ternal irritation,  that  is,  of  the  senses — sight  and  hearing — as 
well  as  an  adequate  cerebral  reaction  to  this  irritation.  Along 
with  this  we  have  an  understanding  of  the  relation  or  agree- 
ment between  the  consciousness  and  the  external  irritation. 
In  insanity  the  brain  is  under  abnormal  conditions.  It  is  the 
seat  of  disease  in  which  internal  irritations  will  cause  mental 
action.  The  mind  acts  spontaneously,  uninfluenced  by  occur- 
rences in  the  external  world.  So  the  patient  stands  in  his  inner 
world  in  opposition  to  the  outer  world,  but  this  inner  irritation 
produces  the  same  result  as  if  due  to  external  irritation.  This 

1  Boughton  v.  Knight,  1872,  L.  R.  3  P.  &  D.,  84;  D.  Hack  Tuke :   "Dic- 
tionary of  Psychological  Medicine. " 


HALLUCINATIONS.  175 

spontaneous  internal   action  is  the  result  of  disturbed  nutri- 
tion of  the  cortex  of  the  brain. 

We  have  two  important  disturbances  resulting,  viz. :  (1) 
a  changed  reaction  to  external  irritation,  either  increased  or 
decreased,  or  qualitatively  changed;  (2)  a  change  in  the  ego, 
that  is,  in  the  self-consciousness,  and  therefore  a  danger  of  tak- 
ing the  subjective  internal  irritations  for  objective  external 
ones.  The  disturbance  of  the  ego  is  the  basis  for  the  under- 
standing of  insanity.  It  consists  especially  in  the  failure  to  re- 
call former  experiences,  and  is  important,  therefore,  as  ex- 
plaining the  origin  of  delusions;  or  again,  in  taking  for,  or 
confounding,  former  perceptions  with  the  present  objective  per- 
ceptions through  mistaken  interpretation  of  impressions  in  the 
disturbed  consciousness.  As  all  mental  action  is  expressed 
through  the  feelings,  thoughts,  and  actions,  we  must  especially 
direct  our  attention  to  these  three  divisions.  Under  the  head 
of  feelings  we  shall  therefore,  as  already  said,  observe  changes 
in  the  individual,  as  indicated  by  depression  or  exaltation.  As 
all  thought  or  conception  depends  upon  the  perceptions,  and  as 
the  latter  are  only  received  through  the  special  senses,  we  must 
look  for  errors  of  perception  of  the  special  senses,  such  as  hear- 
ing, smell,  etc.  We  therefore  find  hallucinations  and  delusions 
among  the  common  symptoms  of  mental  disease. 

HALLUCINATIONS. 

Hallucinations  may  be  defined  as  erroneous  perceptions,  not 
dependent  on  present  external  impressions,  but  evolved  from 
the  diseased  brain  itself,  and  dependent  upon  previous  percep- 
tions ;  or,  as  Taylor  has  defined  them :  "  Those  sensations  which 
are  supposed  by  the  patient  to  be  produced  by  external  impres- 
sions, although  no  material  object  acts  upon  his  senses  at  the 
time." 

While,  in  general,  we  may  accept  this  statement  that  hal- 
lucinations are  not  due  to  excitation  of  the  special  sense  in- 
volved, still  they  may  depend  on  some  disease  of  that  sense  organ 
which  without  external  irritation  is  thus  capable  of  exciting  an 
impulse  to  the  receptive  centre  in  the  brain.  It  is  more  proba- 
ble, however,  that  the  actual  cause  is  the  morbid  cerebral  state, 
as  otherwise  the  irritation  would  be  correctly  interpreted.  An- 


176  INSANITY — FISHER. 

other  evidence  of  this  lies  in  the  fact,  that  where  the  special  sense 
is  congenitally  absent,  no  hallucinations  referred  to  that  spe- 
cial sense  take  place.  Those  born  blind  do  not  have  hallucina- 
tions of  sight,  but  again,  on  the  other  hand,  those  who  become 
blind  may  have  them,  showing  that  the  hallucination  depends 
on  previous  sight-perceptions. 

Hallucinations  are  very  common  in  the  insane,  Esquirol 
putting  the  percentage  as  high  as  eighty  per  cent,  which  is 
probably  too  high.  In  many  cases  they  are  recognized  as  such, 
but  oftener  are  accepted  as  real  and  lead  to  acts  as  a  logical  se- 
quence. The  character  of  the  hallucination  will  depend  largely 
on  the  occupation  or  the  object  which  immediately  interests 
the  person.  Sights  may  constantly  recur,  which  were  but  im- 
perfectly observed  as  at  the  time  of  a  surgical  operation,  while 
the  patient  was  passing  under  the  influence  of  ether.  A  patient 
related  to  me  that,  following  an  operation,  he  felt  as  if  he  were 
before  an  abyss,  and  that  the  surgeon  was  about  to  throw  him 
into  it.  An  interesting  feature  in  this  case  was  the  occur- 
rence of  a  double  hallucination,  in  which  he  heard  voices  say- 
ing that  he  was  damned. 

While  realizing  that  these  voices  were  not  real,  if  spoken  to 
about  them,  he  could  not  prevent  himself  from  firing  his  pistol 
in  the  court  from  which  they  apparentl}7  came. 

Hallucinations  may  affect  any  or  all  the  special  senses,  as 
sight,  hearing,  taste,  smell,  as  well  as  the  general  sensibili- 
ties or  sensations.  Hallucinations  of  sight  and  hearing  are 
the  most  common,  and  the  latter  more  so  than  the  former;  the 
importance  of  those  of  hearing  is  greater,  as  here  we  more  often 
have  imperative  orders  from  God,  or  some  other  influence  di- 
recting the  performance  of  some  act.  Without  warning  an 
act  may  be  suddenly  committed.  These  forms  are  most  common 
in  melancholia  and  mania,  and  while  their  presence  cannot 
be  absolutely  accepted  as  evidence  of  insanity,  they  are  strong 
proofs  in  its  favor.  Hallucinations  of  smell  and  taste  are 
much  more  rare ;  however,  some  of  the  disgusting  acts  of  the 
insane,  as  the  eating  of  human  excrement,  or  the  covering  them- 
selves with  it,  may  be  due  to  them. 

I  have  observed  in  the  blind  that  hallucinations  of  smell  are 
not  uncommon.  Among  the  class  of  so-called  degenerates  this 
form  is  frequent,  and  may  be  of  a  sexual  character.  Religion:- 


HALLUCINATIONS.  177 

hallucinations  are  of  frequent  occurrence,  in  which  God  or  the 
Virgin  Mary  or  the  devil  may  appear  or  may  address  them. 

An  illusion,  according  to  Griesinger,  is  a  "  false  interpreta- 
tion of  an  external  object."  The  distinction  between  it  and  a 
hallucination,  therefore,  lies  in  the  fact  that  the  object  in  the 
one  case  is  not  present,  while  in  the  other  it  is.  In  illusion* 
and  hallucinations  the  perceptions  in  both  cases  are  false. 

There  is  always  some  confusion  in  law  in  understanding 
these  terms,  often  no  distinction  being  made. 

The  remarks  in  regard  to  hallucinations  involving  the  special 
senses  and  general  sensibility  apply  equally  t<>  illusions,  per- 
haps, in  regard  to  general  sensibility,  they  are  more  frequent 
Visceral  disturbances  or  cutaneous  states,  being  misinterpreted, 
lead  oftener  to  illusions  than  hallucinations. 

Delusions  are  erroneous  or  false  conceptions  which  may 
result  from  hallucinations  and  illusions  or  be  the  result  of  false, 
reasoning.  A  delusion  may  be  defined  as  an  al>surd  and  un- 
founded belief  (Foster). 

Delusion  has  reference  to  the  reason,  differing  in  this  re- 
spect from  illusion  and  hallucination,  which  have  to  do  with  the 
senses.  It  involves,  therefore,  more  seriously  the  mental  proc- 
esses, and  is  a  surer  indication  of  insanity. 

It  is  not,  however,  always  present  in  the  insane,  as  Qrie- 
singer well  says:  "In  many  cases  no  special  delusion  is  pres- 
ent, or  at  least  none  is  exhibited,  but  the  sentiments,  disposi- 
tions, and  conduct  are  altered  in  a  morbid  manner,  and  owing 
to  a  morbid  state  of  the  brain  the  individual  is  influenced,  so 
that  the  healthy  faculty  of  judgment  is  obscured,  the  intel- 
ligence formally  involved,  and  the  spirit  held  in  bond." 

Delusions  vary  in  character,  especially  as  they  so  often 
depend  on  false  perceptions  of  the  special  senses.  Their  charac- 
ter depends  largely  also  on  the  form  of  the  mental  disorder  in 
which  they  appear. 

Those  occurring  in  the  various  forms  of  mania  are  generally 
of  an  expansive  character,  in  which  the  eyo  has  become  so  altered 
that  changes  in  the  personality  occur.  The  jwrson  imagines 
himself  some  exalted  personage,  either  a  great  general,  or  artist, 
or  even  God  himself.  Especially  in  this  form  do  delusions  of 
an  erotic  or  religious  character  occur.  The  sexual  element  is 
frequently  prominent  in  religious  delusions.  This  may  be  oh 


178  INSANITY — FISHER. 

served  in  those  cases  of  religious  delusion  where  young  women 
having  hallucinations  of  sight  or  hearing  have  had  the  delusion 
of  being  pregnant  through  the  influence  of  the  Holy  Spirit. 

Delusions  may  be  systematized;  by  which  we  mean,  there  is 
usually  some  basis  for  their  origin.  It  may  indeed  be  an  absurd 
one  or  have  actually  some  ground  for  belief.  In  any  case  the 
patient  has  established  a  chain  of  logical  reasoning,  satisfac- 
tory to  himself  in  explanation.  Another  element  in  this  form 
of  delusion  is  its  permanence.  They  are  as  a  rule  few  in  num- 
ber; indeed,  there  may  be  but  one.  They  may  exist  for  years, 
the  intellectual  faculty  being  but  little  impaired  with  the  course 
of  time. 

Conjoined  with  this  form  of  delusion  is  that  of  persecution. 
The  process  of  reasoning  in  these  cases  is  simple  and  logical. 
The  ego  or  self-consciousness  being  unable  to  understand  the 
various  false  perceptions  received  into  consciousness,  the  in- 
dividual arrives  at  the  conclusion  that,  as  he  feels  a  definite 
change  in  his  personality,  he  must  be  some  personage  of  impor- 
tance, but  realizing  that  he  is  not  so  considered  by  others,  he 
readily  assumes  the  idea  that  some  one  is  preventing  him  from 
assuming  his  proper  position,  and  that,  therefore,  he  is  being 
persecuted. 

It  is  a  short  step  from  this  to  delusion  of  suspicion,  of  being 
followed,  etc. 

Unsystematized  delusions,  to  use  a  term  which  has  fast- 
ened itself  upon  our  nomenclature,  are  usually  multiple,  varying 
with  the  circumstances  of  the  individual  and  the  causes.  There 
is  not,  as  a  rule,  any  attempt  to  explain  them  on  the  part  of  the 
patient;  they  simply  arise,  and,  according  to  their  character, 
cause  elation  or  depression. 

Especially  in  this  form  do  we  observe  sudden  impulses 
arise,  imperative  conceptions  (Hamilton).  The  logical  ele- 
ment is  absent.  They  may  be  those  of  suspicion,  of  persecution, 
of  changed  personality,  etc.  In  these  cases,  however,  the  in- 
tellect is  much  more  involved — their  tendency  to  disappear  is, 
however,  much  greater  than  in  the  former  kind.  The  imme- 
diate cause,  as  exhaustion,  fear,  worry,  alcohol,  toxic  agents  of 
various  nature,  being  removed,  they  cease. 

While  delusions  are,  as  we  said,  not  necessary  to  a  diagnosis 
of  insanity,  they  are  of  great  importance  and  perhaps  the  strong- 


LUCID    INTERVALS. 

est  evidence,  when  observed,  that  we  possess.  This  is  true  in  a 
medical  as  well  as  a  legal  sense. 

The  law,  however,  requires  that  the  delusion  shall  have 
reference  to  the  particular  act  committed,  both  in  civil  and 
criminal  relations,  and  it  is  here  that  the  great  difference  be- 
tween the  medical  and  legal  aspect  of  the  question  of  insanity 
manifests  itself. 

Another  element  in  delusions  is  of  great  importance;  that 
ts,  the  concealment  of  them  by  the  insane. 

This  is  especially  observed  in  systematized  delusions ;  here 
the  intellect  not  being  involved  to  so  great  an  extent,  the  person 
may  with  groat  cunning  suppress  them.  A  patient  who  has 
been  many  years  under  observation,  and  who  considers  himself 
a  great  mathematician  as  well  as  the  inventor  of  a  theory  in 
regard  to  the  ocean  tides,  has  a  systematized  delusion  of  perse- 
cution. 

Ordinarily  nothing  can  be  elicited  from  him  in  regard  to  it 
— to  the  general  observer,  he  has  the  appearance  of  a  dignified, 
learned  gentleman.  So  long  as  he  can  see  no  object  in  speak- 
ing of  himself  the  delusion  is  concealed;  if,  however,  he  thinks 
he  has  before  him  a  person  or  audience  with  influence,  he  be- 
comes loquacious  to  a  degree  in  the  expression  and  defence  of 
his  delusion. 

Concealed  delusions  are  of  great  importance  in  a  legal  as- 
pect, and  man}'  instances  could  be  cited  from  the  courts  show- 
ing how  court  and  jury  have  been  deceived  by  the  cunning  and 
skill  of  an  insane  person. 

Lucid  intervals  may  occur  in  the  course  of  mental  dis- 
ease, and  are  of  importance  in  a  legal  sense.  Bucknill  and 
Tuke  define  them  "  as  consisting,  not  in  a  mere  cessation  of 
the  violent  symptoms  of  the  disorder,  but  an  interval  in  which 
the  mind,  having  thrown  off  disease,  has  recovered  its  general 
habit.  The  party  must  be  capable  of  forming  a  sound  judg- 
ment of  what  he  is  doing,  and  his  state  of  mind  such  that  any 
indifferent  person  would  think  him  capable  to  manage  his  own 
affairs."  Ordronaux  defines  a  lucid  interval  as  ua  suspension 
of  the  active  manifestations  of  mental  disorder.  It  does  not 
imply  complete  restoration;  it  simply  means  restoration  to  a 
degree  of  enabling  the  party  to  judge  soundly  of  the  act.** 
Lucid  intervals  not  infrequently  occur  in  melancholia  and 


180  INSANITY — FISHER. 

mania,  lasting  sufficiently  long  to  enable  the  patient  to  be  fully 
cognizant  of  the  legal  responsibility  of  his  acts,  whether  in 
civil  or  criminal  relations.  "  In  regard  to  criminal  offences 
committed  during  a  lucid  interval,  it  is  the  opinion  of  many 
alienists  that  no  person  should  be  convicted  under  such  cir- 
cumstances, because  there  is  a  probability  that  he  might  at  the 
time  have  been  under  that  degree  of  cerebral  irritation  which 
renders  a  man  insane.  This  remark  applies  especially  to  those 
instances  in  which  the  lucid  interval  is  very  short"  (Taylor ') . 

A  lucid  interval  in  a  legal  sense,  therefore,  implies  that  a 
condition  may  arise  during  the  continuance  of  mental  disease, 
in  which  the  individual  may  be  able  to  understand  his  relations 
to  the  outer  world;  especially  does  this  apply  to  his  civil  capa- 
city. Where  the  act  carried  out  is  consonant  with  what  is 
known  of  the  character  and  wishes  of  the  person,  there  seems 
to  be  nothing  out  of  the  way  in  this  view.  In  a  medical  sense, 
especially  in  the  so-called  functional  psychoses,  it  would  seem 
reasonable  to  expect  that  in  mental  disease,  as  in  the  delirium 
of  typhoid  fever,  there  could  occur  intervals  in  which  the  self- 
consciousness  would  be  able  to  reassert  itself  for  a  longer  or 
shorter  period. 

The  burden  of  proof  in  these  cases  would  naturally  rest  with 
the  side  making  the  assertion.  It  is  difficult  to  define  the  differ- 
ence between  a  remission  and  a  lucid  interval,  except  perhaps, 
as  we  might  say,  the  latter  is  more  complete  than  the  former. 

In  a  remission  there  is  a  mere  abatement  of  the  symptoms. 
It  has  been  said  that  a  lucid  interval  is  only  a  more  perfect  re- 
mission, and  that,  although  the  lunatic  may  act  rationally  and 
talk  coherently,  yet  his  brain  is  in  an  excitable  state,  and  he 
labors  under  a  greater  disposition  to  a  fresh  attack  of  insanity 
than  one  whose  mind  has  never  been  affected. 

Of  this  there  can  be  no  doubt,  but  the  same  reasoning  would 
show  that  insanity  is  never  cured,  for  the  predisposition  to  an 
attack  is  undoubtedly  greater  in  a  recovered  lunatic  than  in  one 
who  is  and  always  has  been  perfectly  sane.  Even  admitting 
the  correctness  of  this  reasoning,  it  cannot  be  denied  that  luna- 
tics do  occasionally  recover  for  a  longer  or  shorter  period  to 
such  a  degree  as  to  render  them  perfectly  conscious  of  and 
legally  responsible  for  their  acts.'' ' 

1  Taylor's  "Medical  Jurisprudence,"  llth  ed. 


MEMORY.  181 

The  statement  that  a  lucid  interval  "  consists  not  in  a  mere 
cessation  of  the  violent  symptoms  of  a  disorder,  but  an  interval 
in  which  the  mind,  having  thrown  off  the  disease,  has  recovered 
its  general  habit"  (see  Collinson  on  "  Lunacy"),  is  hardly  correct, 
for  while  we  observe  a  return  to  a  reasonable  judgment  in  his 
acts,  and  "  that  any  indifferent  person  would  think  him  able  to 
manage  his  own  affairs,"  still  it  is  rarely  that  we  can  say  that 
there  is  a  return  to  a  normal  state.  The  emotions  still  remain 
affected,  the  intellect  shows  evidence  of  improvement  indeed, 
but  were  there  a  complete  return  there  would  no  longer  be  a 
question  of  insanity  at  all.  The  law,  in  its  attempt  to  be  pre- 
cise or  exact,  passes  beyond  the  bounds  of  the  probable  or 
possible. 

Memory  is  involved  in  all  forms  of  insanity.  When  the 
consciousness  is  much  affected,  as  in  a  profound  condition  of 
melancholia,  it  may  be  almost  a  complete  blank.  In  mania, 
with  its  rapidity  of  ideas,  it  may  appear  as  even  accentuated, 
but  this  in  reality  is  not  the  case.  The  passing  conceptions 
have  lasted  for  so  short  a  period  individually  that  they  have 
made  no  permanent  impression.  All  perceptions  and  concep- 
tions require  time  and  intensity  to  be  properly  received  into  the 
consciousness  and  be  capable  of  recall — the  image  must  at  one 
time  be  a  distinct  one. 

This  loss  of  memory  refers  especially  to  matters  of  the  pres- 
ent; past  history  may  remain  as  clear  in  the  consciousness  as 
ever.  While  these  statements  are  true  in  the  main,  yet  even 
in  profound  depression  it  is  not  rare  to  find  that  the  individual 
can  recall  many  if  not  all  of  the  incidents  that  have  occurred. 
This  is  not  so  often  true  in  mania.  In  dementia  there  may  be 
a  complete  loss  of  memory,  but  this  is  general  in  character,  no 
idea  of  time,  place,  or  even  of  the  identity  of  the  person  himself 
remaining. 

More  important  are  the  temporary  losses  of  memory  during 
special  emotional  or  paroxysmal  conditions,  as  in  the  mania  fol- 
lowing epileptic  seizures,  or  in  cases  which  have  been  defined 
as  mania  transitoria.  The  importance  of  this  condition  is  very 
apparent  in  a  legal  aspect.  A  complete  blotting-out  of  all  pre- 
vious experiences  may  take  place,  the  patient  living  only  in  the 
present,  so  that  there  are  really  two  individualities.  Rare  in- 
stances in  certain  forms  of  mental  disease  are  recorded,  when,  in 


182  INSANITY — FISHER. 

passing  from  one  state  to  another,  no  recollection  of  the  previ- 
ous state  is  recognized  in  the  succeeding  one.  Persons  met  or 
places  seen  are  no  part  of  the  experience  in  the  separate  states. 
These  statements  are  always  to  be  received  with  caution,  how- 
ever, especially  if  any  motive  can  be  suspected. 

Delirium  is  "  a  perversion  of  the  mental  processes,  the  per- 
version being  manifested  in  speech  or  action.  The  disturbance 
is  characterized  by  incoherent  speech,  hallucinations,  illusions 
and  delusions,  restlessness,  watchfulness,  apparently  purpose- 
less actions,  inability  to  fix  the  attention.  Delirium  in  a 
general  sense  implies  disorder  of  the  mind,  and  according  to 
this  definition  is  equivalent  to  insanity."  * 

From  the  fact  that  in  delirium  the  patient  is  subject  to  delu- 
sions frequently  accompanied  by  hallucinations  and  illusions  of 
sight  and  hearing,  this  term  is  frequently  used  for,  and  confused 
with,  delusion. 

While  delirium,  either  active  or  quiet,  is  often  present  in 
well-defined  mental  disease,  it  is  more  frequently  due  to  either 
the  exhaustion  of  the  disease  or  accompanies  the  initial  acute 
onset  as  in  acute  mania.  It  is  rather  a  physical  sign  of  mental 
disorder,  following  upon  the  various  false  perceptions  and  con- 
ceptions. 

It  is  a  mistake  to  speak,  therefore,  of  various  forms  of  de- 
lirium, as  delirium  grandiosum,  delirium  epileptoid,  etc.  The 
condition  is  simply  the  result  in  the  first  case  of  delusion  of 
grandeur  and  general  exaltation  common  to  mania  and  espe- 
cially to  the  'earlier  stages  of  general  paralysis. 

The  proof  of  this  statement  is  shown  by  the  fact  that  in  the 
various  fevers,  as  typhoid  and  pneumonia,  or  in  toxic  conditions 
caused  by  various  drugs,  similar  stages  are  common,  and 
while  they  are  truly  mental  disturbances,  and  therefore  mani- 
fest themselves  by  disturbances  in  the  field  of  feeling,  thought, 
and  volition,  we  do  not  consider  such  states  as  forms  of  mental 
disease. 

In  a  legal  sense  the  question  would  naturally  and  only  arise 
in  regard  to  responsibility,  and  the  general  rule  would  apply  that 
where  there  is  such  a  loss  of  consciousness  as  to  prevent  any 
knowledge  of  the  act,  all  responsibility  ends. 

Heredity  as  an  aid  in  diagnosis  is  of  vast  importance,  as 
•Tuke:  "Diet,  of  Psych.  Medicine." 


PREVIOUS    ATTACKS.  Jg3 

can  be  seen  from  the  importance  in  which  it  is  held,  as  an 
etiological  factor.  It  has  especial  value  when  the  disease  is 
directly  received  from  the  parents  or  even  when  a  predisposition 
to  mental  disease  can  be  presumed  from  the  existence  of  vari- 
ous conditions  in  the  parents  or  even  collateral  branches,  as 
nervous  diseases,  alcoholism,  or  consanguinity.  It  is  admitted 
as  legal  evidence  in  criminal  and  civil  cases. 

"  The  degree  of  hereditary  taint  may  to  a  certain  degree  be 
ascertained  and  estimated.  Thus  the  insanity  of  one  parent 
would  indicate  a  less  degree  of  predisposition  than  that  of  a 
parent  and  an  uncle,  and  still  less  than  that  of  a  parent  and 
grandparent  or  of  two  parents.  The  insanity  of  a  parent  and 
a  grandparent  with  an  uncle  or  aunt  in  the  same  line,  may  be 
held  to  indicate  even  stronger  predisposition  than  the  insanity 
of  both  parents.  The  influence  of  the  insanity  of  parents  in 
creating  a  predisposition  will  depend  to  a  great  extent  upon 
whether  it  has  taken  place  before  or  after  the  state  of  parentage 
commenced.  The  insanity  of  a  parent  occurring  after  the  birth 
of  a  child,  if  it  arises  from  a  cause  adequate  to  excite  it,  without 
previous  predisposition,  would,  of  course,  be  held  as  of  no  value 
in  the  formation  of  an  hereditary  tendency.  The  insanity  of 
brothers  or  sisters  may  be  of  much  or  little  value,  as  evidence 
of  predisposition,  according  to  the  circumstances  under  which 
it  has  shown  itself.  If  several  of  them,  both  older  and  younger 
than  the  patient,  have  become  insane,  the  fact  shows  strongly 
in  favor  of  predisposition,  although  neither  parent  nor  grand- 
parent may  have  been  lunatics;  since  it  is  well  known  that 
other  conditions  in  the  parent  besides  that  of  actual  insanity 
may  create  this  predisposition;  for  instance,  violent  and  habit- 
ual passion,  the  debility  of  old  age,  and  most  of  all,  habits  of 
intemperance  at  the  time  of  procreation.  It  will  thus  be  seen 
that  the  evidence  of  hereditary  predisposition  may  be  of  such  a 
character  as  to  render  the  insanity  of  the  patient  an  event  in 
the  highest  degree  probable;  or,  on  the  other  hand,  it  may  be  so 
weak  as  to  add  a  scarcely  appreciable  amount  of  probability  to 
the  character  of  the  disease." 

Previous  attacks  must  be  considered  as  strong  evidence 
in  favor  of  insanity,  especially  when  the  act  committed  bears 
on  its  face  signs  of  being  irrational  or  larking  motive.  Its 

1  Bucknill  and  Tuke  :  "Psychological  Medicine." 
III.— 14 


184  INSANITY — FISHER. 

importance  is  much  increased  if  it  can  be  shown  that  the  pres- 
ent attack  commenced  in  a  similar  manner  with  the  previous 
one.  It  has  long  been  observed  that  succeeding  attacks  follow 
the  same  course,  even  in  detail,  of  those  preceding  them. 

This  can  be  observed  in  periodical  insanity,  and  is  of  special 
interest,  as  months  or  years  may  elapse  between  the  different 
seizures. 

Again,  complete  recovery  from  even  the  simple  psychoses  is 
difficult  to  predicate,  as  there  is  frequently  left  a  change  or  at 
least  an  instability  in  the  emotional  and  intellectual  condition. 

Slight  attacks,  if  due  to  some  adequate  cause,  as  domestic 
loss,  financial  reverses,  injuries,  or  some  special  illness  as  fevers, 
have  not  as  much  weight. 

While  these  special  signs  of  mental  disease  are  more  or  less 
marked  in  every  case,  there  is  also  to  be  observed  the  general 
change  in  the  individual  himself.  A  most  important  indication 
is  whether  the  disposition,  which  may  have  been  lively,  has  be- 
come the  reverse,  whether  extravagance  or  parsimony  is  present 
in  contradistinction  from  the  usual  habit. 

Excesses,  alcoholic  or  venereal,  occurring  in  a  person  whose 
life  has  been  previously  correct,  even  without  any  evidence  of 
delusion  or  other  signs,  is  significant. 

SOMATIC  INDICATIONS. 

Physical  or  somatic  conditions  are  of  importance,  especially 
in  certain  forms  of  mental  disease,  as  tremor,  paralysis,  loss  or 
exaggeration  of  the  reflexes,  contraction  or  inequality  of 
the  pupils,  interference  with  articulation,  which  may  become 
involved  or  clumsy,  interference  with  general  nutrition,  etc. 

Haeatoma  Auris — Insane  Ear. — Among  the  insane, 
especially  the  chronic,  this  affection  of  the  ear  is  not  uncommon. 
Is  is  difficult  to  say  that  it  can  be  regarded  as  a  sign,  for  we 
find  it  among  the  sane,  especially  pugilists,  who  are  exposed  to 
blows  in  this  region.  M.  D.  Field  showed  this  in  a  number  of 
cases  which  he  described  among  this  class  of  professionals. 

However,  it  cannot  be  denied  that,  outside  of  the  consider- 
ation of  injuries  received  by  the  insane,  this  condition  appears 
very  frequently,  and  must  be  regarded  as  an  indication  of  defec- 
tive nutrition. 


FACIAL  EXPRESSION.  185 

FACIAL  EXPRESSION  IN  THE  INSANE. 

Various  types  of  mental  disease  are  often  characterized  by 
special  facial  expression.  Physiognomy  is  of  considerable  im- 
portance, especially  in  the  class  of  patients  coming  under  the 
head  of  the  so-called  degenerative  types.  We  find  among  the 
insane  irregularity  of  features,  es|)ecially  noted  in  the  ears, 
which  show  various  malformations  in  the  structure  of  the  helix 
or  rim  of  the  ear,  and  in  the  lobe.  The  former  is  not  infre- 
quently very  much  flattened  so  as  to  be  almost  absent.  The 
lobe  is  often  adherent  or  deficient.  There  may  also  be  a  ten- 
dency for  the  ears  to  stand  out  far  from  the  head.  The  whole 
structure  may  be  very  much  deformed.  This  condition  is  usu- 
ally a  congenital  one. 

The  eyes  and  orbits  are  also  frequently  irregular,  the  almond 
shape  being  not  uncommon,  or  one  eyebrow  being  higher  than 
the  one  on  the  opposite  side,  or  there  being  an  inequality  in  the 
size  of  the  eyeballs. 

The  nose  and  jaw  may  show  peculiarities,  and  there  is  not 
infrequently  facial  asymmetry.  The  cranial  measurements 
show  asymmetrical  conditions  or  excessive  developments  beyond 
the  physiological  limits.  The  palate,  especially  in  congenital 
conditions,  is  frequently  very  highly  arched. 

Many  of  the  insane,  it  must  be  remembered,  however,  pre- 
sent almost  classical  features  and  typically  correct  cranial  mea- 
surements, while  excessive  deviations  are  frequently  observed 
among  our  most  distinguished  and  highly  gifted  men. 

The  expression  of  the  face  as  shown  in  various  well-defined 
mental  disorders  can  be  classified  under  a  few  heads.  In  mel- 
ancholia the  angles  of  the  mouth  are  usually  depressed,  the  fore- 
head wrinkled,  the  eyes  downcast,  and  there  is  an  apj>earanco 
of  despair  associated  with  mental  anxiety.  The  features  are 
also  extremely  immobile  and  fixed.  This  condition  has  various 
grades  of  development.  At  times,  the  mental  agony,  as  ex- 
pressed in  the  wrinkling  of  the  forehead,  is  the  essential  fea- 
ture. Where  the  dementia  is  more  marked  and  mental  action 
has  been  more  completely  stopped,  the  simple  depression  as 
shown  in  the  lower  part  of  the  face  and  mouth  is  the  most 
prominent  feature.  Delusions,  if  present,  of  sight  or  hearing, 


186 


INSANITY — FISHER. 


will  again  give  an  expression  of  attention  in  these  directions, 
the  patient  appearing  to  see  and  watch  for  something  or  to  listen 

attentively.  I  f 
fear  be  present, 
the  attitude  will 
be  expressive  of 
this  condition. 

In  mania  there 
is  the  reverse  of 
what  has  been 
described.  The 
features  are  mo- 
bile, constantly 
changing,  and 
there  is  an  ap- 
pearance of  pleas- 
ure and  exalta- 
tion. The  eye  is 
bright  and  con- 
stantly changing 

FIG.  1,-Meianchoiia.  its  position.  Here 

the  hallucinations 

come  and  go  more  rapidly,  and  lead  to  a  marked  facility  of  ex- 
pression, changing  with  each  new  emotion.  Fear  and  delusions 
of  persecution  show  themselves  by  an  alertness  of  expression 
and  an  energy  of  resistance. 
(See  photographs  of  Mental 
Disease.) 

In  paranoia,  while  perhaps 
not  showing  any  well-defined 
expression,  to  the  experienced 
eye  the  face  reveals  a  sense 
of  general  self  -  satisfaction 
which  is  peculiar  to  the  dis- 
ease. Vanity  and  personal 
pride  in  their  physical  ap- 
pearance is  a  marked  feature. 
The  fear  of  opposition  or  per- 
secution so  commonly  pres- 
ent, but  ascribed  to  envy  of  Fm.  2. -Mania. 


FACIAL   EXPRESSION. 


187 


Flo.  8.— Dementia. 


personal  attain- 
ments or  ability, 
or  physical  supe- 
riority, is  here 
seen. 

Dementia  man- 
ifests itself  chief- 
ly by  loss  of  ex- 
pression,  or  vacu- 
ity. This  is  inter- 
rupted from  time 
to  time  in  less  ad- 
vanced cases  by 
expressions  of  joy 
or  depression,  ac- 
cording as  the 
emotions  are  ex- 
cited by  corre- 
sponding d  e  1  u  - 
sions  or  hallucinations.  In  chronic  cases  where  the  delusion 
has  become  fixed,  the  expression  remains  permanent  and  de- 
pends on  its  nature. 
In  general  paral- 
ysis the  face  is 
characteristic  o  f 
the  disease.  There 
is  usually  a  wash- 
ing-out of  the  par- 
ticular lines  char- 
acteristic of  the  in- 
dividual— a  blank- 
ness  and  flatness 
almost  diagnostic 
of  this  disease. 
There  is  rarely, 
however,  any  ap- 
pearance of  depres- 
sion or  anxiety, 
but  rather  that  of 

Fio.  4. -General  Paresi*.  fatUOUS  placidity. 


188  INSANITY — FISHER. 

Too  much  importance  has  been  attached  to  the  facial  expres- 
sion in  the  insane,  the  rolling  eye,  the  hair  standing  erect,  giv- 
ing a  wild  appearance  to  the  individual.  The  hair  may  become 
coarse  and  thick  in  chronic  mania,  and  in  melancholia  it  may 
become  thin ;  these  states  are,  however,  dependent  on  the  general 
state  of  nutrition.  Certainly  in  acute  cases  of  mania  I  have 
not  observed  any  special  change.  The  scalp  may  in  cases,  usu- 
ally of  imbecility  or  dementia,  especially  in  hereditary  or  con- 
genital diseases,  be  formed  into  folds  or  ruga?.  Some  such  cases 
have  been  reported,  and  I  have  had  one  under  my  observation — 
the  hair  was  coarse  and  thick.  Many  of  these  ideas  have  been 
handed  down  by  tradition.  The  malingerer  usually  attempts 
such  a  characterization. 

CHANGES  IN  MANNERS  AND  HABITS. 

An  important  sign  of  mental  disease  is  a  complete  change 
in  manner  of  living  and  in  dress.  The  more  distinct  this  is, 
the  more  valuable  does  it  become.  If  a  sedate,  methodical  man 
becomes  prodigal  and  profligate,  or  if  he  becomes  depressed  and 
sees  nothing  but  ruin  and  loss  when  there  is  no  cause  for  it,  we 
must  regard  it  as  a  strong  indication  of  mental  disturbance.  It 
is  necessary  to  inquire  carefully  into  the  previous  habits;  often 
latent  tendencies,  when  the  balance  of  self-control  is  removed 
by  disease,  will  develop  themselves.  Every  one  is  more  or  less 
influenced  and  controlled  by  his  surroundings ;  what  makes  a 
person  honest  or  moral  is  frequently  simply  his  regard  for  the 
opinions  of  others;  if  this  feeling  is  removed  by  emotional  ex- 
citement or  depression,  acts  of  a  character  entirely  foreign  to 
what  has  been  known  of  the  character  of  the  individual  may  be 
committed. 

The  appearance  and  dress  are  often  strong  indications  of 
insanity. 

The  emotion  which  is  predominant,  or  the  delusion  which 
prevails,  frequently  leads  to  gross  carelessness  in  dress ;  a  gen- 
eral lack  of  order  and  method  in  all  personal  arrangements,  and 
in  home  and  business  relations  is  usually  present.  Erotic  ten- 
dencies may  lead  to  ornamentation  of  the  person,  or  to  indecent 
exposure  of  the  person.  Again,  if  the  delusion  of  being  some 
important  personage  is  present,  there  may  be  a  tendency  to 


EYE   SYMPTOMS.  ]S<) 

decoration  of  the  person  with  innumerable  medals,  often  of  a 
perfectly  valueless  character. 

An  epileptic  long  under  my  observation  always  decorated 
his  coat  with  any  badges  of  the  various  societies,  city  depart- 
ments, as  the  police,  fire,  etc.,  which  he  could  obtain.  These 
were  of  absolutely  no  value,  but  afforded  him  infinite  pleasure, 
as  showing  the  importance  with  which  ho  was  regarded. 

This  is  especially  noticed  in  the  chronic  insane,  who  are  apt 
to  decorate  themselves  with  any  bright  colors  which  they  can 
obtain. 

Sudden  changes  are  of  especial  significance.  Mere  exag- 
geration of  natural  characteristics  does  not  have  so  much  weight. 

Due  consideration  must  also  be  given  to  a  provocative  cause 
if  present.  Loss  of  friends  or  property,  or  any  annoyance,  pro- 
duce an  exaggeration  of  feeling  and  action,  which,  although 
normal  in  character,  is  increased  beyond  that  found  in  the  sane. 
The  action  and  gestures  are  important,  different  forms  of 
mental  disturbance  manifesting  themselves  in  special  ways. 
The  maniacal  are  restless  and  constantly  in  motion ;  they  never 
seem  to  tire,  their  muscular  system  seeming  to  correspond  to 
their  mental  state.  As  no  two  thoughts  or  ideas  are  the  same 
or  continue  long,  so  their  motions  and  gestures  never  remain 
long  the  same.  In  depression  the  attitude  is  often  expressive 
of  the  despair  within  them.  "  It  cannot  be  called  acting,  since 
it  is  real,  and  hence  arises  the  most  frequent  cause  of  failure  in 
attempts  to  simulate  insanity." 

EYE  SYMPTOMS. 

These  are  of  importance  more  especially  in  organic  diseases. 
There  cannot  be  said  to  be  anything  diagnostic  in  them  in  tlu» 
so-called  functional  psychoses,  as  melancholia  or  mania,  as  they 
are  not  constant,  depending  on  the  physical  state  or  nutrition. 

Dr.  Clifford  Allbutt  found  in  fifty-one  cases  of  mania  in  the 
West  Riding  Asylum,  which  he  examined,  aiuemia  of  the  optic 
disc. 

In  general  paresis  inequality  of  the  pupils  is  common,  or 
there  may  be  marked  myosis.  The  Argyll-Rol>ertson  pupil  is 
also  present  and  perhaps  has  especially  connection  with  cases 
involving  disease  of  the  spinal  cord.  According  to  Mickle  in 
his  work  on  general  paresis,  marked  contraction  of  the  pupil 


190  INSANITY— FISHER. 

succeeded  by  dilatation  is  a  bad  sign.  The  optic  nerve  not  in- 
frequently shows  evidence  of  hypersemia  in  general  paresis,  and 
it  may  even  go  on  to  atrophy.  These  conditions  are  not  present, 
as  a  rule,  except  in  the  later  stages  of  the  disease.  Rarely  do 
we  find  ptosis  or  strabismus. 

APHASIA  IN  INSANITY. 

Aphasia  is  generally  due  to  a  lesion  within  the  brain  in- 
volving the  cortex  area  for  speech  or  regions  in  the  internal 
capsule,  pons,  and  medulla.  The  motor  centre  for  speech  in  the 
cortex  is  in  the  third  frontal  convolution,  while  the  sensory 
perceptive  centres  are  posterior,  in  the  parietal  and  temporal 
lobes.  The  two  forms  of  aphasia  are  motor  and  sensory.  The 
former  represents  an  inability  to  articulate  words  with  or  with- 
out a  loss  of  memory  of  the  word  or  name  itself.  Sensory 
aphasia  implies  a  loss  of  the  power  to  understand  spoken  or 
written  language,  resulting  in  word-deafness  or  word-blind- 
ness. This  latter  condition  especially  indicates  some  mental 
impairment,  and  in  fact  in  most  cases  we  find  loss  of  emotional 
control.  Such  persons  are  easily  provoked  to  laughter  or  tears. 
The  memory  of  present  events  may  be  impaired. 

The  question  of  responsibility,  civil  or  criminal,  is  one 
of  considerable  importance  in  these  cases.  It  is  perfectly  possi- 
ble, especially  in  motor  aphasia,  for  the  patient,  although  unable 
to  speak,  to  possess  a  full  comprehension  of  his  surroundings 
and  of  what  is  presented  to  him,  either  in  words  or  in  writing. 
In  sensory  aphasia  the  question  is  more  doubtful,  if  neither 
writing  or  spoken  language  is  intelligible.  This  latter  condi- 
tion in  the  double  state  is,  however,  very  rare,  and  if  the  disease 
were  so  extensive,  other  symptoms  showing  marked  evidence  of 
dementia  would  probably  be  present.  Where,  therefore,  as  in 
making  a  will  or  executing  legal  documents,  there  is  nothing 
inconsistent  with  the  previous  character  of  the  patient  in  the 
statements  made,  or  where  no  motive  is  shown  which  is  con- 
trary to  what  would  be  naturally  expected  from  the  previous 
character  and  actions  of  the  patient,  the  person  should  be  con- 
sidered as  capable,  and  as  possessing  sound  reasoning  power. 
This  is  often  of  great  importance  where  estates  have  been  de- 
vised away  from  the  immediate  relations. 

Aphasia  as  a  symptom  in  mental  disease  is  commonly  ob- 


HANDWRITING.  191 

served  in  general  paralysis.  It  is  usually  of  short  duration  and 
liable  to  recurrence.  It  is  frequently  associated  with  hemi- 
plegia  and  in  most  cases  due  to  a  meniugeal  hemorrhage.  It, 
however,  occurs  at  times  as  an  isolated  symptom  and  is  of  im- 
portance in  point  of  diagnosis. 

This  is  not  to  be  confounded  with  the  difficulty  of  articula- 
tion which  is  one  of  the  common  symptoms  in  paresis. 

It  is  usually  in  connection  with  paralysis,  i.e.,  hemiplegia, 
that  we  have  to  consider  aphasia,  and  especially  in  civil  cases. 
The  well-known  Parish  will  case  is  an  example. 

Masturbation  should  be  regarded  as  a  symptom  rather 
than  a  cause  of  insanity.  It  occurs  in  various  forms  of  in- 
sanity, as  paranoia,  for  example;  in  fact,  most  cases  of  so-called 
masturbational  insanity  are  to  be  classified  with  this  disease. 
We  especially  note  the  erotic  and  religious  type.  It  is  com- 
mon also  among  epileptics,  general  paretics,  and  in  demen- 
tia resulting  from  melancholia  and  mania.  It  is  a  sign  of 
mental  impairment,  indicating  a  loss  of  the  higher  ethical 
nature  of  the  individual.  It  may  occur  as  a  symptom  in  se- 
nility, where  the  most  shameless  and  open  practice  of  it  may 
be  carried  on.  Savage  refers  to  a  case  in  a  chronic  lunatic  of 
over  ninety  years  of  age. 

The  same  is  observed  among  idiots  and  imbeciles.  It  may 
exist  as  an  exciting  cause  of  insanity  or  as  an  active  agent  in 
continuing  the  mental  disorder,  and,  by  its  effects  on  general 
nutrition,  prevent  recovery. 

"  Handwriting  must  be  looked  upon  as  a  highly  developed 
method  of  muscular  expression,  and  as  such  will  be  affected  by 
any  nervous  states  or  conditions  which  affect  the  nervous  con- 
trol and  the  distribution  of  nervous  energy.  Persons  suffering 
from  any  form  of  nervous  exhaustion  will  show  it  in  their 
methods  of  expression,  the  result  being  want  of  clearness  and 
definiteness."  l 

We  have  two  points  to  consider  in  the  letters  of  the  in- 
sane, the  contents  and  the  handwriting  itself. 

In  some  cases  they  are  a  direct  help  in  diagnosis,  especially 
in  the  formation  of  the  letters  as  evidencing  tremor  or  again  in 
the  omission  or  repetition  of  certain  letters  in  a  word. 

This  is  especially  seen  in  general  paralysis  of  the  insane; 
>Tuke:  "Diet,  of  Psych.  Medicine." 


192  FISHER  —  INSANITY. 

early  in  the  disease,  perhaps  one  of  the  first  signs  to  be  observed 
when  the  person  has  acted  in  the  capacity  of  an  accountant, 
there  will  be  tremor  causing  indistinctness  of  the  lines  —  again 
misspelled  words  are  frequent.  At  times  again  the  letters  form 
no  definite  word. 

In  the  first  three  specimens  here  shown  of  well-marked  gen- 
eral paresis  —  all  represent  educated  men.     Fig.  5  was  an  expert 


FIG.  5. 

accountant.  The  attempt  to  write,  "And  they  whistled  as 
they  drew  near,"  is  unintelligible;  there  is,  however,  very  little 
tremor. 

The  confusion  in  the  formation  of  the  words  is  not  unlike 
the  indistinctness  of  the  articulation  in  these  cases. 

Fig.  6  is  a  letter  of  an  educated  man,  a  lawyer  and  college 


FIG.  6. 

graduate.     The  tremor  is  well  marked,  and  the  omission  of 
certain  words  necessary  to  complete  the   sense.     There  is  no 


HANDWRITING. 


193 


structure  to  the  sentence  and  the  two  words  "this"  and  "tiling" 
are  run  into  one. 

Fig.  7  is  an  instance  showing  the  mental  confusion,  the  mis- 
spelling, the  repetition  of  syllables,  and  the  tremor  characteris- 

*    188    V 


. 

take  notice  that  a  Bill  of  Exchange 


on 


_ 

endorsed  by  you,  and  due  this  day,  having  been  duly  presented  for 

dLvtL 

jjnicn  was  duly  demanded  but  refused,  is  protested  for  non~ 


aiy.  and  that  the  holders  look  to  you  for  the  payment  thereof. 
Fio.  7. 

tic  of  these  cases.     This  man  had  for  years  been  engaged  in 
serving  notice  in  cases  of  notes  going  to  protest. 

One  peculiarity  in  most  of  these  c<is<>s  is  the  apparent 
absolute  ignorance  of  anything  wrong  about  their  produc- 
tions; they  appear  perfectly  satisfactory,  and  even  when  unable 
to  read  them,  they  are  satisfied.  This  is  the  case  long  U»f«>re 
the  final  stage  of  dementia  has  taken  place,  and  while  the  delu- 
sions of  grandeur  and  ideas  of  great  wealth  and  wonderful  plant 
are  most  prominent. 


Fio.  8. 


194  INSANITY — FISHER. 

Figs.  8  and  9  illustrate  the  excessive  tremor  which  is  com- 
monly present. 

Tremor  alone  is  insufficient  to  form  a  diagnosis  on,  as  it  is 


FIG.  9. 


present  in  various  other  conditions,  as  in  alcoholism,  mercurial- 
ism,  old  age,  etc. 

In  chronic  mania  there  is  a  tendency  to  almost  endless  letter- 
writing,  one  subject  being  followed  by  another.  No  class  of 
patients  in  our  asylums  are  such  voluminous  writers  as  these. 
Here  we  find  special  characteristics,  as  the  underscoring  of 
words,  the  frequent  use  of  capitals.  This  is  especially  seen  in 
paranoiacs,  where  the  egotism  of  the  writer  becomes  very  appar- 
ent. Where  delusions  pertaining  to  religion  are  present,  the 
words  God  and  Christ  are  very  frequent,  and  usually  under- 
scored and  in  large  letters. 

Rhyming  is  not  infrequent. 

The  letters  may  be  the  only  sign  for  a  long  time  of  any  men- 
tal disturbance  and  are  of  importance  in  this  direction.  A  delu- 
sion may  be  concealed  before  others,  but  the  strong  belief  in  it 
may  find  expression  in  letters.  This  is  often  observed  in  para- 
noia. Letters  of  the  most  obscene  character  may  be  written. 

The  contents  are  often  diagnostic  of  the  form  of  the  disease. 
In  mania  we  have  long  epistles,  carelessly  written,  with  frequent 
omissions  of  words  and  letters;  in  hypochondria  there  is  the 
dwelling  on  the  personal  ailments  in  great  detail,  the  various 
hallucinations  and  delusions  are  minutely  described.  This  is 
not  rare  among  melancholies.  Tuke  quotes  Dr.  Bacon's  sum- 
mary of  the  important  points  of  handwriting  in  relation  to  the  in- 
sane as  follows : 

(1)  The  handwriting  as  illustrating  chronic  insanity;  (2) 
as  illustrating  acute  attacks;  (3)  as  rarely  the  only  evidence 
of  insanity;  (4)  as  a  sign  of  convalescence;  (5)  as  evidencing 
an  oncoming  attack;  (6)  as  illustrating  phases  of  cases  of  ordi- 
nary mania;  (7)  as  showing  the  changes  in  handwriting  in 
general  paralysis. 


OENEKAL    PATHOLOGY.  195 

In  concluding  the  description  of  the  indications  I  would  de- 
signate the  conditions  of  melancholia  or  depression  and  mania  or 
exaltation  as  mental  states,  rather  than  definite  diseases.  In 
taking  up  the  various  forms  of  insanity,  we  shall  observe  that 
both  these  conditions  are  common  to  all  the  various  forms  of 
mental  disease. 

Dementia  can  be  considered  as  the  final  stage  toward  which 
all  insanity  tends,  where  recovery  does  not  take  place. 

In  its  completed  form  there  is  absence  of  the  functional 
activity  of  mind.  We  have,  therefore,  an  absence  of  all  percep- 
tion and  conception;  there  is  merely  a  vegetative  existence. 
Hallucinations  and  delusions  are  absent,  only  the  somatic 
signs,  as  interference  with  nutrition,  tremor,  pupillary  changes, 
etc.,  are  present. 

Melancholia  is  "a  condition  of  depression  marked  by  a 
feeling  of  misery  in  excess  of  what  is  justified  by  the  circum- 
stances in  which  the  individual  is  placed"  (Kirchhoff). 

Mania,  like  melancholia,  is  one  of  the  primal  elements  of 
mental  disease,  and  is  a  term  which  has  been  used  from  the 
earliest  days.  In  our  simpler  classification  it  represented  one  of 
the  chief  forms  of  insanity,  as  melancholia  did  on  the  other  side, 
the  final  stages  of  both  these  conditions  being  represented  by 
dementia.  This  classification  was  long  used,  and  is  still  em- 
ployed in  our  hospitals,  all  cases  being  put  under  those  three 
heads  irrespective  of  the  varying  conditions  under  which  they 
appear.  Of  late  years,  we  know  that  mania  may  appear  in 
various  well-defined  mental  states  which  represent  distinct  dis- 
eases, and  of  which  mania  itself  is  simply  one  of  various  symp- 
toms— as,  for  instance,  mania  in  general  paralysis,  in  hysteria, 
in  puerperal  fever,  or  again  in  alcoholism,  etc. 

Mania  may  be  defined  as  consisting  of  great  excitement 
characterized  by  increased  mental  activity,  as  shown  in  the 
great  number  of  mental  imprea^ions  or  perceptions  constantly 
received,  and  most  frequently  given  out  by  continuous  speech. 

GENERAL  PATHOLOGY. 

In  our  classification  of  mental  disease  l>ased  on  the  patho- 
logical condition  found  in  the  brain,  we  divide  insanity  into  the 
so-called  functional  and  organic  forms.  Among  the  former  we 


196  INSANITY— FISHER. 

do  not  find  evidence  of  marked  disease  of  the  vessels  of  the 
brain,  its  membranes  or  structure  ;  while  in  the  latter  we  find 
changes  in  some  or  all  of  these  structures.  In  mania  and  mel- 
ancholia, functional  diseases,  anemia  or  congestion  is  present. 
In  melancholia  there  may  be  a  tendency  to  thromboses  of  cere- 
bral sinuses,  especially  the  longitudinal  sinus.  It  is  probable, 
however,  that  many  of  these  thromboses  occur  a  short  time 
before  death,  so  that  it  is  questionable  whether  they  can  be 
considered  as  etiological  factors  in  the  disease.  HyperaBmia, 
active  or  passive,  is  always  difficult  of  recognition  post  mortem ; 
similar  conditions  are  frequently  found  in  cases  associated  with 
high  temperature,  with  or  without  delirium,  in  which  no  evi- 
dence of  mental  disturbance  has  been  present  clinically ;  while 
again  in  some  cases  of  mania  grave,  slight,  if  any,  changes 
outside  of  congestion,  which  may  not  be  marked,  are  found. 
AnaBmia  of  the  brain  is  present  in  most  diseases  of  an  exhaust- 
ing nature,  as  phthisis,  and  while  in  phthisis  we  not  infrequently 
have  insanity  of  a  definite  type  peculiar  to  that  disease,  it  is 
on  the  whole  rare.  In  the  so-called  degenerative  types  of  men- 
tal disease  where  heredity  is  an  important  factor  in  its  causa- 
tion, or  where  insanity  has  resulted  in  the  course  of  well-known 
neuroses,  such  as  epilepsy,  hysteria,  neurasthenia,  and  hypo- 
chondria, no  definite  pathological  changes  characteristic  of 
these  diseases  have  been  found.  In  the  more  chronic  forms  of 
these  so-called  functional  diseases,  where  secondary  dementia  is 
present,  it  is  not  unusual  to  find  arterial  changes,  as  thickening 
of  the  walls  of  the  vessels,  or  an  increase  in  the  neuroglia  tissue, 
with  atrophy  of  the  nerve  cells  and  nerve  fibres.  These  changes, 
however,  are  not  distinctive  of  these  special  diseases,  either  as  to 
localization  or  as  to  character,  not  infrequently  being  present 
where  mental  disease  has  not  manifested  itself.  In  some  cases 
of  epileptic  insanity,  it  has  been  held  that  the  frontal  lobes  show 
special  signs  of  atrophy,  or  that  the  temporal  lobes  (Meynert) 
give  evidence  of  connective-tissue  changes  with  cellular  degen- 
eration. In  organic  diseases  of  the  brain,  as  in  general 
paralysis  of  the  insane,  we  find  inflammation  of  the  dura 
mater  with  thickening  associated  with  great  increase  of  new 
blood-vessels,  which  frequently,  on  account  of  the  thinness  of 
their  walls,  lead  to  hemorrhages  giving  rise  to  pachy meningitis 
interna  hemorrhagica.  Again,  there  may  be  thickening  of  the 


GENERAL   PATHOLOGY.  197 

pia  mater  with  adhesions  between  it  and  the  dura  mater  as  well 
as  the  brain  substance.  The  structure  of  the  cortex  of  the  brain 
gives  also  evidence  of  disease,  being  atrophied  and  showing 
slight  punctate  depressions  which  give  it  a  worm-eaten  appear- 
ance. This  is  probably  caused  by  obstructions  in  the  small 
capillaries  entering  from  the  pia  into  the  substance  of  the  brain. 
We  not  infrequently  find  along  lymph  tracts  deposits  of  a 
hyaline  nature.  The  vessels  themselves  are  frequently  thick- 
ened, and  probably  the  seat  of  slight  cortical  hemorrhages. 
The  neuroglia  tissue  is  increased;  the  nerve  cells  are  atro- 
phied and  vacuolated,  their  processes  lost,  and  in  their  in- 
terior we  find  granular  substances,  pigment,  etc.  The  asso- 
ciation fibres  which  connect  functionally  adjoining  groups 
of  cells  and  different  areas  of  the  brain  are  also  involved, 
explaining  perhaps  the  loss  of  association  of  ideas,  and  con- 
sequently of  memory  and  judgment  so  frequently  seen  in 
general  paresis.  In  syphilitic  insanity  we  find  changes  point- 
ing specially  to  arterial  disease.  The  walls  of  the  vessels  are 
thickened,  and  an  infiltration  of  a  gummatcus  character  de- 
creases the  lumen,  leading  to  atrophy  following  loss  of  nutri- 
tion from  partial  or  complete  thrombosis.  We  may  thus 
have  in  these  cases  more  or  less  dementia.  Insanity  depen- 
dent upon  alcoholism  generally  shows  affections  of  the  mem- 
branes of  the  brain,  while  in  the  brain  structure  there  may 
be  diseased  vessels  with  increase  of  the  neuroglia  tissue  and 
atrophy  of  the  cortex  cells.  It  is  not  surprising,  therefore, 
that  both  of  these  latter  diseases  may  have  symptoms  resem- 
bling general  paresis,  and  may  be  not  infrequently  taken  for 
that  disease.  In  idiocy  and  imbecility,  we  have  to  deal  with 
defective  structure  of  the  brain.  The  defects  found  are  either 
atrophy,  as  seen  in  microcephaly  or  hydrocephalus  with  en- 
larged ventricles  resulting  in  great  decrease  in  the  depth  of 
the  cortical  substance;  or  we  may  find  partial  or  complete 
absence  of  certain  portions  of  the  brain  structure,  as  the 
greater  part  of  the  cerebrum,  the  basal  ganglia  only  being 
present.  The  morbid  changes  in  imbecility  are  of  a  similar 
nature,  but  the  lesions  have  not  been  so  destructive.  Many  of 
these  changes  seem  inadequate  to  explain  the  various  forms  of 
insanity  in  a  clinical  aspect.  H.  A.  Tomlinaon,  in  a  recent 
article  entitled  "  The  Inadequacy  of  the  Morbid  Changes  Found 


198  INSANITY — FISHER. 

Post  Mortem  to  Explain  the  Manifestations  of  Insanity,"  well 
says  after  a  study  of  twenty-four  cases :  "  A  further  proof  of  the 
want  of  significance  of  these  changes  in  explanation  of  mental 
perversion  is  found  in  the  facts  that  in  an  individual,  no  matter 
whether  the  condition  be  one  of  violent  delirium  or  profound 
depression,  if  the  attack  has  been  acute,  identical  changes  in 
the  cortex  and  meninges  will  be  presented,  sometimes  varying 
in  their  locality  and  extent,  but  never  materially  in  their  char- 
acter. Again,  there  appears  the  implication  that  these  may 
not  stand  in  the  relation  of  a  causative  factor  to  the  mental  per- 
version, and  that  the  histological  changes  found  do  not  result 
directly  from  the  manifestations  of  mental  perversion,  but  in- 
directly through  impaired  nutrition  and  exhaustion  following 
in  the  wake  of  excessive  motor  activity  accompanying  insanity 
— an  auto-intoxication  resulting  from  impaired  or  inhibited 
somatic  activity.  A  further  fact  seldom  referred  to,  but  stated 
elsewhere  by  the  writer  in  this  relation,  is  the  evidence  furnished 
by  primary  and  terminal  dementia.  Either  of  them  may,  and 
often  do,  proceed  to  a  degree  involving  mental  annihilation 
without  interfering  with  the  somatic  activities  which  are  auto- 
matically performed,  and  yet  post  mortem  no  distinct  histologi- 
cal changes  are  to  be  found.  Whether  mental  activity  is  repre- 
sented in  the  most  unstable  cells  of  the  cortex  independently, 
or  whether,  as  I  believe,  it  is  represented  synchronously  with 
motor  generative  activity,  and  is  the  reflex  of  an  association  of 
all  somatic  activity,  has  not  been  demonstrated,  and  may  not 
be  capable  of  demonstration ;  but  the  latter  would  seem  to  be 
the  most  reasonable  assumption  from  the  data  we  have ;  espe- 
cially as  it  will  most  definitely  explain  the  absence  of  distinctive 
changes  in  the  mental  perversion,  and  the  uniformity  of  change 
in  associated  mental  and  somatic  impairment  or  destruction. 
The  first  point  to  study  in  the  pathology  of  insanity  is  that  we 
have  to  deal  with  alterations,  not  destruction  of  function.  The 
activities  involved  are  the  same  in  amount  and  kind  in  both 
normal  and  abnormal  mental  function." 

Nothing  definite  has  been  established  in  regard  to  the  so- 
called  criminal  brain.  The  Italian  school,  especially  among 
others  Lombroso,  have  brought  forward  many  interesting  facts 
in  reference  to  the  convolutions  and  fissures  in  their  efforts  to 
establish  a  special  type,  but  they  are  far  from  conclusive. 


CLASSIFICATION.  199 

The  weight  also  shows  but  little  difference  from  those  of  the 
normal  brain.  Bischott' '  compared  i:JT  brains  of  criminals  with 
422  normal,  and  found  but  little  difference. 

The  difference  between  the  two  hemispheres  is  not  signifi- 
cant. Giacomeni  found  in  42  criminal  brains  the  right  hemi- 
sphere heavier  in  20  cases,  the  left  in  18,  while  2  were  equal. 

Benedikt  reports  that  in  10  criminal  brains  he  found  the 
cerebellum  not  covered  by  the  cerebral  hemispheres  in  six  in- 
stances, and  in  three  cases  but  partially  so. 

The  author  is  a  strong  advocate  of  the  criminal  type  of 
brain. 

Bevan  Lewis  remarks  that  "  our  studies  of  the  pathology  of 
insanity  would  impress  us  with  the  important  principle,  that 
whenever  the  nervous  elements  of  the  cortex  are  primarily  the 
seat  of  disease  originating  mental  derangement,  then  the  im- 
plication of  the  sphere  of  mind  tends  always  to  be  more  gener- 
ally or  universally  involved ;  but  where  the  nerve  changes  are 
secondarily  induced  as  the  result  of  vascular  disease,  the  greater 
tendency  is  shown  toward  a  local  or  partial  implication  of  that 
sphere.  Hence  we  find  that  whereas  in  ordinary  uncomplicated 
acute  insanity  (acute  mania  or  melancholia)  the  territorial  im- 
plication is  a  very  general  one,  although  invariably  expressed 
at  certain  sites  more  than  at  others;  yet  that  in  certain  insani- 
ties (i.e.,  general  paralysis)  special  sites  of  election  are  taken 
by  the  diseased  process,  one  area  being  affected  after  the  other, 
until  ultimately  the  localizing  character  of  the  ailment  fades 
into  a  widespread  general  implication." 

CLASSIFICATION. 

"  The  exigencies  of  affairs  compelled  the  lawyers  themselves 
to  construct  one  of  the  earliest  classifications  of  insanity,  namely, 
that  well-known  one  of  Lord  Coke,  who  divided  insane  persons 
into  (1)  idiots  from  birth;  (2)  the  accidentally  insane  who  have 
wholly  lost  memory  and  understanding;  (U)  those  who  have 
lucid  intervals;  and  (4)  those  who  deprive  themselves  of  under- 
standing by  vicious  actions,  as  drunkards.  Like  all  kinds  of 
insanity  which  have  any  interest  for  lawyers,  it  is  based  upon 
the  mental  qualities  and  conditions,  and  not  upon  the  physical 

1  "Hirngewirht  d.  Mensch."    Wien.  1880. 
ill.  —15 


200  INSANITY— FISHER. 

substratum.  It  is  this  point  which  more  than  any  other  we  are 
bound  always  to  bear  in  mind  in  the  consideration  of  the  diag- 
nosis of  insanity  for  legal  purposes."  As  the  writer  further 
says,  it  is  not  (disease)  as  the  cause  of  disease  in  which  law  inter- 
ests itself,  but  rather  the  product  of  that  disease.  This  is,  how- 
ever, only  begging  the  question,  for  we  all  acknowledge  that 
insanity  is  simply  a  group  of  symptoms,  the  result  of  disease  of 
the  brain. 

This  subject  has  engaged  the  attention  of  all  writers,  so  that 
we  have  had  presented  many  and  various  divisions.  The  etio- 
logical  classification  has  always  received  many  supporters,  and 
has  its  advantages  in  so  far  as  it  definitely  defines  the  character 
of  the  disease.  It  leads,  however,  into  a  very  complex  subdi- 
vision which  is  of  little  value  in  a  medico-legal  sense.  The 
law  recognizes  simply  the  fact  of  insanity,  not  its  particu- 
lar form,  it  is  interested  only  secondarily  in  the  latter  in 
so  far  as  it  explains  the  degree  of  impairment  of  the  mental 
faculties.  "  The  medical  terms  are  not  recognized  in  law — 
the  legal  terms  are  dementia  naturalis,  which  is  equivalent  to 
idiocy  and  imbecility,  and  dementia  adventitia  or  acquired 
insanity."  ' 

Krafft-Ebing  has  in  his  classification  carried  out  this  idea 
in  some  respects,  as  he  divides  all  insanity  into  that  of  the  un- 
developed brain  and  that  of  the  fully  developed  brain. 

In  the  first  division  fall  idiocy  and  imbecility,  correspond- 
ing, therefore,  to  "dementia  naturalis,"  while  in  the  second 
come  all  the  true  forms  of  mental  disease  or  insanity  proper, 
corresponding  to  dementia  adventitia,  or  acquired  insanity. 

He  further  bases  his  division  of  the  various  forms  of  insan- 
ity on  the  pathological  changes  found.  All  insanity  must  be 
ascribed  to  disease  of  the  brain,  either  of  a  functional  (nutri- 
tional) or  organic  character.  Under  the  first  head  will  come 
the  so-called  functional  forms  of  mental  disease,  as  melancholia 
and  mania,  and  also  he  includes  here  the  large  class  of  degen- 
eratives  in  which  the  element  of  heredity  is  the  most  important 
factor,  as  well  as  the  forms  of  insanities  following  from  the 
various  neuroses,  as  epilepsy,  chorea,  etc.  Under  the  second 
head  are  included  those  diseases  due  to  organic  disease  of  the 
brain.  We  have  here  a  practical  basis  for  subdivision  of  the 
1  J.  Dixon  Mann  :  "  Forensic  Medicine  and  Toxicology." 


CLASSIFICATION.  201 

various  forms  of  insanity,  retaining  the  advantages  of  the  etio- 
logical  plan. 

The  attempt  to  divide  insanities  into  those  affecting  the 
emotions  and  those  involving  the  intellect  and  will,  as  has  beeii 
done  by  Griesinger  and  Maudsley,  seems  to  be  based  on  a  false 
principle.  It  is  rare  to  find  a  distinct  form  of  either  class.  If 
we  include  melancholia  and  mania  as  under  this  head,  and  as 
therefore  being  essentially  emotional  states,  we  are  confronted 
with  many  cases  where  the  intellect  is  also  affected  as  shown  by 
the  presence  of  well-defined  delusions.  This  last-named  state 
implies  an  affection  of  the  intellect,  for  delusion  cannot  take 
place  without  thought  or  conception.  Again,  in  delusional  in- 
sanity or  the  various  organic  forms,  as  general  paresis,  there  is 
always  emotional  disturbance.  We  must  conceive  of  the  mind 
as  a  whole,  in  which  no  one  element  can  be  affected  without  to 
a  greater  or  less  extent  affecting  the  integrity  of  the  rest. 

There  is  no  doubt,  at  times,  an  involvement  of  the  emotions, 
almost  to  the  exclusion  of  the  other  function,  and  as  a  rule  it 
does  not  imply  as  serious  a  lesion. 

With  some  few  modifications  I  will  give  Krafft-Ebing's 
classification : 

A.  PSYCHICAL  DISEASE  OF  THE  DEVELOPED  BRAIN. 

I.  Functional  neuroses  or  diseases  without  a  pathological 
basis. 

(1)  Melancholia  (inhibition  of  mental  action). 

a.  Melancholia  simplex. 

b.  Melancholia  cum  stupore. 

(2)  Mania. 

a.  Mania  with  exaltation. 

b.  Mania  with  frenzy. 

(3)  Confusional  insanity,  or  primary  dementia. 

(4)  Stu porous  insanity. 

(5)  Secondary  dementia. 

a.  With  agitation. 

b.  With  apathy. 

II.  Psychical  degenerations,  that  is,  diseased  conditions  of 
the  developed  brain,  inherited  or  acquired. 

(1)   Constitutional  affect  ire  insanity  (folie  raisonnante). 


202  INSANITY — FISHER. 

Moral  insanity. 
Impulsive  insanity. 
Transitory  mania. 

Kleptomania. 

Pyromania. 

Dipsomania. 

Homicidal  mania. 

Suicidal  mania. 

(2)  Paranoia. 

a.  Primary. 

b.  Acquired. 

1.  Typical  form  (with  delusions  of  persecution  and 

grandeur) . 

2.  Questioning  paranoia. 

3.  Religious  paranoia. 

4.  Erotic  paranoia  (sexual  perversion) . 

(3)  Periodical  insanity — circular  insanity. 

(4)  Insanity  from  constitutional  neuroses. 

a.  Neurasthenic  insanity. 

Agoraphobia. 
Claustrophobia. 
Aerophobia. 
Zoophobia. 

b.  Epileptic  insanity. 

c.  Hysterical  insanity. 

d.  Hypochondriacal  insanity. 

III.  Cerebral  disease  with  constant  pathological  changes,  or 
organic  psychoses. 

(1)  Acute  delirium. 

(2)  General  paresis  (dementia  paralytica). 

(3)  Syphilitic  insanity. 

(4)  Alcoholic  insanity. 

(5)  Senile  insanity. 

B.  ARRESTED  CEREBRAL  DEVELOPMENT. 

(1)  Idiocy. 

a.  With  predominant  intellectual  defect. 

b.  With    predominant  ethical  defect  (primary  moral 

weakness) . 


MELANCHOLIA.  O03 

The  mere  statement  of  the  varieties  of  insanity  as  given  by 
the  College  of  Physicians  may  be  useful,  although  it  can  scarcely 
be  placed  under  the  head  of  a  classification : 

Mania. 

Melancholia. 

Dementia. 

Imbecility. 

Idiocy. 

General  paralysis. 

Puerperal  insanity. 

Insanity  of  puberty. 

Climacteric  insanity. 

Senile  insanity. 

Toxic  insanity  (alcohol,  gout,  lead,  etc.). 

Delirium  tremens. 

Traumatic  insanity. 

Insanity  associated  with  obvious  morbid  change  or  changes 
in  the  brain. 

Consecutive  insanity,  from  fevers,  visceral  inflammations. 

SPECIAL  FORMS  OF  INSANITY  DESCRIBED. 

Following  our  classification  we  first  take  up  the  simple  psy- 
choses and  those  mental  diseases  characterized  by  a  loss  of 
responsibility  in  civil  and  criminal  relations. 

Melancholia. — Melancholia  is  characterized  by  marked 
mental  depression,  with  or  without  cause.  There  is  usually 
what  may  be  termed  mental  neuralgia ;  the  patient  is  centred  in 
himself,  and  ascribes  his  trouble  to  some  act  of  his  own.  Hal- 
lucinations, illusions,  and  delusions  may  or  may  not  be  present. 
Those  of  hearing  are  more  common  than  those  of  sight.  Voices 
condemnatory  in  character  are  not  infrequently  heard.  Sin 
against  God,  which  is  held  as  unpardonable,  is  frequently  as- 
sumed. Life  becomes  wearisome  from  the  tedium  of  one  con- 
stant idea  which  cannot  be  driven  away,  and  which  absorbs  the 
patient  to  the  exclusion  of  all  other  thought.  In  extreme  cases 
he  is  unconscious  of  his  surroundings,  and  frequently  assumes 
an  attitude  of  despair  or  one  of  petition.  The  physical  condition 
manifests  itself  by  marked  anremia.  loss  of  appetite — depend- 
ent often  upon  delusions,  as  of  the  fear  of  poisoning — emacia- 


204 


INSANITY — FISHER. 


tion,  and  insomnia.  The  pupils  are  frequently  dilated,  the 
pulse  is  slow  and  feeble.  This  condition  may  remain  for  sever- 
al weeks  or  months,  the  earliest  signs  of  recovery  manifesting 
themselves  by  the  recognition  on  the  part  of  the  patient  of  his 
delusions  as  such,  and  an  improvement  in  his  physical  condition, 


Fio.  10.— Melancholia.  Shows  very  characteristically  the  attitude  assumed  in  melan- 
cholia of  the  passive  form— suicidal.  M.  S.,  female,  set.  21,  single;  admitted  to  the 
hospital  March,  1893.  Patient  has  apparently  no  delusions,  but  cries  and  moans  con- 
stantly and  has  suicidal  tendencies.  Death  occcured  in  June,  1894,  from  phthisis. 

principally  shown  by  an  increase  in  weight.  The  terminal  con- 
dition of  this  state,  when  recovery  does  not  take  place,  is  in 
secondary  dementia. 

Melancholia  comprises,  therefore,  all  those  morbid  states  in 
which  depression  of  a  painful  character  is  the  cardinal  symp- 
tom. It  may  more  especially  involve  either  the  emotions  or 
the  intellect.  In  the  simple  form  there  is  usually  an  absence 
of  delusions  or  hallucinations;  in  fact,  these  are  often  later 


MELANCHOLIA. 


205 


symptoms,  dependent  upon  and  arising  from  the  depression 
(Savage). 

Melancholia  is  indeed  a  symptom  in  many  of  the  different 
forms  of  insanity,  but  must  in  these  relations  be  considered  in 
a  different  light  from  the  recognized  psychosis.  In  true  melan- 
cholia there  is  "  a  complete  process  in  itself."  It  passes  through 
certain  stages,  and  its  course  of  development  can  be  followed. 

Holtzendo  r  f  f 
defines  melan- 
cholia as  a  dis- 
ease the  essence 
of  which  is  a 
painful  depres- 
sion of  mind, 
which  is  not  jus- 
tified by  any  suf- 
ficient cause,  be- 
ing an  expression 
of  a  morbid 
trouble  of  the 
cerebral  function. 
Those  affected 
feel  sad  without 
reason,  anxious, 
discouraged, 
troubled  by 
gloomy  thoughts, 
cares,  and  doubts. 
They  feel  them- 
selves and  their 

relations  with  the  outer  world  changed;  they  are  indifferent  to 
their  interests  in  life;  their  usual  occupations  become  difficult, 
even  impossible,  for  them.  Thought  is  checked ;  certain  painful 
ideas  are  constantly  before  them  (compulsory  ideas),  excluding 
or  driving  out  all  other  ideas  and  thus  destroying  all  volition. 
There  is  usually,  at  least  at  first,  a  clear  recognition  of  this  state 
by  the  patient,  so  that  he  feels  himself  under  some  mysterious 
control,  often  ascribing  it  to  electricity  or  hypnotism.  Subse- 
quently hallucinations  and  illusions  of  the  senses  arise,  which 
are  not  infrequently  rather  secondary  to  the  depression  than  its 


Fio.  11.— Melancholia.  Exhibits  typical  facial  exprcmlon 
of  anxiety  in  inelancholiacs.  Patient,  u-t  53,  female,  widow, 
had  an  acute  attack  at  age  of  33;  had  delusions  of  bearing, 
and  at  times  is  violent. 


206  INSANITY — FISHER. 

cause.  The  mental  agony  may  become  so  extreme  that  there  is 
loss  of  self-consciousness,  the  individual  becoming  oblivious  to 
his  surroundings.  Such  conditions  (raptus  melancholicus)  may 
occur  in  hypochondriacs,  epileptics,  hysterics,  and  in  alco- 
holics, but  the  duration  is  brief  and  the  course  of  the  disease  is 
irregular.  The  physical  and  mental  symptoms  generally  go 
hand  in  hand.  The  face  has  an  anxioi  s  expression,  the  fore- 
head is  wrinkled,  often  characteristically,  with  special  lines  over 
and  between  the  eyes  (see  Fig.  11).  The  general  nutrition  is 
impaired,  the  digestion  is  poor,  flatulence  is  common,  the  skin 
is  dry,  the  hands  and  feet  are  cold  and  blue,  the  cardiac  action 
is  weak,  the  pupils  are  usually  dilated.  There  may  be  marked 
insomnia  or  the  sleep  may  be  restless,  with  little  feeling  of  re- 
freshment on  rising.  The  patient  is  frequently  the  victim  of 
subjective  sensations  of  numbness,  or  there  may  even  be  anaes- 
thesia. These  states  lead  to  hallucinations  or  delusions  in 
many  cases.  A  feeling  as  if  the  skin  were  pinched,  as  de- 
scribed by  a  man  under  my  observation,  was  instantly  ascribed 
to  spirits  about  to  seize  him,  and  while  perhaps  laughing  at  the 
idea  while  speaking  of  it,  he  was  unable  to  cast  it  aside  when 
alone.  There  may  be  marked  mental  weakness,  even  approach- 
ing dementia;  but  this  is  rare,  the  patients  usually  being  able 
on  their  recovery  to  relate  all  the  instances,  or  many  of  them, 
occurring  during  their  illness.  The  refusal  to  speak  or  perform 
any  act  when  requested  is  often  due  to  a  delusion ;  they  may 
hear  a  voice  advising  them  not  to  do  it. 

The  refusal  to  take  food,  which  is  so  common  among  melan- 
choliacs,  is  usually  based  on  some  delusion,  rather  than  sensory 
anesthesia  to  the  pangs  of  hunger.  There  may  be  the  belief 
that  the  food  is  poisoned  or  that  the  stomach  is  diseased  and 
can  no  longer  digest  it.  Suicide  is  common  and  may  be  an  im- 
pulsive act  or  a  deliberate  one.  Where  the  fear  of  being  killed 
is  present,  to  escape  from  it  suicide  may  be  attempted. 

A  boy,  set.  18,  brought  up  in  the  lowest  part  of  New  York,  after 
losing  his  position,  became  depressed  and  heard  voices  calling  him 
opprobrious  names,  with  threats  of  killing  him.  He  applied  to  the 
police  for  protection  and  was  sent  to  the  asylum.  He  was  completely 
filled  with  the  terror  of  being  killed,  crying  out  constantly  for  protec- 
tion and  saying  that  he  had  done  nothing.  To  escape  this  constant 
fear,  he  attempted  suicide. 


MELANCHOLIA.  ^()7 

Homicide  is  not  rare  in  the  agitated  or  excited  cases. 
Where  excessive  misery  or  want  has  been  a  causative  agent  in 
the  disease,  there  may  be  the  desire  and  wish  to  relieve  the 
victims  from  like  suffering,  or  the  fear  that,  after  killing  them- 
selves, the  children,  for  instance,  may  be  left  without  support. 
Again,  when  the  belief  of  having  committed  the  unpardonable 
sin  is  entertained,  there  may  exist  the  wish  to  save  others  from 
a  like  condition.  A  mother  may  deliberately  kill  her  children 
to  save  them  from  suffering,  as  in  the  case  reported  by  Dr.  M. 
D.  Field,  which  I  include  here  in  full. 

The  Case  of  Mrs.  Wilhelmina  C.  D.  Lefefcuc/iner.1— Mrs.  Lebkuch- 
ner  was  indicted  for  the  murder  of  two  children.  It  was  shown  that 
on  March  21st,  1888,  she  admininistered  "  Rough  on  Rats"  to  three 
children,  two  of  whom  died. 

I  saw  Mrs.  Lebkuchner  several  times  during  the  month  of  October, 
1888,  and  from  time  to  time  until  the  trial  in  March,  1889.  I  may 
state  that  I  was  called  upon  to  make  three  reports. 

First. — Capacity  to  plead  to  the  indictment.  Was  she  capable  of 
comprehending  the  nature  of  the  crime  charged,  and  of  aiding  her 
counsel  in  the  formation  of  a  defence,  if  sbe  had  any  ? 

Second. — What  was  her  probable  mental  condition  at  the  time  of 
the  commission  of  this  crime? 

Third. — After  acquittal,  to  determine  whether  sbe  be  discharged  or 
committed  to  an  asylum. 

First  report  was  as  follows  :  Physical  condition  poor.  Is  thin  and 
appears  at  least  ten  years  older  than  she  really  is.  Her  pulse  is  108 
and  irregular.  She  has  anaemic  heart  murmur  (i.e.,  a  false  sound  of 
the  heart  due  to  poor  blood).  Her  circulation  is  feeble  ;  the  extremities 
being  cool.  She  has  an  eruption  on  her  face  due  to  syphilis.  She 
complains  of  numbness  in  right  arm  and  leg  ;  examination  shows  ex 
cited  reflexes  and  slight  loss  of  power  on  that  side.  She  complains  of 
pain  in  her  right  side  (abdomen),  but  much  less  than  formerly.  She 
states  that  sbe  sleeps  fairly  well,  and  has  an  average  apj>etite.  While 
tbere  is  a  very  apparent  indifference  and  lack  of  interest  and  she  is 
without  anxiety  regarding  her  fate,  little  or  no  emotion,  and  no  attempt 
to  excuse  or  justify  her  acts,  she  is  nevertheless  rational,  coherent,  of 
good  perception  and  rather  remarkably  good  memory.  She  is  free  from 
illusions,  hallucinations,  and  delusions  so  far  as  a  searching  and 
thorough  examination  could  determine.  Sbe  makes  no  attempt  to  sim- 
ulate insanity;  on  the  contrary,  she  does  not  want  the  plea  of  insanity 
entered,  and  did  not  inform  me  when  asked  that  she  had  a  sister  in- 

1  By  Matthew  D.  Field,  M.D..  of  New  York. 


208  INSANITY — FISHER. 

sane,  though  she  knew  that  her  sister  was  or  had  been  at  the  asylum 
on  Black  well's  Island. 

My  conclusions  are  that  she  is  now  capable  of  comprehending  the 
nature  of  the  crime  of  which  she  stands  indicted,  and  of  aiding  her 
counsel  in  the  formation  of  a  defence,  if  she  has  one,  as  far  as  her 
natural  intelligence  would  permit  under  ordinary  circumstances. 

Second  report — probable  mental  condition  on  March  21st,  1888. 
To  arrive  at  any  satisfactory  conclusion  as  to  her  mental  state  at  the 
time  when  this  deed  was  committed,  it  is  necessary  to  carefully  : 

1.  Review  her  life,  both  before  and  after  marriage. 

2.  Her  family  history. 

3.  Her  physical  condition. 

4.  The  circumstances  leading  up  to  the  deed. 

5.  The  deed  itself.     The  manner  of  its  execution.    The  time  of  day. 

6.  Her  conduct  after  the  deed. 

7.  The  analogy  and  similarity  of  this  deed  with  acts  of  the  insane. 

8.  Were  there  rational  motives  for  the  commission  of  this  deed  ? 

9.  Finally,  was  this  deed  the  probable  outcome  of  a  diseased  body 
and  mind  ? 

1.  She  was  born  in  Germany  some  thirty-six  years  ago,  and 
received  a  fair  education,  and  in  religion  was  brought  up  to  attend  the 
German  Reformed  Church,  but  for  years  has  neglected  all  church 
duties.  She  came  to  America  in  1871,  and  was  employed  as  a  domestic 
up  to  the  time  of  her  marriage  on  the  28th  of  November,  1877,  when 
she  married  a  man  over  twice  her  own  age,  and  whose  daughters  were 
as  old  as  herself.  Her  husband  lost  his  money,  and  then  started  a 
saloon  and  became  a  drunkard.  Her  relations  with  his  children  were 
always  unpleasant.  By  this  husband  she  had  two  children  and  two 
miscarriages,  and  was  again  pregnant  on  the  23d  of  June,  1883,  when 
he  deserted  her,  leaving  her  nothing  in  the  saloon  but  bills  and  notices 
of  dispossession.  She  struggled  to  keep  the  saloon  and  pay  off  the 
debts  and  make  a  living  for  herself  and  her  children.  She  sought  to 
find  her  husband,  but  his  children  and  other  relatives  deceived  her  as 
to  his  whereabouts,  and  gave  her  no  aid.  On  September  1st,  1883,  she 
was  compelled  to  abandon  the  saloon,  and  was  with  her  two  children 
and  pregnant  again  upon  the  streets,  without  money,  friends,  or  home. 
On  the  7th  of  September  she  applied  to  the  Superintendent  of  the 
Out-door  Poor,  Department  of  Public  Charities  and  Corrections,  and 
the  Society  for  the  Prevention  of  Cruelty  to  Children  for  aid,  and 
on  the  following  day  her  two  children  were  committed  to  the  care  of 
the  society.  Her  sister  became  insane  and  was  taken  to  Bellevue  Hos- 
pital, and  on  September  llth,  1883,  was  pronounced  insane,  and  on 
September  13th,  1883,  she  was  sent  to  the  Lunatic  Asylum  on  Black- 
well's  Island.  Mrs.  Lebkuchner  herself  now  fell  ill,  and  on  September 
12th,  1883,  was  admitted  to  Ward  11,  Charity  Hospital,  where  she  was 
treated  for  syphilis.  Christopher  was  born  March  21st,  1884.  The 


MELANCHOLIA. 

above  dates  and  facts  have  been  verified  by  me  from  inspection  of 
records. 

Her  husband  died  October  8th,  1888.  For  some  time  she  lived  with 
another  man  off  and  on,  but  was  never  married  to  him.  Ho  was  also 
a  drunkard,  and  contributed  little  or  nothing  to  her  support.  By  this 
man  she  had  a  child,  born  in  February,  1887.  This  child  was  placed 
in  some  institution.  In  the  summer  of  1887  she  found  herself  again 
pregnant,  and  during  the  late  fall  or  early  winter  she  injured  her  right 
side  while  carrying  a  stove.  Such  was  her  life  up  to  the  winter  of  1887 
and  1888. 

2.  Family  history  (heredity).    Maternal    grandmother    was    in- 
sane.    Mother  died  of  consumption.     Father  was  an  intemperate  man. 
Sister  Annie  now  an  inmate  of  the  City  Asylum,  whore  she  was  com- 
mitted in  September,  1883  (I  gave  one  of  the  certificates  upon  which 
she  was  committed). 

3.  Her  physical  condition  was  bad.     She  is  still  in  a  very  poor 
physical  condition,  and  from  those  who  saw  her  l>efore  and  soon  after 
the  21st  of  March,  and  from  her  own  statements,  she  was  at  that  time 
in  very  much  worse  physical  condition  than  now.     The  matron  and 
others  about  the  Tombs  tell  me  that  she  was  much  depressed  ami  Con- 
fused when  first  received,  and  that  there  has  been  marked  improvement 
since  her  child  was  born. 

She  was  and  still  is  suffering  from  syphilis  manifested  by  an  erup- 
tion upon  her  face,  and  syphilitic  disease  of  the  brain  is  strongly  sug- 
gested by  the  numbness,  excited  reflexes,  and  loss  of  ]x>wer  on  the 
right  ride,  and  slight  irregularity  and  inactivity  of  the  left  pupil.  She 
was  approaching  the  end  of  pregnancy,  her  poor  physique  was  being 
taxed  to  nourish  this  coming  and  developing  child,  had  the  morbid 
feelings  of  women  at  such  times,  aggravated  by  hick  of  food,  hard 
work,  harassed  and  crippled  by  pain  in  her  side,  and  l>elieving  that 
she  would  not  survive  her  confinement,  and  that  she  would  be  confined 
on  the  29th  of  March. 

4.  The  circumstances  leading  up  to  the  deed.    We  must  not,  in 
considering  this  part  of  the  inquiry,  lose  sight  of  her  physical  condition 
as  just  cited.     She  was  living  in  rooms  for  which  she  |>aid  $S  a  month  ; 
was  paying  for  a  sewing-machine  by  instalments  of  £{  IKM-  month. 
Anthony  was  at  the  asylum,  but  in  February  she  was  notified  to  take 
him  home  or  he  would  be  sent  to  the  West.     Christopher  was  being 
boarded  at  twenty-five  cents  a  day.     Charlie  was  sent  to  a  day  nursery 
when  she  went  out  to  work,  and  for  this  she  paid  ten  cents,  and  it  cost 
her  ten  cents  a  day  for  car  fares  in  taking  him  up  and  bringing  him 
home,  and  then  she  allowed  five  cents  for  his  supper,  and  this  made 
twenty-five  cents  a  day  for  Charlie.     This  made  her  monthly  expenses 
(30  da;      twenty-six  dollars  ($26).     This  is  $1  for  every  week  day.  ami 
not  a  cent  was  allowed  for  light,  fuel,  or  foot).     When  she  went  out  to 
work  she  received  her  food.     This  problem  was  always  with  her,  and 


210  INSANITY — FISHER. 

she  says  at  night  she  could  not  sleep,  thinking  of  what  would  become 
of  them  if  it  rained  on  the  morrow  and  she  could  not  work,  for  she 
could  never  make  up  for  a  day  that  was  lost,  and  the  expenses  were 
all  she  could  possibly  earn,  even  if  she  could  work  every  day.  When 
the  pain  in  her  side  got  worse  and  she  was  unable  to  work,  then  she 
could  not  sleep.  The  officers  of  the  society  came  to  the  house  to  make 
inquiries  about  her,  and  she  got  the  idea  that  she  was  followed  by 
detectives  (this  statement  is  verified  by  Mrs.  Vermilyea,  of  No.  696 
Greenwich  Street,  where  she  was  employed  pretty  regularly  for  some 
two  years,  and  where  she  worked  on  Tuesday,  March  20th).  In  Feb- 
ruary, when  she  was  notified  to  take  Anthony  from  the  Juvenile 
Asylum,  she  was  much  depressed,  and  the  idea  of  this  crime  first  came 
to  her,  but  she  fought  it  off  and  things  were  better,  and  she  could  work 
more  regularly.  Anthony  was  sent  home.  She  could  not  have  him 
go  West,  because  she  had  the  idea  that  the  West  was  a  terrible  place, 
and  that  there  he  would  suffer  worse  than  death.  It  was  in  describing 
what  she  thought  the  West  to  be  that  she  displayed  the  only  emotion 
shown  during  my  interviews  with  her.  On  the  12th  of  March  the 
"blizzard"  came,  and  that  week  she  could  work  little  and  was  com- 
pelled to  buy  food  and  fuel,  and  everything  was  very  expensive  that 
week.  She  was  compelled  to  spend  the  money  she  had  been  saving  to 
pay  the  rent  and  the  instalment  on  the  sewing-machine.  She  had 
promised  to  pay  the  rent  on  March  21st,  and  the  woman  called  for  the 
sewing-machine  money  early  on  Wednesday  morning  (March  21st). 
The  Friday  before  the  crime  she  was  sick  and  unable  to  work,  and 
late  in  the  afternoon  she  fell  asleep  on  the  sofa  in  her  room  and  slept 
soundly,  and  when  she  awoke  she  found  Anthony  and  Charlie  looking 
at  her  and  crying.  When  she  asked  them  what  was  the  matter  they 
said  they  thought  she  was  dead.  This  made  a  great  impression  upon 
her,  and  she  began  to  think  what  would  become  of  them  if  she  should 
die,  and  she  believed  she  was  surely  going  to  die  when  the  baby  was 
born,  for  she  had  never  suffered  such  pain  before  as  she  was  suffering 
from  her  side.  Now  the  idea  of  killing  the  children  and  herself  again 
came  to  her,  and  she  told  the  little  girl  who  came  for  the  money  for 
Christopher's  board  to  bring  him  home  to  her  the  next  night.  She 
wanted  all  the  children  together  that  they  might  die  together.  Satur- 
day she  was  better  and  she  was  able  to  work,  and  on  Sunday  she 
took  home  some  work  and  received  a  dollar  and  a  half.  She  was 
brightened  now  and  the  idea  left  her.  On  Monday  she  could  not  work, 
but  Tuesday  she  went  to  work  and  took  little  Christopher  with  her,  but 
she  suffered  severe  pain  in  her  side,  and  in  the  afternoon  was  com- 
pelled to  stop  work.  She  took  a  car  home,  but  on  the  way  was  very  sick 
with  great  pain,  and  she  had  some  discharge  that  soiled  her  clothes 
(says  her  petticoat  would  show  this  now  if  it  could  be  recovered  from 
her  effects  left  at  her  rooms),  and  she  believed  that  she  would  soon  be 
confined.  In  this  state  she  reached  home;  but  she  could  not  sleep  that 


MELANCHOLIA.  oj] 

night;  she  "cried  and  prayed  all  night,"  and  "she  felt  that  it  was 
best  that  she  should  kill  the  children  and  herself  than  that  she  should 
die  and  leave  the  children  hehind."  This  idea  took  possession  of  her, 
and  she  sent  Anthony  out  for  a  box  of  "  Rough  on  Rate."  While  he 
was  gone  the  woman  called  to  collect  the  sewing-machine  money. 

5.  The  deed  itself.     This  was  done  in  the  morning,  after  a  sleepless 
and  troubled  night.     It  was  calmly  and  quietly  done.     She  put  all  the 
poison  in  a  pot  of  tea  and  made  four  portions,  one  for  each  of  the 
children  and  one  for  herself.     She  did  not  take  her  own  j>ortion,  be- 
cause she  might  die  first,  and  she  was  not  cowardly  enough  to  leave 
them  to  suffer  without  somebody  to  look  after  them.     She  gave  them 
the  tea  containing  the  poison  and  told  them  to  drink  it,  but  she  could 
not  look  at  them,  but  turned  away  and  became  faint  and  sustained  her- 
self by  holding  on  to  the  mantel. 

6.  Her  conduct  after   the  poisoning.    She  remained  with  and 
cared  for  them  as  best  she  could.     She  would  have  gone  for  help,  but 
she  could  not  leave  them,  but  stayed  and  looked  at  them.    Two  died 
and  she  put  them   in  the  bed.     On   Saturday  morning,  3:30,  little 
Christopher  fell  asleep  and  then  when  he  was  quiet,  and  would  not 
miss  her,  she  ran  to  the  police  station  and  told  them  what  she  had  done 
and  asked  them  to  send  a  doctor.     She  did  not  seek  a  doctor  to  save  his 
life,  she  seems  not  to  have  thought  of  this,  but  to  relieve  his  sufferings. 
She  was  calm,  gave  herself  up,  made  no  excuse,  and  showed  no  re- 
morse.    She  still  believed  that  little  Christopher  could  not  recover,  and 
that  she  would  still  die.     She  had  not  looked  upon  this  as  a  crime,  but 
thought  that  they  would  soon  all  be  together  in  a  better  world. 

7.  The  analog}/  and  similarity  of  thin  deed   icith   acts   of    the 
insane.     It  does  not  appear  that  this  deed  was  the  result  of  a  defined 
insane  delusion,  or  was  the  result  of  a  defined  hallucination.     By  this 
I  mean  that  she  was  not  impelled  by  any  fixed  and  governing  false 
idea,  nor  by  any  commanding  voice,  or  any  vision  pointing  out  to  her 
what  she  should  do.     She  did  not  appear  to  have  had  what  is  called  an 
imperative  conception,  that  is,  any  sudden  irresistible  impulse  taking 
such  possession  of  her  as  to  overpower  all  will  and  reason.     She  does 
not  appear  to  have  been  unconscious  at  the  time  of  the  commitment  of 
this  deed,  nor  is  there  any  evidence  that  she  ever  had  epilepsy,   the 
existence  of  which  might  account  for  the  crime.     Nevertheless,  this 
deed,  contrary  to  every  natural  instinct  of  a  human   being,   much 
worse,  a  mother,   without  selfish  motive,  apparently  the  only  selfish 
motive  that  might  be  attributed  would  l>e  that,  at  any  cost,  these  chil- 
dren should  be  kept  from  the  relatives  of  her  latt-  husband.     Had  she 
wished  to  have  freed  herself  from  the  care  in  order  to  abandon  herself 
to  a  dissolute  life,  as  is  claimed,  she  might  have  left  her  children  with 
the  society  without  committing  this  crime.     It  is  evident  that  she  in- 
tended to  take  her  own  life,  but  was  unwilling  to  do  this  until  she  was 
assured  that  all  the  children  were  dead.     Suicides  and  homicides  of  the 


212  INSANITY — FISHER. 

insane  are  committed  more  f  requently  in  the  morning  hours,  especially 
after  a  sleepless  and  troubled  night,  and  before  the  will  and  reason  have 
fully  asserted  themselves.  Insanity  involves  the  ego,  the  insane  delu- 
sions and  hallucinations  always  pertain  to  and  involve  the  egro,  and 
that  which  is  closest  to  the  ego  ;  and  this  is  nowhere  more  conclusively 
shown  than  in  the  homicidal  acts  of  the  insane.  Statistics  show  that 
thirty  suicides  are  perpetrated  by  the  insane  to  every  homicide,  and  of 
the  homicides  committed  by  the  insane  those  of  the  nearest  and  dearest 
relatives  are  eight  times  as  frequent  as  of  those  not  joined  to  them  by 
these  close  ties.  There  was  no  attempt  at  concealment  or  self -protec- 
tion ;  no  effort  to  escape ;  but,  on  the  contrary,  she  voluntarily  gives 
herself  up  and  confesses,  in  the  calmest  manner,  all  that  she  had  done. 
There  was  also  lack  of  all  emotion  and  remorse. 

8.  Were  there  rational  motives  for  the  commission  of  this  deed  ? 
Only  that  they  would  be  better  off  dead  than  left  unprotected  in  this 
world,  when  it  was  plain  to  her  that  she  was  too  sick  and  poor  to  care 
for  the  children  longer  herself,  and  that  she  was  going  to  die. 

There  was  no  motive  of  gain,  anger,  or  revenge.  In  fact,  there 
was  nothing  about  the  deed  that  was  not  irrational. 

9.  Was  this  deed  the  probable  outcome  of  diseased  body  and 
mind?     Yes.     We  find  strong  hereditary  predisposition.     We  have 
syphilis,  with  symptoms  of  involvement  of  the  brain. 

We  have  pregnancy,  with  its  morbid  fears.  I  have  said  that  there 
was  no  defined  delusion,  but  there  was  great  mental  depression,  with 
the  ill-defined  delusions  that  she  would  die  during  her  confinement. 
Her  distorted  ideas  of  the  West,  and  what  her  children  would  suffer 
there.  She  saw  no  hope  in  the  future,  and  want  and  starvation  at 
hand  for  herself  and  her  children.  She  was  in  very  poor  physical 
condition  and  not  fit  to  work,  yet  working.  She  was  suffering  from  a 
severe  injury  to  her  side  while  carrying  a  heavy  stove.  She  was 
troubled  in  every  way,  and  was  sleepless,  and  was  in  too  poor  a  physi- 
cal condition  to  appreciate  the  nature  of  her  acts  or  to  resist  the  im- 
pulse that  impelled  her  to  the  commission  of  this  act. 

The  act  seems  to  have  been  the  result  of  heredity,  pregnancy, 
circumstances,  a  diseased  and  worn-out  body,  a  mind  weakened  by 
these,  and  harassed  by  poverty  and  want,  and  so  deeply  depressed  that 
the  judgment  and  will  were  unable  to  act  with  anything  like  their  ac- 
customed' power  and  force. 

The  third  report  was  in  the  form  of  a  certificate  of  insanity,  the 
body  of  which  read  as  follows  : 

"  She  is  in  very  poor  physical  condition.  She  is  thin,  pale,  and  has 
an  anaemic  heart  murmur,  with  a  rapid,  quick  pulse.  Her  pupils  are 
unequal,  and  there  is  loss  of  power  and  excited  reflexes  on  the  right 
side.  She  has  an  eruption  upon  her  face,  probably  due  to  syphilis. 
She  is  at  times  depressed,  and  at  other  times  is  elated  without  adequate 
cause.  She  does  not  appreciate  the  gravity  of  her  present  position,  nor 


MELANCHOLIA.  213 

the  enormity  of  her  crimes.  Sho  has  displayed  l*>th  suicidal  and 
homicidal  impulses.  On  one  occasion  she  i>oisoned  thr«»  children, 
two  of  whom  died.  Considering  this  history,  with  her  prevent 
physical  and  mental  states,  I  believe  her  an  unsafe  person  to  bo  at 
large." 

This  case  presents  many  points  of  especial  interest  to  both  the  med- 
ical and  legal  professions.  She  was  at  first  put  on  trial  before  Judge 
Martiue  and  a  jury  as  to  her  present  sanity  and  cnjwu-ity  to  plead  to  the 
indictment.  The  prosecution  called  Dr.  Allen  McLanc  Hamilton  and 
Dr.  George  B.  Fowler.  Dr.  Frank  II.  Ingram  and  myself  were  called 
by  the  counsel  for  the  accused.  The  testimony  was  practically  the 
same,  and  the  jury  found  her  sane. 

A  month  later  she  was  placed  on  trial  before  Judge  Gilderalecve 
and  a  jury  upon  the  indictment ;  insanity  was  interposed  as  the  de- 
fence; the  prosecution  was  conducted  by  Assistant  District  Attorney 
Macdonna,  the  prisoner  being  defended  by  Mr.  John  R.  Hcinzelman. 
The  defence  placed  upon  the  stand,  upon  the  question  of  insanity,  Dr. 
Stuart  Douglas,  Dr.  Allen  McLane  Hamilton,  Dr.  Frank  H.  Ingram 
and  myself ;  no  expert  witnesses  were  called  by  the  people.  His  Honor 
Judge  Gildersleeve  charged  the  jury.  After  reviewing  the  evidence 
and  defining  the  degrees  of  murder  and  manslaughter,  he  charged 
upon  the  question  of  resjKmsibility  as  follows  : 

"If  you  are  satisfied,  therefore,  gentlemen,  that  she  administered 
this  poison  and  it  resulted  in  the  death  of  Charles  Lebkuchner,  ami  that 
she  did  it  from  a  deliberate  and  premeditated  design  to  effect  his  death 
and  you  are  so  satisfied  beyond  any  fair  and  reasonable  doubt,  then  she 
is  guilty  of  the  crime  of  murder  in  the  first  degree,  unless  you  are 
satisfied  that  the  defence  which  she  has  set  up  here  has  been  established, 
viz.,  that  of  insanity. 

"The  20th  section  of  the  Penal  Code  provides  as  follows  :  'An  act 
done  by  a  person  who  is  an  idiot,  imbecile,  lunatic  or  insane,  is  not  a 
crime.'  It  is  claimed  that  the  act  of  this  defendant  which  it  is  chargvd 
resulted  in  the  death  of  the  deceased,  is  not  a  crime  because  she  was 
insane  at  the  time.  Now  that  is  a  question  of  fact  for  you  to  decide  in 
the  light  of  all  the  evidence — her  conduct,  what  she  said  and  did,  in  the 
lightof  what  the  experts  who  have  been  called  here  have  said  in  respect 
to  that  question.  The  rule  of  law  that  is  controlling  on  the  question  of 
insanity  seems  to  be  clearly  expressed  in  the  opinion  of  Judge  Andrew* 
of  the  Court  of  Appeals  in  the  case  of  Flanagan  against  the  People,  a 
portion  of  which  was  read  to  you  by  the  learned  District  Attorney  : 
'  It  must  be  regarded  as  the  settled  law  of  this  State  that  the  test  of 
responsibility  for  criminal  acts  where  unsoundness  of  mind  is  inter- 
posed as  a  defence,  is  the  capacity  of  the  defendant  to  distinguish 
between  right  and  wrong  at  the  time  of  and  with  respect  to  the  act 
which  is  tho  subject  of  inquiry.'  The  physicians  when  asked  their 
opinion  as  to  the  condition  of  the  defendant's  mind  at  the  time  of  the 


214  INSANITY — FISHER. 

commission  of  the  act  based  upon  the  circumstances  and  condition  of 
things  disclosed  by  the  evidence,  such  as  her  conduct,  her  previous 
history,  all  the  circumstance  under  which  the  act  was  committed,  their 
answer,  you  remember,  was  that  it  was  their  opinion  that  she  was  in- 
sane. Dr.  Douglas  was  asked  :  '  Might  she  have  known  the  differ- 
ences between  right  and  wrong  and  yet  not  have  capacity  to  act  upon 
that?'  The  answer  was:  'Yes.'  Dr.  Hamilton  said:  'I  think 
her  will  was  affected,  that  she  committed  this  under  a  condition  of 
diseased  responsibility,  she  was  irresponsible  as  the  result  of  disease. 
Q.  Do  you  believe  that  a  person  hi  the  condition  she  was,  was  able  to 
choose  between  the  right  and  wrong?  A.  I  do  not.  Q.  You  have 
heard  the  circumstances  detailed  under  which  it  is  claimed  that  this 
defendant  poisoned  her  children?  A.  Yes,  sir.  Q.  You  have  heard 
what  her  condition  in  life  was  at  that  time;  without  my  stopping, 
therefore,  to  repeat  all  these  conditions  and  all  these  details,  bearing 
them  in  mind,  what  is  your  opinion  now,  at  the  time  she  administered 
the  poison,  was  she  sane  or  insane  ?  A.  I  believe  her  to  be  insane,  sir, 
and  from  my  conversation  with  her.'  This  answer,  viz. :  'I  think  her 
will  was  affected,  that  she  committed  this  under  a  condition  of  dis- 
eased responsibility,  she  was  irresponsible  as  the  result  of  disease  : '  and 
then  this  question  :  '  Do  you  believe  that  a  person  in  the  condition 
she  was,  was  able  to  choose  between  the  right  and  the  wrong?'  and 
the  answer :  '  I  do  not ' — brings  up  the  real  turning-point  in  this  case. 
You  must  find  from  the  evidence,  before  she  is  entitled  to  be  acquitted 
on  the  ground  of  insanity,  that  she  had  not  the  capacity  to  distinguish 
between  right  and  wrong  in  respect  to  that  particular  act.  If  you  find 
in  the  abstract  that  her  mind  was  sufficiently  sound  to  enable  her  to 
distinguish  between  right  and  wrong,  she  would  not  necessarily  be  re- 
sponsible. You  may  find  that  she  had  sufficient  control  of  her  intellect 
and  of  her  faculties  to  be  able  to  know  and  understand  that  it  was 
wrong  to  kill,  that  it  was  a  crime  to  take  life,  and  yet  that  would  not 
fasten  the  responsibility  of  taking  the  life  of  the  deceased  upon  her 
under  the  law.  Was  her  mind  sufficiently  sound,  did  she  have  suffi- 
cient control  of  her  judgment  to  be  able  to  distinguish  right  from  wrong 
in  respect  to  this  particular  act,  viz. ,  the  taking  of  the  life  of  her  own 
child  under  those  particular  circumstances  ?  If  her  mind  was  so  af- 
fected by  reason  of  the  poverty  that  had  pursued  her,  by  reason  of  the 
misfortunes  that  had  befallen  her  and  followed  her  along  from  month 
to  month  and  from  year  to  year,  if  the  sufferings  she  saw  ahead 
of  her  or  in  store  for  her  children  in  case  of  her  death,  or  that  she 
believed  she  saw  in  store  for  them,  if  this  so  affected  her  mind,  so 
disturbed  and  deranged  her  judgment,  so  interrupted  the  ordinary  and 
sensible  course  of  reasoning  as  to  honestly  induce  her  to  believe  that 
she  was  doing  a  kind  and  merciful  act,  that  she  was  taking  this  son 
from  a  world  of  trouble  to  a  haven  of  peace  and  happiness,  and  that 
it  was  right  for  her  to  do  it,  although  she  knew  and  believed  that 


MELANCHOLIA.  215 

murder  in  the  abstract  was  wrong  and  a  crime — if,  induced  by  thin 
condition  of  things  she  was  brought  urouud  to  that  condition  of  mind 
and  was  not  able  by  reason  of  that  condition  of  things  to  distinguish 
right  from  wrong  in  respect  to  that  particular  act,  then  she  is  entitled 
to  an  acquittal.  The  rule  is  the  capacity  of  the  defendant  to  distinguish 
between  right  and  wrong  at  the  time  of  and  with  respect  to  the  act 
which  is  the  subject  of  inquiry.  The  principle,  or  more  properly  the 
theory  upon  which  she  is  entitled  to  an  acquittal,  if  you  believe  that 
condition  of  things  which  I  have  named  existed,  must  be  distinguished 
from  an  uncontrollable  impulse,  because  the  courts  have  held  that 
where  it  appears  that  a  person  takes  the  life  of  another  under  an  un- 
controllable impulse  by  reason  of  the  pressure  or  influence  they  feel 
brought  to  bear  upon  them,  having  sufficient  capacity  to  know  that  the 
act  was  wrong,  being  of  sufficiently  sound  mind  to  distinguish  right 
from  wrong  in  respect  to  that  particular  act,  although  they  have  not 
the  will  power  to  resist  this  impulse,  this  insane  force  that  is  operating 
upon  them,  nevertheless,  the  law  holds  them  responsible.  The  law 
does  not  recognize  a  form  of  insanity  in  which  the  capacity  of  knowing 
right  from  wrong  exists  without  the  power  of  choosing  between  them, 
says  one  case.  Another  case  says,  it  is  no  defence  that  in  consequence 
of  an  uncontrollable  impulse  the  prisoner  has  no  power  over  his  will. 
In  a  case  where  the  accused  have  said:  '  I  felt  a  command  from  God 
to  do  this  act;  I  knew  it  was  wrong;  I  did  not  want  to  do  it,  but  I  had 
not  the  will  power  to  resist  what  I  believed  was  the  command.'  Now, 
under  these  rulings  in  these  cases,  a  person  taking  life  under  those 
circumstances  would  be  held  responsible  for  his  acta.  So  that  all  thus 
reasoning,  you  will  see,  gentlemen,  brings  you  right  around  back  to 
this  principle,  what  was  the  particular  condition  of  mind  of  the  defen- 
dant at  the  time  of  the  commission  of  the  act?  Was  the  defendant's 
mind  so  unsound  that  she  was  not  capable  of  distinguishing  between 
right  and  wrong  in  respect  to  the  act  which  she  was  committing?  This 
defence  of  insanity  is  an  affirmative  one.  The  burden  is  on  the  accused 
of  establishing  it;  the  burden  is  upon  the  accused  of  satisfying  the  jury 
that  the  defendant's  mind  was  unsound  at  the  time  of  the  commission  of 
the  act.  It  is  hardly  proper  for  me  to  say  to  you  that  they  are  bound 
to  go  as  far  as  the  people  are  bound  to  go  in  making  out  a  case,  vix.,  to 
satisfy  you  beyond  any  fair  and  reasonable  doubt,  and  yet  the  evidence 
must  be  convincing  and  satisfactory  to  the  jury." 

The  jury  retired,  and  after  about  two  hours  forwarded  to  the  judge 
the  two  following  questions: 

"In  case  we  find  the  defendant  knew  tho  difference  between  right 
and  wrong,  but  had  not  the  will  power  to  resist  the  impulse  to  commit 
the  crime,  must  we  consider  the  law,  as  read  by  the  District  Attorney, 
binding,  that  is,  take  no  regard  as  to  her  will  power?"  "Did  the 
Court  charge  that  in  the  case  we  found  the  defendant  merely  acted 
under  an  uncontrollable  impulse,  we  should  find  her  guilty  ? 
III.— 16 


216  INSANITY — FISHER. 

At  this  time  I  understood  the  jury  stood  nine  "not  guilty,"  and 
three  "guilty;"  the  ground  of  difference  being  embraced  in  the  two 
questions  presented  to  the  Court.  The  jury  were  again  called  into 
court  and  were  addressed  by  Judge  Gildersleeve  as  follows  : 

"Gentlemen  of  the  jury : — In  answer  to  these  two  questions  which 
you  have  submitted,  I  doubt  if  I  can  do  better  than  have  the  stenog- 
rapher read  to  you  what  I  said,  and  yet  I  will  add  to  what  I  have  said 
by  reading  from  some  authorities  from  which  I  did  not  read  at  the  time 
of  delivering-  the  charge.  The  question  presented  for  your  considera- 
tion is  a  very  delicate  one,  and  so  the  principles  of  law  that  control 
cases  of  insanity  are  not  very  well  settled.  They  differ  in  different 
States.  I  am  bound  to  give  you  the  law  as  it  maintains  in  this  State, 
where  this  court  has  jurisdiction.  It  is  not  an  easy  matter  to  determine 
just  where  responsibility  ceases  and  irresponsibility  begins  in  respect 
to  particular  acts,  and  I  am  not  surprised  that  you  ask  for  some 
further  instruction.  Now,  the  law  does  not  recognize  any  moral 
power  compelling  a  man  to  do  what  he  knows  to  be  wrong;  that  is 
substantially  what  I  meant  to  say  in  reference  to  the  operation  of  the 
alleged  uncontrollable  impulse.  That  convenient  form  of  insanity 
which  enables  a  person  who  does  not  choose  to  bridle  his  passions,  to 
allow  them  to  get  and  keep  the  upper  hand  just  long  enough  to  com- 
mit an  act  of  violence  and  then  subside,  is  not  recognized  by  the  law. 
The  insanity  which  takes  away  the  criminal  quality  of  the  act 
must  be  such  as  amounts  to  mental  disease  and  prevents  the  accused 
from  knowing  the  nature  and  quality  of  the  act  he  was  doing.  The 
doctrine  that  a  criminal  act  can  be  excused  upon  the  notion  of  an 
irresistible  impulse  to  commit  it  where  the  offender  has  the  ability  to 
discover  his  legal  and  moral  duty  in  respect  to  it,  has  no  place  in  the 
law.  To  establish  defence  on  the  ground  of  insanity — I  now  read  an 
opinion  of  the  Court  of  Appeals — it  must  be  clearly  proven  that  at  the 
time  of  committing  the  act,  the  subject  of  the  indictment,  the  party 
accused,  was  laboring  under  such  a  defect  of  reasoning,  of  diseased 
mind,  as  not  to  know  the  nature  and  quality  of  the  act  he  was  doing, 
and  if  he  did  not  know  it,  that  he  did  not  know  that  he  was  doing 
wrong.  Where  insanity  is  interposed  as  a  defence  to  an  indictment 
for  an  alleged  crime,  the  inquiry  is  always  brought  down  to  the  single 
question  of  capacity  to  distinguish  between  right  and  wrong  at  the 
time  the  act  was  done;  and,  I  might  add,  in  respect  to  that  particular 
act,  it  must  be  regarded  as  the  settled  law  of  this  State  that  the  test  of 
responsibility  for  criminal  acts  where  unsoundness  of  mind  is  inter- 
posed as  a  defence  is  the  capacity  of  the  defendant  to  distinguish 
between  right  and  wrong  at  the  time  of  and  with  respect  to  the  act 
which  is  the  subject  of  the  inquiry.  That  is  the  law  of  this  State  with 
reference  to  this  defence,  and  it  is  the  law  by  which  you  will  be 
governed  in  determining  the  question  whether  the  defence  that  has 
been  interposed  here  has  been  established  or  not.  Now,  as  to  the 


MELANCHOLIA.  2j? 

burden  of  proof.  Crimes  can  only  be  committal  by  human  beings 
who  are  in  a  condition  to  be  resj>onsible  for  their  arts ;  and  upon  this 
general  proposition  the  prosecutor  holds  tin- atlirmative  and  the  burilen 
of  proof  is  upon  him.  Sanity  being  the  normal  and  usual  condition 
of  mankind,  the  law  presuming  every  individual  is  in  that  state,  hence 
a  prosecutor  may  rest  upon  that  presumption  without  other  proof. 
The  fact  is  deemed  to  be  proved  prima  facie,  and  whoever  denies  this 
or  interposes  a  defence  based  upon  its  untruth  must  prove  it ;  the 
burden  of  overthrowing  the  presumption  of  sanity  and  of  showing 
insanity  is  upon  the  person  who  alleges  it ;  and  if  evidence  is  given 
tending  to  show  insanity,  then  the  question  is  presented  to  the  court 
and  jury  whether  the  crime,  if  committed,  was  committed  by  a  IMTSOII 
responsible  for  his  acts,  and  upon  this  question  the  presumption  of 
sanity  and  the  evidence  are  all  to  be  considered,  and  the  prosecutor 
holds  the  affirmative.  If  a  reasonable  doubt  exists  as  to  whether  the 
prisoner  is  sane  or  not,  he  is  entitled  to  the  beneiit  of  the  doubt  and  to 
an  acquittal.  Now,  I  declined,  you  remember,  to  instruct  you  that 
the  defence  were  bound  to  establish  the  insanity  of  the  accused  beyond 
any  fair  and  reasonable  doubt.  The  benefit  of  a  fair  and  reasonable 
doubt  upon  the  whole  case,  upon  all  the  evidence  for  the  people,  and 
for  the  defence  is  always  the  property  of  any  prisoner  charged  with 
crime.  Now  you  will  see  that  if  the  defendant  was  required  to  satisfy 
you  beyond  any  fair  and  reasonable  doubt  of  her  insanity  and 
succeeded  in  satisfying  you  from  the  evidence  that  there  was  some 
doubt  of  her  sanity,  and  if  I  charged  you  the  projiosition  of  law 
that  you  are  bound  to  find  beyond  any  fair  and  reasonable  doubt, 
although  she  did  go  far  enough  to  create  some  doubt,  she  would  not 
have  the  benefit  of  the  general  principle  of  law  that  the  accused  is 
always  entitled  to  the  benefit  of  any  fair  and  reasonable  doubt  upon 
the  whole  case — that  would  be  requiring  the  defendant  to  go  further 
than  the  law  requires.  Now  I  will  not  go  over  what  I  said  to  you  in 
the  first  instance.  I  instruct  you  according  to  my  own  recollections  of 
the  law,  not  with  the  accuracy  and  precision  with  which  the  law  is  laid 
down  in  these  authorities  from  which  I  have  now  read.  These  author- 
ites  which  I  have  read  to  you  embody,  as  I  believe,  tho  principles  of 
law  which  I  intended  to  lay  before  you  in  my  charge.  I  have  empha- 
sized the  principles  by  reading  these  authorities  and  perhaps  have  made 
clear  to  you  the  questions  of  doubt  that  were  in  your  minds.  If  any 
of  you  have  any  question  that  you  would  like  to  ask,  any  point  upon 
which  you  are  not  entirely  clear,  I  will  endeavor  to  it  make  clear.  Then- 
can  be  no  conviction  unless  an  accused  jx^rson  has  sufficient  mind,  has 
sufficient  control  over  his  reasoning  faculties  as  to  be  able  to  form  a 
criminal  intent.  Bishop,  one  of  the  leading  authorities  on  criminal 
law,  I  think  defines  the  question  in  alnnit  those  words,  and  that  is  the 
test  the  jury  is  to  apply,  Was  the  mind  of  the  accused,  although 
diseased,  sufficiently  sound  to  be  able  to  form  a  criminal  intent?  It  all 


218  INSANITY — FISHER. 

comes  back  to  this  original  statement  which  I  said  to  you  was  the  law 
of  this  State.  The  test  of  responsibility  for  criminal  acts  where 
unsoundness  of  mind  is  interposed  as  a  defence,  is  the  capacity  of  the 
defendant  to  distinguish  between  right  and  wrong  at  the  time  of,  and 
with  respect  to,  the  act  which  is  the  subject  of  inquiry.  Now  in 
determining  that  question  you  see  you  must  take  into  consideration 
the  defendant's  condition  of  pregnancy,  and  ail  her  troubles,  and  all 
that  happened  before,  and  her  conduct  subsequently,  as  I  instructed 
you,  for  the  purpose  of  determining  that  particular  question.  You  may 
now  retire,  gentlemen." 

The  jury  rendered  a  verdict  of  not  guilty,  on  the  ground  of 
insanity  at  the  time  of  the  commission  of  the  offence. 

Subsequently,  Judge  Gildersleeve  committed  Mrs.  Lebkuchner  to 
the  State  Hospital  for  the  Insane,  at  Poughkeepsie,  upon  certificates 
of  insanity  furnished  by  Dr.  Ingram  and  myself.  Mr.  Heinzelman 
procured  a  writ  of  habeas  corpus,  returnable  before  Justice  Beach  of 
the  Supreme  Court,  to  show  cause  why  she  should  not  be  discharged. 
Justice  Beach  discharged  Mrs.  Lebkuchner  upon  the  ground  that  the 
commitment  was  unauthorized,  illegal,  and  void. 

Again,  the  misery  may  be  so  great  that  instead  of  the  usual 
passive  state  of  these  patients  there  may  be  almost  a  mani- 
acal state  resembling  acute  mania,  in  which  the  patient  feels 
impelled  to  do  something  to  escape  from  the  depression,  and, 
knowing  no  cause  for  it  on  his  own  part,  may  ascribe  his  con- 
dition to  some  enemy  or  to  a  conspiracy  against  him.  These 
impulses  to  suicide  or  homicide  are  frequently  recognized  by  the 
patient  himself,  so  that  self-commitments  are  more  common  in 
this  disease  than  in  any  other  form  of  insanity.  As  Cullen 
says,  however,  crimes  are  rare  in  melancholia.  There  are  spe- 
cial forms  of  melancholia  either  dependent  on  the  nature  and 
duration  of  the  seizure  or  on  some  special  character  of  the  delu- 
sions accompanying  it. 

Simple  melancholia,  by  which  we  mean  mental  depression 
without  delusions,  is  usually  subacute  or  chronic.  We  find  it 
most  frequently  among  the  overworked,  or  in  persons  subject 
to  great  strain  or  mental  worry,  especially  of  a  domestic  or 
financial  character.  There  is  a  marked  tendency  to  suicide,  a 
constant  fear  that  they  will  commit  it.  There  is  often  a  hypo- 
chondriacal  element  in  these  cases,  the  patients  having  an  in- 
tense desire  to  explain  their  whole  mental  state.  There  is  often 
a  fear  that  the  natural  affection  for  their  children,  husband, 
wife,  or  family  is  absent.  This  condition  is  especially  common 


MELANCHOLIA.  jJl'J 

in  women,  occurring  in  the  young  and  unmarried,  when  perhaps 
an  unfortunate  love  affair  may  be  the  provocative  cause.  We 
observe  it  also  at  the  menopause. 

As  Savage  has  observed,  the  attempts  at  suicide  are  often  not 
serious,  resembling  those  in  hysteria. 

The  following  cases  illustrate  the  effect  of  over-strain  in  a 
patient  with  a  predisposition  to  mental  disease  from  hereditarv 
taint,  and  also  the  influence  of  mental  disease  in  one  patient  on 
another : 

Two  sisters,  set.  36  and  38  respectively,  were  brought  to  the  hospital 
with  the  history  of  having  attempted  suicide. 

Family  history  was  as  follows  :  The  mother,  still  living,  had  beon 
confined  in  a  hospital  for  some  years  for  melancholia  with  xuicidal 


I    _    1   '/••      i    '  \ 


Flo.  12. — Shows  melancholia  occurring  within  a  few  months  of  each  other  In  two 
sisters.  Both  markedly  depressed,  and  possessed  of  the  delusion  that  some  one  wl»he»l 
kill  them.  They  were  both  single  and  lived  together,  being  seamstresse*  by  occupation. 

tendencies,  and  was  at  the  time  in  a  state  of  dementia.  The  father  hod 
also  been  in  an  asylum  for  several  months,  but  had  recovered  to  the  ex- 
tent that  he  was  able  to  return  to  his  work,  although  somewhat  weak- 
minded. 

Both  sisters  were  very  hard-working,  conscientious  women,  and  had 
tried  successfully  to  support  the  family.  They  were  of  highly  nervous, 
hysterical  temperaments  and  had  both  previously  been  conniunl  in  an 
asylum  for  several  months,  for  melancholia  with  suicidal  tendencies. 

The  present  attack,  in  the  first  sister,  was  due  to  anxiety  and  want  of 
sleep,  incurred  in  watching  over  the  other  sister  during  u  seven*  attack 
of  nervous  prostration.  She  attempted  to  throw  herself  out  of  the 
window,  and  on  being  prevented  became  violent.  The  second  sister. 


220  INSANITY — FISHEK. 

who  was  recovering  from  her  illness,  then  became  maniacal  and  at- 
tempted to  take  poison.  There  was  the  same  idea  present  in  both,  that 
her  illness  was  preventing'  the  other  from  working  and  supporting  the 
aged  parents.  There  was  considerable  mental  confusion  and  extreme 
depression,  without  delusions  of  any  kind  (see  Fig.  12). 

These  periods  of  depression  are  usually  most  marked  during 
the  menstrual  periods,  or  following  sexual  excess,  especially 
masturbation,  which  is  not  uncommon  in  both  sexes  in  these 
cases. 

The  following  case  of  simple  melancholia  without  delusion 
illustrates  these  conditions : 

A.  B.,  female,  aet.  27,  family  history  negative.  Five  or  six  years 
previously,  after  a  disappointment  in  love,  had  nervous  prostration ; 
following  which  she  became  filled  with  a  constant  desire  to  kill  her- 
self ;  however,  was  always  anxious  to  have  some  one  with  her.  These 
attacks  would  occur  every  spring.  The  patient  became  anaemic,  de- 
pressed, and  lost  flesh,  and  suffered  from  amenorrhrea  and  dysmen- 
orrhoea.  Any  report  of  a  case  of  suicide  in  the  papers  would  in- 
crease this  feeling,  and  she  felt  that  she  must  read  the  full  details. 
She  made  several  futile  attempts  to  take  her  life  :  in  one  she  tied  a 
handkerchief  around  her  throat,  and  was  found  in  a  practically  un- 
conscious state  ;  at  another  time  she  swallowed  the  sulphur  from  some 
matches  which  she  had  made  into  a  solution.  In  none  of  her  various 
attempts  was  the  intent  truly  serious.  She  was  always  ready  after  the 
attack  to  take  any  remedy  which  might  relieve  her. 

This  patient  was  an  unusually  intelligent  person,  of  many 
accomplishments.  She  described  herself  as  never  free  from  this 
feeling,  whether  apparently  enjoying  herself  at  some  place  of 
amusement  or  alone  in  her  room. 

This  condition  is  quite  distinct  from  acute  melancholia 
with  delusions,  into  which,  however,  it  not  infrequently  passes, 
and  which  may  be  active  or  passive.  In  both  these  latter 
states  there  is  a  profound  depression ;  in  the  first,  however,  there 
is  an  inability  to  keep  quiet,  a  constant  desire  to  escape  from 
themselves  or  from  the  hallucinations  of  hearing  and  sight. 
The  second  form  seems  to  be  often  a  stage  on  the  way  to  mel- 
ancholia with  stupor  or  melancholia  attonita.  It  is  in  these 
latter  cases,  as  we  have  already  stated,  that  delusions  fixed 
in  character  are  at  the  base  of  all  their  actions.  Cataleptic 
states  are  not  uncommon  in  which  the  muscles  become  rigid 
and  remain  fixed  in  certain  positions  for  a  long  period.  Even 


MELANCHOLIA. 


221 


here,  however,  there  is  usually  consciousness  of  what  is  going 
on  around.  Patients  in  this  condition  will  frequently  accept 
food,  when  given,  without  opposition.  All  these  forms  of  mel- 
ancholia may  be  regarded,  however,  as  simply  phases  of  the 
same  condition. 

Chronic  melancholia  may  result  from  either  acuto  or 
ubacute  states ;  there  is  usually  some  more  or  less  tixed  delusions 
remaining,  but  it 
differs  from  the 
fixed  or  system- 
atized delusion 
found  in  para- 
noia. There  is 
no  attempt  to  un- 
derstand it  or  ex- 
plain it,  nor  any 
logical  process  of 
reasoning  c  o  n  - 
cerning  it.  The 
legal  relations  are 
often  difficult  in 
those  forms  unas- 
sociated  with  stu- 
por. It  is  often 
difficult  to  find 
either  a  motive 
or  the  presence  of 
a  delusion  to  ex- 
plain some  of  the 
acts  committed. 

Many  of  the  acts  are  sudden  and  unexpected,  but,  as  Casper 
has  stated,  careful  investigation  will  often  reveal  delusions. 
This  difficulty  is  increased  by  the  fact  that  at  times  delusions 
are  often  concealed. 

Letters  of  the  patient,  in  which  the  whole  mental 
has  been  defined,  are  frequently  of  great  importance. 

There  is  usually  a  premonitory  state,  which,  howev* 
passed  unobserved,  giving  the  act  the  character  of  suddenne* 
or  impulsiveness.     Casper  relates  the  case  of  one  Tayl 
had  always  had  the  reputation  of  being  a  loving  father  and  had 


Fio.  13.—  Melancholia.  8.  R,  male,  aet.  35,  tailor:  maternal 
uncle  Insane;  habits  temperate;  admitted  to  the  hospital  De- 
cember, 1892.  Patient  would  sit  in  one  position  all  day  and 
refused  to  answer  any  question.  Had  no  hulhicinatlons  or 
delusions  at  any  time.  Was  discharged  improved. 


222 


INSANITY— FISHER. 


never  been  suspected  of  being  insane  by  his  friends.  Having 
reverses,  he  killed  his  four  children  "  to  save  them  from  becom- 
ing a  public  charge."  He  made  a  confession  without  any  at- 
tempt at  a  defence  of  his  act.  Examination  showed  that  his 
grandmother  and  sister  had  been  insane;  the  latter  (having  a 
delusion  of  being  pregnant  by  the  Holy  Ghost)  had  also  mur- 
dered her  children. 

The  absence  of  all  motive  for  the  act,  or  repentance  or 
remorse,  or  attempts  at  concealment  or  escape,  is  strong  evi- 
dence, in  a  legal 
sense,  of  absence 
of  responsibility. 
P.  Max  Simon1 
says  that  impul- 
sive acts  are  es- 
pecially frequent 
in  those  melan- 
cholies who  shut 
themselves  up 
within  them- 
selves, remaining 
oblivious  to  all 
their  surround- 
ings. It  is  true 
that  very  often 
there  has  been  a 
long  struggle  be- 
tween the  impulse 
and  the  will,  and 
that  the  sudden- 
ness of  the  act  is 
only  the  final  vic- 
tory of  the  impulse  over  the  will,  in  a  long  but  silent  battle. 

He  relates  the  case  of  a  melancholic  who  had  apparently 
recovered,  who  suddenly  struck  his  wife  with  a  heavy  stone 
which  he  had  carefully  concealed,  killing  her  instantly.  He 
was  filled  with  remorse  but  said  that  for  a  week  past  he  had 
felt  the  desire  to  kill  some  one,  which  finally  overcame  all  his 
powers  of  resistance. 

1  "Crimes  et  Delets  dans  la  Folie." 


FIG.  14.— Melancholia.  A.  B.,  female,  set.  24,  duration  of 
disease  five  years.  On  admission  to  the  hospital  in  August, 
1893,  was  melancholic,  with  the  delusion  of  being  followed, 
and  also  that  she  had  been  poisoned ;  hallucinations  of  hear- 
ing. Patient  has  become  demented  and  childish,  but  has  not 
lost  her  delusions. 


MELANCHOLIA.  303 

This  goes  far  to  prove  that  these  acts  are  truly  morbid 
impulses  and  if  the  defence  of  insanity  is  pleadtxl  they  should 
only  be  put  forward  tis  symptoms  of  a  definite  psychosis. 

In  this  State  a  criminal  act  cannot  be  excused  upon  the 
theory  of  irresistible  impulse,  where  the  offender  knew  what  he 
was  doing  and  had  the  ability  to  discover  his  legal  and  moral 
duty  in  respect  to  it.  Again  the  mere  presence  of  a  delusion  is 
not  sufficient  to  establish  irresponsibility,  as  the  decision  in  the 
following  case  shows : 

Appeal  from  judgment1  of  the  Court  of  Oyer  and  Terminer  of 
Cayuga  County,  entered  upon  a  verdict  rendered  January  12th,  1999, 
convicting  defendant  of  the  crime  of  murder  in  the  first  degree. 

William  G.  Taylor,  the  defendant,  upon  a  conviction  for  burglary 
was  sentenced  to  Dannemora  prison  for  a  term  of  three  years,  which 
expired  in  the  summer  of  1888,  he  having  received  the  usual  commuta- 
tion for  good  behavior.  Very  soon  after  his  discharge,  and  in  the  same 
year,  he  was  returned  to  the  prison  to  serve  out  two  sentences  for 
burglary,  aggregating  alx>ut  eleven  years.  From  the  time  of  his  read- 
mission  his  conduct  was  exemplary  with  a  single  exception,  when,  on 
April  28th,  1890,  without  provocation  or  warning,  he  assaulted  his  keeper 
with  a  hatchet  and  felled  him  to  the  floor.  The  prison  physician  stated 
melancholia  (with  sucidal  and  homicidal  impulses).  On  September  29th, 
1890,  he  was  transferred  to  the  asylum  for  insane  criminals  at  Auburn. 
On  September  20th,  1891,  he  was,  as  "not  insane,  "returned  to  the  prison. 
The  medical  superintendent  of  the  asylum  stated  that  during  this  period 
he  was  sane,  while  his  assistant  was  of  the  opinion  that  during  all  the 
time  there  was  doubt  as  to  his  sanity.  From  the  readmission  his  record 
was  good.  He  had  friendly  relations  with  Salomon  Johnson,  the 
deceased,  a  fellow-convict,  but  in  the  month  of  April  he  exhibited, 
without  any  apparent  cause,  a  feeling  of  great  hostility  to  him,  and  dur- 
ing the  summer  he  frequently  threatened  to  kill  him.  On  September  19th, 

1892,  he  effected  a  reconciliation  with  the  deceased,  and  the  next  after- 
noon he  lured  him  into  a  shed  under  the  shop,  upon  the  pretense  that 
he  had  some  contraband  articles  to  show  him,  and  there  killed  him 
with  a  knife  which  he  had  concealed  upon  his  person.     Without  any 
emotion  he  confessed  his  deed,  stating  that  he  had  to  tlo  one  of  three 
things:  either  starve  to  death,  or  kill  the  deceased,  or  kill  himself,  and  he 
did  it  in  order  "to  l>e  electrocuted."     Until  his  trial,  on  January  10th, 

1893,  he  was  subject  to  medical  examination.     Three  physicians  stated 
melancholia  (with  homicidal,  respectively  homicidal  ami  suicidal  delu- 

1  Reports  of  cases  decided  in  the       People  r.  Taylor  (vol.  188,  p.  896), 
Court  of  Appeals  of  the  State  of  New      decided  June  6th,  1898. 
York  (by  H.  E.  Sickels) .     Albany. 


224  INSANITY — FISHER. 

sions),  five  physicians  declared  him  to  be  sane.  The  jury  found  him 
guilty.  He  was  sentenced  to  death. 

Maynard,  J. ,  said  : 

Proof  on  the  trial  of  an  indictment  for  murder  that  there  existed  in 
the  mind  of  the  defendant  an  insane  delusion  with  reference  to  the 
conduct  and  attitude  of  the  deceased  will  not  excuse  the  homicide, 
unless  the  delusion  was  of  such  a  character  that  if  it  had  been  true  it 
would  have  rendered  the  act  excusable  or  justifiable. 

Accordingly  held,  that  proof  upon  trial  of  such  an  indictment  of 
the  existence  of  a  delusion  in  the  mind  of  the  defendant  that  the  de- 
ceased was  acting  as  a  spy  upon  the  defendant  and  had  betrayed  a  plan 
of  escape,  did  not  affect  the  criminal  nature  of  the  act. 

Under  the  provision  of  the  Penal  Code  (§  21)  proof  of  partial  or 
incipient  insanity  is  not  sufficient  to  require  an  acquittal,  if  there  was 
still  the  ability  to  distinguish  between  right  and  wrong. 

Mania  is  a  condition  of  exaltation  which  affects  the  emo- 
tions and  the  intellect,  and  expresses  itself  by  increased  activity 
— mental  and  physical. 

There  are  two  forms  to  be  considered,  one  in  which  there  is 
mere  excitement  and  the  other  in  which  this  has  passed  on  to 
frenzy.  It  is  the  reversal  of  the  picture  of  melancholia ;  there  is 
a  rapid  succession  of  ideas,  and  never  a  fixed  idea. 

The  feeling  of  well-being  and  power  is  as  well-defined  in 
mania  as  the  sense  of  a  depression,  which  it  is  impossible  to  ex- 
plain or  throw  off,  is  in  melancholia.  We  have  to  do,  how- 
ever, with  an  entity  in  both  instances  distinct  from  the  depres- 
sion or  exaltation  which  may  accompany  other  well-recognized 
forms  of  mental  disease. 

Mania  rarely  commences  suddenly,  it  is  usually  preceded  for 
some  time  by  feelings  of  depression  or  irritability,  with  indiffer- 
ence to  the  usual  interests  of  daily  life. 

This  depression  soon  changes  to  one  of  exaltation  with  a 
resistless  impulse  to  activity  in  all  directions,  without,  however, 
persistence  in  any  one  thing.  The  attempt  to  restrain  the 
patient  provokes  opposition,  he  feels  satisfied  only  when  per- 
mitted to  talk  and  act  as  he  pleases.  Esquirol  defines  mania 
as  "  a  chronic  affection  of  the  brain,  ordinarily  without  fever, 
characterized  by  the  perturbation  and  exaltation  of  the  sensi- 
bility, the  intelligence,  and  will." 

Hallucinations,  illusions,  and  delusions  are  usually  pres- 
ent, the  patient  seems  to  have  lost  all  restraint  over  his 


MANIA.  22ft 

thoughts  and  actions.  He  appears  to  be  in  relation  with  an- 
other world,  entirely  apart  from  his  environment.  He  holds 
conversations  with  various  imaginary  persons.  His  delusions 
may  take  the  form  of  grandeur,  in  which  he  thinks  he  is  the 
greatest  athlete  or  pugilist  in  the  world,  or  that  he  possesses 
great  wealth,  or  again,  that  he  is  the  ruler  of  the  universe. 

If  the  feelings  go  in  the  direction  of  sexual  desire,  there 
may  be  evidence  of  marked  eroticism,  and  the  speech  may  be 
obscene.  This  is  frequently  seen  in  those  whose  whole  educa- 
tion has  been  directly  the  reverse. 

Combined  with  this,  delusions  of  a  religious  character  are 
often  present,  direct  commands  from  God  are  received,  and  a 
change  in  the  personality  may  take  place. 

There  is  often  the  appearance  of  being  under  the  special 
influence  of  some  delusion,  as  in  the  position  assumed  of 
listening  to  some  voice,  or  seeing  something  invisible  to  others 
(see  Fig.  15).  The  special  senses  are  especially  acute,  and 
general  sensibility,  as  shown  by  the  irritation  caused  by  the 
clothing  and  the  desire  to  remove  anything  that  might  cause 
restriction  of  the  movements.  The  intellect  seems  at  times 
peculiarly  active,  attention  is  fixed  for  the  time  intently  on 
the  object  before  it,  and  the  memory  of  details  is  sometimes  re- 
markable. There  is,  however,  a  real  loss  or  decrease  of  mental 
power.  The  judgment  is  weakened,  as  no  idea  remains  long 
enough  in  the  consciousness  to  become  fixed.  The  most  notable 
symptom  is  loss  of  control,  with  great  emotional  excitement. 

The  physical  condition  seems  to  be  an  index  of  the  mental. 
There  is  in  the  early  stages  an  appearance  of  vigor,  the  appetite 
may  be  excessive,  and  a  tendency  to  the  use  of  alcoholic  stimu- 
lants may  precipitate  the  attack,  while  not  being  an  etiological 
factor. 

Many  such  cases  bear  a  close  resemblance  to  alcoholic  mania, 
when  on  investigation  it  has  been  shown  that  the  mental  dis- 
turbance preceded  the  drinking. 

There  is  always,  however,  finally  a  failure  of  nutrition  with 
loss  of  flesh,  the  tongue  becomes  coated  and  the  bowels  are 
constipated.  The  pulse  may  be  somewhat  rapid,  but  frequently, 
even  during  great  excitement,  there  is  little  change,  it  often 
being  slow  and  small.  Insomnia  is  a  marked  symptom,  days 
passing  without  sleep  despite  the  ceaseless  activity. 


226 


INSANITY — FISHER. 


There  is  one  peculiarity  about  this  constant  activity,  in  that 
there  seems  to  be  no  sense  of  fatigue  accompanying  it.  There 
is,  in  fact,  apparently  a  cerebral  an&sthesia.  This  applies  also 
to  pain  perception,  as  exposure  to  cold  does  not  seem  to  be  rec- 
ognized, and  even  painful  operations  can  be  carried  on  without 
apparent  suffering.  Acts  of  self-mutilation,  which  are  espe- 
cially common  where  sexual  disturbance  is  associated  with  the 
mania,  are  often  done,  which  are  harrowing  in  the  extreme  and 
yet  are  not  appreciated  by  the  patient. 

In  one  case  under  observation  the  attempt  was  made  to  cut 
off  the  testicles ;  the  patient  in  describing  the  act  had  no  reali- 
zation that  it  was  painful.  The  absorbing  idea  at  the  time 
precluded  any  other  perceptions  entering  into  his  conscious- 
ness. 

The  special  forms  are  acute  and  chronic.  In  the  former 
we  may  have  actual  frenzy,  corresponding  to  the  so-called 
raving  madness.  In  such  cases  there  is  complete  mental  con- 
fusion, all  knowledge  of  time  and  place  is  lost,  no  attention  is 
given  to  what  is  going  on  around,  one  delusion  follows  after 

another,  the  patient  being  in 
a  state  of  muttering  delirium. 
Such  conditions  are  common 
in  acute  fevers,  but  the  pres- 
ence of  a  high  temperature 
differentiates  them.  There  is 
great  exhaustion,  probably 
due  largely  to  the  loss  of 
sleep  (see  Fig.  15). 

In  chronic  mania  there  is 
generally  present  some  more 
or  less  fixed  delusion,  as  the 
result  of  the  previous  delu- 
sional state.  The  patient  may 
consider  himself  a  king  or  a 
great  general.  There  is  never, 
however,  any  attempt  to 
prove  the  truth  of  this  belief ; 
it  is  satisfactory  to  him  to  make  the  assertion.  There  is  no  in- 
congruence  in  the  fact  that  he  is  in  an  asylum  or  dressed 
poorly.  These  patients  are  very  excitable  at  times ;  it  is  purely 


FIG.  15. — -Mania,  Acute.  There  is  evidence 
here  of  considerable  excitement,  and  an  hal- 
lucination of  hearing,  as  shown  by  the  atti- 
tude of  apparent  listening. 


MANIA. 


227 


an  emotional  state,  however,  which  is  easily  aroused  by  some 
trivial  irritation  and  usually  as  quickly  subsides;  there  ia  apt  to 
be  a  quick  response 
by  a  blow  or  a  tor- 
rent of  abuse.  (See 
Fig.  16.) 

These  patients 
are  great  letter- 
writers,  the  prod- 
uct being  a  con- 
fused, incoherent 
mass  of  material, 
every  passing 
thought  being  re- 
corded. There  may 
be  a  tendency  to 
write  rhymes. 
There  is  almost 
always  associated 
with  this  condition 
a  generally  happy- 
go-lucky  state  of 
mind.  There  is  in 
fact  more  or  less  dementia,  the  state  toward  which  all  cases 
tend  which  do  not  end  in  recovery. 

The  following  poem  and  letter  taken  from  hundreds  written 
by  the  same  patient  show  very  clearly  the  mental  condition  re- 
ferred to : 


Fio.  16.— Chronic  Mania.— Hallucinations  of  Sight  Fe- 
male, a»t.  34.  married,  addicted  to  alcohol  and  morphine; 
has  delusions  of  being  followed  by  strange  peopla  who  wish 
to  kill  her.  Is  passing  into  stage  of  dementia. 


LINES  ON  THE  WRECK  OF  THE  BRITISH  MAN-OF-WAR  "THE  SER- 
PENT"— ON  THE  COAST  OF  SPAIN  ON  Nov.  12TH.  1890— A.D. 

O  Spain  of  Royal  fame  ; 

What  occured  on  the  main. 

Or  Has  the  serpent  and  all  his  fangs  ; 

Left  the  ocean  on  thy  land  he  sprang 

Or  is  thy  monarch  in  his  bibbs  so  short 

Thy  shores  invaded  for  war  or  extort — 

Thy  infantile  sway  both  night  and  day 

To  thy  Savour  ever,  ever  pray 

To  be  saved  from  such  a  fate 

As  befall  the  serpaut  of  late 


228  INSANITY — FISHER. 

Her  Britanic  majesty  a  monarch  pure 
Would  not  envy  thee  in  thy  craddle  sure — 
For  in  the  days  eer  mans  estate 
O'Donnell  Ruled  thy  dominion  to  date — 
Thy  Royal  Mother  Queen  Christina 
To  Queen  Victoria  sends  a  line— 
With  greetings  from  Her  monarch  son. 
Hail  Queen  Victoria  my  day  will  come 
When  in  kingly  state  I'll  not  write  on  slate 
But  in  languarge  thy  mariner  I'll  berate — 
Thy  sailors  Joyous,  marines,  and  Jackets  Blue — 
In  Neptunes  embrace  all  are  strew. 
In  numbers  a  hundred  and  seventy  three 
All  are  prisoners,  and  three  are  free — 
God  in  His  power  that  rules  the  weeve 
Defend  the  defenseless,  and  bless  the  brave 
Many  are  the  weeping  eyes  on  english  Shores 
Bereft  of  fathers  laid  in  their  Watery  gore — 
Lunatic  Asylum  Wards  Island 

U.  S.  America  16th  Nov  1890,  A.D. 
Count  The  O'Haughey  X  O.  P. 

Lord  and  Poet  to 

Queen  Victoria — By  Pope  Leo  XIII. 
Alfonso  XIII.    The  CPHaughey  XIIII. 

Ward's  Island,  State  and  City  of  New  York,  and  U.  S.  of  America — 

January  16  1891,  An.  Dom. 

I  am  The  O'Haughey  to  P.  D.  D.  M.  D.  M.  America,  late  Sergeant 
and  Hereditary  chief  of  the  Royal  Irish  Constabulary  Ireland  36238  a 
Knight  of  the  Garter  and  Commander  of  the  Bath  and  Hereditary 
Knight  of  St.  Patrick  Erin.  Under  all  these  circumstance  I  want 
Prince  Thomas  to  bear  all  these  titles  each  and  every  one  them  legally 
and  constitutionally.  I  now  put  them  in  a  row,  so  that  they  may  not 
be  confounded  by  the  illiterate  or  inexperienced — or  not  know  how  to 
fix  these  titles  or  show  the  respect  due  to  the  wearer —  : 

O.  P.  D.  D.  M.  D.  F.  L.  R.  C.  Q.  C.  V.  C.  S.  L.  B.  A.  &c.,  &c.— 
Sergeant  at  law  and  attorney  General — and  K.  C.  B.  and  Knight  of 
St  Patrick  and  Hereditary  Prince  of  the  Universe  by  the  Roman 
Pontiff — and  by  the  special  direction  of  the  Blessed.  Virgin — and  now  I 
am  The  O'Haughey  chief  of  R.  I.  C. 

"Are  you  there  Moriarty." 

We  have  excluded  from  our  description  of  mania  a  condi- 
tion called  delirium  grave,  or  delirious  mania,  as  it  represents 
an  entirely  different  disease  both  in  its  clinical  and  pathological 


MANIA. 

aspects.  In  our  classification  it  is  placed  under  the  head  of 
organic  insanities  with  definite  pathological  changes.  Clinically 
also  it  is  distinct,  generally  running  an  acute  course  with  a 
high  temperature  of  103-105°,  and,  as  a  rule,  ending  fatally  from 
exhaustion  in  five  or  six  days  (see  Fig.  17). 

We  also  do  not  include  here  the  special  manias,  associated 
with  epilepsy,  alcohol,  the  menstrual  periods,  etc.,  as  their 
description  belongs  more  properly  to  those  special  diseases. 

Criminal  acts  are  rarely  committed  in  mania;  the  general 


Fio.  17.— Chronic  Mania.  T.  O.  H.,  »t.  30,  single,  no  hereditary  history:  admitted  to 
hospital  October.  1800.  Had  delusions  that  he  was  married  spiritually  to  the  queen  of 
Heaven.  Says  that  sh«  appears  to  him  and  speaks  to  him  by  signs,  never  In  word*.  Says 
also  that  he  is  the  Poet  Laureate  of  England,  and  a  count  by  Pope  Leo  XIII..  etc.,  etc. 
Patient  frequently  asks  whether  any  telegram  has  come  from  his  royal  highne«  for 
him.  This  case  presents  all  the  characteristics  of  chronic  mania,  e.g.,  the  loquacious- 
ness and  tendency  to  letter-writing  and  to  poetry;  his  condition  has  remained  practically 
unchanged  for  five  years.  There  is  an  expression  of  self-satisfaction  in  his  face,  depend- 
ent  upon  the  absolute  belief  In  his  claims  to  royalty. 

disturbance  of  the  intellect  renders  it  impossible  to  carry  out  or 
form  any  plans.  During  the  paroxysm  of  delirium  to  which 
the  patient  is  sometimes  exposed,  there  may  be  as  a  consequence 
acts  of  violence  and  destruction  committed.  In  such  cases  the 
knowledge  of  the  facts  is  sufficient  for  the  appreciation  of  their 
character. 


230  INSANITY— FISHER. 

STTJPOROTJS  INSANITY  OR  PRIMARY  DEMENTIA. 

It  consists  in  an  almost  complete  loss  of  all  mental  action. 

There  may  be  hallucinations  and  delusion  of  sight  and  hear- 
ing. The  patient  appears  to  be  under  the  influence  of  some 
overmastering  spell.  No  notice  is  taken  of  the  surroundings; 
there  is  no  appreciation  of  the  wants  of  nature ;  hunger  or  cold 
is  not  felt.  One  position  may  be  taken  and  maintained  for 
hours.  A  cataleptic  state  is  not  uncommon. 

While  the  attitude  seems  to  be  that  of  despair  or  melancholia 
to  a  certain  degree,  it  represents  more  fully  a  condition  of 
absolute  loss  of  all  mental  action.  New  perceptions  certainly 
do  not  take  place,  and  no  thought  goes  on.  However,  at  times, 
from  the  movement  of  the  lips  and  the  muttering,  old  memories 
are  apparently  revived.  Rarely  is  there  any  recollection  of  them 
after  recovery. 

The  physical  state  corresponds  to  the  mental,  the  tempera- 
ture is  lowered,  the  pulse  is  feeble,  the  skin  dry  and  cold,  the 
pupils  are  dilated,  loss  of  flesh  is  constant.  It  is  essentially  a 
condition  of  asthenia.  The  causes  of  this  disease  are  those  of 
an  exhausting  character,  as  loss  of  blood  from  any  cause  as 
during  childbirth  or  shock  consequent  to  an  operation  or  in- 
jury. Fevers  of  an  exhausting  nature  with  high  temperature 
may  result  in  it.  Mental  anxiety  and  worry  may  cause  it.  I 
have  observed  a  number  of  cases  among  immigrants  to  this 
country.  Finding  themselves  among  new  surroundings,  with- 
out friends  or  means  of  support,  confused  by  the  strangeness  of 
the  customs,  or  perhaps  by  a  strange  language,  they  sink  into  a 
condition  of  almost  complete  dementia.  The  onset  appears  sud- 
den, although  as  a  rule  the  cause  has  been  at  work  for  a  long 
period.  Masturbation  in  a  person  weakened  by  various  other 
causes  or  of  a  neurotic  disposition  may  be  the  exciting  cause. 

Heredity  otherwise  does  not  seem  to  be  a  direct  agency  in 
itsjproduction. 

Direct  injury  causing  concussion  of  the  brain  may  result  in 
a  traumatic  psychosis,  sometimes  called  traumatic  hystero- 
neurasthenia.  There  seems  to  be  an  interference  with  the  func- 
tional activity  of  the  brain,  an  inability  to  think  or  act,  a  feel- 
ing of  great  fatigue  on  attempting  to  do  anything.  There  may 
be  great  stupor  with  loss  of  personality. 


SECONDARY    DEMENTIA. 


231 


The  prognosis  in  these  cases  is  usually  favorable.  Of  late 
years  many  such  instances  have  been  brought  before  the  courts, 
the  question  of  simulation  or  exaggeration  of  the  symptoms 
being  a  difficult  one  to  settle. 

In  the  criminal  procedure  these  cases  do  not  often  appear, 
but  are  more  frequent  where  the  question  of  civil  responsibility 
arises.  Shock  from  fright,  some  sudden  and  unexpected  loss, 
has  been  known  to  cause  complete  dementia  accompanied  by 
stupor.  The  condition  may  continue  for  weeks  or  months,  or 
may  even  pass  into  secondary  dementia. 

Secondary  dementia  is  the  form  which  generally  pre- 
sents itself  to  us.  It  is  the  final  result  in  all  cases  of  insanity 
which  do  not  progress  toward  recovery  (see  Fig.  18). 

In  the  various  forms  which  we  have  so  far  considered  it 
is    not    unusual, 
about 


cent 


forty    per 
passing  on 


to  this  state. 

Complete  de- 
mentia would 
imply  an  absence 
of  all  thought, 
and  while  this  is 
not  the  rule,  we 
notice  a  decided 
loss  of  mental 
power.  There  is 
usually  a  substra- 
tum of  the  delu- 
sions which  have 
been  present  in 
the  acute  condi- 
tions, which  have 
become  more  or 
less  fixed  and 
permanent.  The 
melancholic  still 

possesses  the  feeling  of  being  a  great  sinner.     He  may  still  bt» 
constant  in  prayer,  although  hopeless  of  pardon.     An  egotism, 
which  centres  everything  around  his  own  personality,  is  al- 
III.— 17 


Fio.  18.— Secondary  Dementia  following  Mania.    1 
53,  female,  widow;  duration  of  dlwaw  1ft  >•«•»«.     On  adml«- 
slon  wan  inclined  to  »>«  ugly  nnd  nlwtinatr.  ami  liad  dflimlon* 
of  wealth  and  nelf-importanw.    Present  condition,  dementia; 
ipiiet  and  r.iri'ly  p|xmks. 


232 


INSANITY — FISHER. 


ways  observed.  With  the  gradual,  or  at  times  rapid,  dementia, 
the  identity  becomes  lost,  the  idea  of  time  and  place  becomes 
confused,  the  relations  of  his  previous  life  become  vague  and 

indistinct  to  his 
memory;  he 
speaks  of  his  chil- 
dren or  wife  as  if 
he  were  relating 
some  instance 
concerning  a 
stranger. 

The  maniacal 
patient  contin- 
ues with  his  hal- 
lucinations and 
delusions,  which 
are  always  of  an 
expansive  char- 
acter. He  speaks 
of  being  a  rich 
man,  or  a  great 
general,  or  God 
himself,  with  a 
certain  pleasure, 
evident  in  his  ex- 
pression that  he 
All  idea  of  time  and 
Responsibility  is  ab- 


Fio.  19. — Secondary  Dementia  following  Acute  Melancholia. 
E.  M.,  female,  aet.  40;  duration  of  disease  12  years.  On  ad- 
mission was  depressed,  remaining  in  one  position,  indifferent 
to  her  surroundings.  At  times  is  violent  and  has  delusions 
of  being  the  daughter  of  Queen  Elizabeth. 


is  able  to  talk  and  think  so  rapidly, 
place  is  likewise  sooner  or  later  lost. 
sent,  reckless  disregard  of  consequences  is  evident;  the  lan- 
guage is  often  profane  and  obscene.  The  actions  are  restless 
and  apparently  unceasing,  but  aimless.  All  acts  are  impulsive ; 
it  is  impossible  to  think  of  motive  or  premeditation  in  the  true 
sense.  Affection  or  regard  for  family  or  friends  is  lost,  and  the 
ordinary  observances  in  manners  are  forgotten.  These  patients 
when  examined  are  apt  to  exaggerate  all  their  vagaries,  giving 
loose  rein  to  their  actions  and  thoughts. 

Unless  there  is  complete  dementia,  the  character  of  the  ex- 
isting delusions  defines  the  nature  of  the  preceding  disease  (see 
Fig.  19). 

While  these  cases  may  remain  for  }Tears  under  observation, 


SECONDARY   DEMENTIA.  233 

and  while  there  may  be  changes  in  their  mental  power,  they 
have  still  in  the  main  the  same  class  of  delusions  in  the  end  as 
in  the  beginning. 

It  is  so  in  cases  which  relapse  after  recovery.  The  new  seiz- 
ure is  frequently  but  a  repetition  of  the  previous  hallucinations 
or  delusions.  We  do  not  find  on  our  records  that  the  patient 
has  been  admitted  at  one  time  as  melancholic,  at  another  as 
maniacal. 

The  condition  known  as  alternate  or  circular  insanity  is  an 
exception  to  these  remarks.  The  peculiar  fixed  and  permanent 
delusions  which  may  manifest  themselves  in  a  changed  person- 
ality, as  in  the  belief  of  being  a  general  or  king,  may  be  shown 
by  the  attempt  at  decoration  with  medals  or  ribbons.  While 
claiming  to  be  such  great  personages  they  feel  no  incongruity 
in  their  existing  surroundings.  There  is  no  desire  or  attempt 
to  explain  or  logically  to  support  their  delusion,  as  seen  in  the 
following  case. 

A.  B.,  aet  62,  became  melancholic  and  possessed  with  the  delusion 
of  persecution,  fearing  that  he  was  to  be  shot.  He  applied  to  the  police 
for  protection  and  was  sent  to  the  asylum.  His  dementia  progressed 
rapidly ;  he  was  unable  to  state  where  he  was  or  where  he  had  formerly 
lived.  He  later  had  a  delusion  that  his  friends,  to  compensate  him  for 
his  suffering  and  persecution,  had  raised  $100,000,000  for  him,  and  that 
it  was  subject  to  his  draft  at  any  time.  He  could  not  be  reasoned  out 
of  this  belief.  His  plans  of  using  the  money  were  in  consonance  with 
his  previous  religious  delusions  of  self-condemnation,  as  he  intended 
to  give  it  to  the  churches. 

Such  delusions  differ  entirely  from  the  systematized  delu- 
sions observed  in  the  class  of  monomaniacs  or  paranoia.  In 
these  there  is  always  a  logical  train  of  reasoning  ever  ready 
for  the  defence  of  their  opinion.  The  emotional  states  are 
rarely  so  marked.  Excitement  may  indeed  be  extreme  if  there 
is  opposition  to  the  carrying  out  of  the  plans — otherwise  not. 
The  same  may  be  said  in  regard  to  depression :  this  is  rarely  so 
extreme  as  to  manifest  itself  by  marked  melancholia  with  com- 
plete loss  of  all  interest  in  external  matters.  There  may  be 
indeed  suicidal  intent,  but  then  again  it  is  the  result  of  a  proc- 
ess of  reasoning  never  present  in  melancholia  or  in  tho  dementia 
following  it,  with  permanent  delusions  of  a  depressive  charac- 
ter. There  is  almost  invariably  the  history  of  hereditary  or 


234  INSANITY — FISHER. 

acquired  disease  in  those  with  the  systematized  logical  delusions 
of  paranoia.  A  good  example  of  secondary  dementia  in  melan- 
cholia is  seen  in  the  following  instance : 

C.  D.,  merchant,  set.  51,  family  history  negative.  Patient  has  been 
a  very  active  business  man,  and  has  amassed  a  fortune.  He  has,  how- 
ever, been  addicted  to  excess  in  the  use  of  liquor,  and  in  his  sexual 
relation.  In  the  past  year  he  has  had  severe  domestic  trouble,  which 
has  caused  much  loss  of  sleep  and  anxiety.  He  resorted  to  liquor  to 
drown  his  sorrows.  One  year  and  a  half  ago  had  a  severe  attack  of 
delirium  tremens,  from  which  he  recovered,  but  has  never  since  been 
able  to  carry  on  his  business  with  the  same  vigor  or  efficiency  as  pre- 
viously. His  judgment  became  unreliable  and  his  memory  defective. 

Two  months  previously,  after  considerable  mental  worry  and  some 
excess  in  alcohol,  he  became  depressed  and  filled  with  hallucinations,  in 
which  he  saw  a  two-headed  monster  which  attempted  to  kill  him ;  also 
the  porters  and  servants  in  the  hotel  appeared  to  him  as  threatening  to 
do  him  harm.  Patient  would  hold  imaginary  conversation  with  them. 
He  became  sleepless  and  refused  all  food,  fearing  that  he  would  be 
poisoned.  He  interpreted  all  these  terrors  as  a  punishment  and  conse- 
quence of  his  previous  life.  He  had  no  religious  delusions  of  any  kind. 
The  depression  increased,  accompanied  at  times  with  violence  in  his 
attempts  to  escape  from  his  surroundings.  He  gradually  passed  into 
a  state  of  dementia,  which  became  almost  complete,  the  patient  for- 
getting the  day  of  the  week,  the  place  in  which  he  was,  or  any  knowl- 
edge of  his  business  affairs.  All  anxiety  disappeared.  He  would  eat  any- 
thing placed  before  him  ;  seemed  to  have  entirely  lost  all  idea  of  the 
proprieties ;  would  urinate  at  any  time  and  place,  as  the  desire  prompted 
him. 

The  question  from  a  legal  point  of  view  in  this  instance  arose  only 
as  to  his  capability  to  enter  into  a  business  contract  or  to  make  a  will. 
When  aroused  the  force  of  habit  made  his  conversation  and  actions 
apparently  rational  for  a  short  period  of  time.  Any  attempt  to  state 
what  his  property  consisted  of,  and  to  whom  it  should  go,  led  to  com- 
plete mental  confusion.  It  was  plain  that  the  requirements  of  a  dis- 
posing mind,  as  hi  the  making  of  a  will,  were  absent.  Here  also  the 
question  of  undue  influences  would  probably  arise. 

Secondary  dementia  may  be  of  two  varieties,  i.e.,  associated 
with  agitation  or  with  apathy. 

The  first  form  is  more  commonly  the  result  in  mania. 

Here  we  find  almost  ceaseless  activity,  a  marked  tendency 
to  destruction  of  anything  which  comes  into  their  hands. 
There  is  no  motive  present,  but  an  aimless,  objectless  activity. 
Anything  attracts  their  attention  for  the  time,  bright  colors, 


SECONDARY    DEMENTIA. 

music,  etc.,  but  there  is  never  any  concentration  on  it  for  anv 
length  of  time.  There  is  no  real  joy  or  sorrow.  All  serious 
relationship  with  the  outer  world  is  lost.  There  is  usually 
marked  loquaciousness,  a  constant  talking  concerning  innumer- 
able subjects,  a  change  from  moment  to  moment  in  the  emo- 
tional field  from  pleasure  to  anger,  an  almost  constant  obsti- 
nacy to  do  as  they  please.  Various  hallucinations  and  delu- 
sions are  present,  as  evinced  by  the  expression  of  cunning  or 
slyness  or  of  self-importance  shown  in  the  face.  Yet  with  all 
this  activity  there  is  complete  loss  of  any  appreciation  of  their 
circumstances.  There  is  little  feeling  or  regard  for  their  near- 
est relations,  a  visit  from  whom  causes  but  a  transient  evidence 
of  pleasure.  Their  acts  are  all  impulsive. 

They  are  subject  to  excesses  of  maniacal  excitement,  when 
their  mental  powers  seem  to  be  revived,  their  delusions  becom- 
ing more  exact,  and  their  acts  more  purposive.  These  conditions 
are  simply  flashes  from  the  pan,  the  tendency  being  toward 
relapses  into  more  complete  states  of  dementia.  A  final 
characteristic  symptom  is  the  disappearance  of  all  the  former 
hallucinations  and  delusions,  or  at  least  the  absence  of  any  influ- 
ence on  the  individual  when  present.  They  lead  to  no  act  on 
their  part;  there  is  no  pressure  to  carry  out  any  plan  as  the 
result  of  their  feelings  and  thoughts.  A  condition  of  partial 
dementia  may  exist  for  years  without  apparently  progressing 
to  the  final  stage,  although  its  terminal  stage  is  sure  to  follow. 

The  recognition  of  this  state  of  dementia  is  at  times  difficult 
when  the  previous  history  is  unknown.  The  continued  obser- 
vation, however,  of  increasing  intellectual  weakness,  decreas- 
ing emotional  powers,  increased  loss  of  appreciation  of  the  ordi- 
nary relations  of  life,  and  responsibility  or  care  for  any  of  its 
interests,  with  neglect  of  all  the  ethical  and  social  considera- 
tions, indicate  without  question  the  final  state  of  complete 
loss  of  mental  activity,  i.e.,  dementia  (Krafft-Ebing). 

The  description  just  given  applies  most  truly  to  mania,  but 
is  not  infrequently  observed  in  melancholia. 

Feelings  of  mental  anxiety,  unexplainable  even  by  the 
patient  himself,  are  apt  to  recur  in  the  dementia  of  melan- 
cholia; in  fact,  a  recurrence  of  the  early  stages  is  more  common 
in  all  respects  than  in  mania.  Wo  observe,  therefore,  a  rest- 
lessness, a  ceaseless  attempt  to  escape  from  the  unbearable  men- 


230  INSANITY — FISHER. 

tal  state.  This  may  take  the  form  of  violence  of  a  homicidal 
character,  or,  again,  be  suicidal  in  its  nature. 

There  is  rarely  any  plan  in  these  acts,  the  motive  is  a  gen- 
eral one  rather  than  a  specific  one,  and  at  no  time  is  there  in 
any  sense  a  conspiracy.  It  is  rare,  indeed,  that  in  insanity 
there  is  any  combination  for  carrying  out  a  design,  except 
perhaps  in  paranoia,  and  even  in  these  instances  it  is  rare. 
The  absence  of  real  motive  or  of  the  attempt  to  conceal  or  es- 
cape from  the  consequences  of  the  act,  while  not  positive  evi- 
dence in  a  legal  sense  of  the  irresponsibility  of  the  individual, 
necessarily  has  great  weight  in  disproving  criminality.  Doubt 
can  only  arise  where  the  dementia  is  but  partial. 

The  question  of  the  knowledge  of  right  and  wrong  in  regard 
to  the  particular  act  committed  is  the  only  practical  test  which 
the  law  can  make;  the  further  question  whether  the  person  was 
able  to  control  his  acts  is  of  importance  only  in  so  far  as  it  can 
be  established  by  evidence  that  all  knowledge  of  right  and 
wrong  was  absent  or  lost  at  the  time  the  act  was  committed. 

This  does  not  involve  at  all  the  question  of  moral  or  impul- 
sive insanit)r;  for  in  these  cases  the  acts  are  never  impulsive, 
except  in  so  far  as  they  are  random  and  purposeless,  or  a  gen- 
eral result  of  the  mental  confusion  induced  by  some  oppressive 
influences  driving  the  individual  to  attempt  to  escape  from  it, 
as  in  melancholia,  or  as  in  mania  induced  by  the  continuous 
weakened  mental  activity  of  a  purposeless  nature,  which  even 
to  the  patient  himself  often  appears  as  an  abnormal,  unnatural 
condition.  This  is  seen  in  the  often  gradual  loss  of  identity, 
the  life  and  experience  of  the  past  seeming  to  belong  not  to 
themselves  but  to  another  individual. 

This  condition  differentiates  itself  from  the  remissions  of 
either  melancholia  or  mania  by  the  fact  that  the  intelligence  in 
the  latter  is  restored  during  these  so-called  lucid  intervals, 
while  behind  all  the  evidence  of  the  disturbances  of  the  emo- 
tions and  the  presence  of  the  hallucinations  in  dementia  is  seen 
the  defect  of  the  intellect.  All  attempts  at  judgment  or  opinion 
or  reasonable  action  are  impossible.  No  business  can  be  carried 
on,  no  plan  formed. 

Dementia  with  apathy  is  more  commonly  the  result  in 
melancholia  than  mania.  We  frequently  find  at  the  basis  of 
this  profound  interference  with  all  mental  activity  a  fixed  perma- 


HALLUCINATORY    MAMA  037 

nent  delusion  which  controls  and  dominates  the  individual, 
preventing  the  entrance  of  any  outside  or  new  perceptions 
into  consciousness.  It  is  as  if  some  cerebral  compression  was 
present,  which  if  removed  would  permit  the  mind  again  to  take 
up  its  functions.  This  idea  is  supported  by  the  fact  that  in 
some  rare  instances,  even  after  years  of  absolute  passivity,  dur- 
ing which  the  patient  has  apparently  been  unconscious  cf  pass- 
ing  events,  of  time  or  locality,  after  some  sudden  shock,  as  an 
acute  illness,  i.e.,  pneumonia,  or  again  without  any  apparent 
cause  there  is  a  return  of  the  mental  powers.  In  many  such  cases 
there  is  a  more  or  less  complete  knowledge  of  the  past  events. 

There  is  this  to  be  noted,  that  the  depression,  the  condition 
of  mental  or  psychical  pain,  is  no  longer  of  such  an  acute  char- 
acter. There  is  that  condition  previously  referred  to,  as  if 
all  the  events  through  which  they  pass  were  occurring  to  a 
third  person.  There  is  here  also  often  the  tendency  for  a  stay 
in  the  progress  of  the  dementia.  However,  the  final  stage  is 
the  same  in  all,  interrupted  as  it  may  be  by  seizures  of  acute 
depression  and  anxiety — complete  abolition  of  mind  results  if 
life  is  prolonged.  The  physical  appearance  corresponds  to 
the  mental.  The  vegetative  processes  are  impaired.  With 
the  absence  of  active  mental  processes  there  is  frequently  a  ten- 
dency to  obesity,  the  face  appears  vacuous,  differing  from  the 
characteristic  expression  of  worry,  with  the  lines  of  care  on  the 
forehead  so  generally  present  in  the  agitated  form.  There 
seems  to  be  complete  muscular  relaxation ;  the  patient  falls  into 
an  inert  mass;  the  position  is  one  of  flexion;  the  chin  sinks  on 
the  chest;  the  saliva  flows  unnoticed  from  the  mouth. 

As  has  been,  said,  with  "  the  loss  of  all  mental  action  they 
appear  as  animals  after  the  removal  of  the  brain,  and  in  fact 
the  cortex  of  the  brain  has  lost  its  function."  They  no  longer 
appreciate  danger,  hunger  is  absent,  requiring  the  necessity  of 
feeding  them,  and  in  fact  looking  after  all  their  wants.  There 
may  be  indeed  a  true  amnesic  aphasia.  Death  results  from  a 
general  defect  of  bodily  nutrition ;  and  intercurrent  diseases,  88 
pneumonia,  are  common. 

Hallucinatory  mania  (Mendel),  delusional  stupor  (New- 
ington),  or  hallucinatorischer  Wahnsinn  is  an  acute  mental  dis- 
turbance, the  characteristic  condition  of  which  is  the  hallucina- 
tions and  illusions  of  all  the  special  senses.  As  a  result  there 


238  INSANITY  — FISHER. 

is  a  complete  loss  of  identity  and  of  time  and  place,  a  mental 
confusion  almost  approaching  acute  dementia. 

There  are  no  delusions  in  the  proper  sense  of  the  term.  It 
is  essentially  a  disease  consequent  upon  exhaustion.  Therefore 
any  cause,  as  exhausting  fevers,  inanition,  overwork,  alcoholic 
excesses,  sexual  excesses,  the  puerperal  period,  loss  of  blood, 
etc.,  may  be  the  provoking  agent.  These  are  all  accentuated 
in  those  hereditarily  affected  or  of  a  neuropathic  disposition. 
However,  a  distinction  should  be  made  between  this  disease 
and  the  acute  forms  of  paranoia.  Maschka,  in  my  opinion, 
confounds  what  he  terms  primary  paranoia,  a  primary  psy- 
cho-pathological state,  with  this  disease.  If  we  hold  fast  to  the 
idea,  as  will  be  discussed  later,  that  all  forms  of  paranoia  are 
due  to  degenerative  conditions,  either  inherited  or  acquired, 
we  can  separate  without  difficulty  the  two  forms  of  insanity. 
Acute  conditions  may  arise  in  paranoia,  but  when  they  subside 
we  still  have  left  the  original  defective  mental  condition ;  while 
in  hallucinatory  mania,  if  that  is  recovered  from,  the  patient 
returns  to  his  normal  mental  soundness.  It  is  essentially  a 
disease,  therefore,  involving  the  affective  or  emotional  element 
of  the  mind,  and  only  secondarily  the  intellectual.  Reason  and 
judgment  are  for  the  time  absolutely  in  abeyance,  simply  be- 
cause the  numberless  new  and  erroneous  perceptions  do  not 
allow  of  any  proper  conception  of  them  to  take  place,  or,  again, 
may  crowd  out  former  perceptions.  The  mental  confusion  may 
be  increased  by  the  attempt  on  the  part  of  the  patient  to  recon- 
cile the  new  and  the  old  perceptions. 

The  course  of  the  disease  may  be  rapid,  lasting  but  a  few 
weeks  or  months,  and  ending  in  recovery.  Other  cases  pass  on 
to  complete  dementia. 

The  division  of  mental  disturbance  falling  under  the  head 
of  degeneration  is  one  of  the  most  important  which  comes  to 
the  attention  of  the  jurist  and  physician. 

It  is,  as  we  have  said,  a  disease  of  the  brain  without  well- 
defined  pathological  changes,  but  in  which  the  element  of 
heredity  with  all  its  attendant  predispositions  is  the  most  im- 
portant factor. 

Into  this  question  to-day  comes  the  discussion  of  many  of 
the  social  conditions  of  our  generation.  The  criminal,  the 
anarchist,  and  socialist,  all  have  their  defenders  as  irresponsi- 


PSYCHICAL   DEGENERATION.  239 

bles  in  relation  to  the  crimes  which  they  may  commit.  Per- 
haps no  more  important  psychological  considerations  in  their 
bearing  on  legal  relations  exist  in  the  whole  domain  of  insanity 
than  in  this  class.  It  has  been  said  that  general  paralysis  is 
the  distinctive  disease  which  the  exigencies  of  modern  life  have 
developed;  and  while  this  is  true  to  some  extent,  it  is  equally 
certain  that  the  development  of  the  wealth  of  the  world,  to  so 
great  a  degree  by  modern  scientific  discoveries,  the  possibilities 
of  the  individual  in  sudden  acquisition,  together  with  the  free 
discussion  of  all  possible  subjects  of  thought  in  the  religious 
and  philosophical  fields,  without  the  usual  limits  of  control 
formerly  allowed  to  the  Church  and  established  schools,  have 
developed  an  egotism  and  idea  of  self-importance  which  espe- 
cially manifest  themselves  in  the  congenitally  defective  classes. 
This  would  probably  have  been  held  in  check  under  strong  cen- 
tral control,  but  the  spirit  of  equality  and  frequently  license 
thus  evoked  in  the  weak,  and  especially  the  ignorant,  has  devel- 
oped one  of  the  characteristic  symptoms  of  insanity  as  a  whole 
— that  is,  concentration  on  the  individual,  or  egotism.  In  our 
classification  we  have  called  this  affective  insanity,  that  is, 
a  form  in  which  the  feelings  and  emotions  are  chiefly  involved. 
We  have  to  do  with  the  desires,  therefore,  with  the  ethical  side 
of  human  nature,  and  hence  the  whole  field  of  the  social  and 
moral  relations  of  the  individual  to  his  surroundings  is  in  ques- 
tion. The  judgment,  the  reason,  is  not  so  much  affected  ab- 
stractly; the  mind  as  a  reason  ing  organ  is  often  but  slightly  im- 
paired ;  actually  it  is  so  far  affected  in  that  the  emotional  state 
exerts  such  a  control  over  the  intellect  that  it  no  longer  is  free 
to  use  its  powers,  and  as  a  result  we  find  more  or  less  impair- 
ment of  the  will  in  all  these  cases. 

The  degrees  of  loss  of  free-will  is  the  question  for  the 
jury  to  decide;  the  fact  that  it  is  impaired  is  for  the  expert  to 
establish. 

We  find  that  the  etiological  factors  are  especially  of  an 
hereditary  character.  Either  in  the  parents  or  in  collateral 
branches  of  the  family  there  were  insanity,  nervous  diseases  as 
epilepsy,  chorea,  hysteria,  etc.,  or  not  uncommonly  alcoholism, 
tuberculosis,  etc.  Again,  during  early  life  various  deleterious 
causes  may  have  been  active  in  impairing  the  nervous  system,  as 
rachitis,  which  may  have  interfered  with  the  development  of  the 


240  INSANITY — FISHER. 

skull  and  secondarily  the  brain ;  or,  again,  acute  diseases,  as  men- 
ingitis or  encephalitis  or  the  various  acute  exanthematous 
fevers,  as  scarlet  fever  or  measles.  In  such  cases  we  often  find 
evidence  in  the  body  of  defective  organization,  as  in  various 
as}Tnimetries  of  the  head.  The  ears  may  show  evidence  of 
irregularit3T,  the  eyes  be  placed  too  widely  apart,  the  forehead 
be  markedly  receding,  the  palate  high.  We  are  now  approach- 
ing indeed  a  class  of  degenerates  which  belong  to  the  so-called 
borderland  of  insanity.  There  is  evidence  from  the  previous 
history  of  their  departure  from  the  normal  type,  but  often  in- 
sufficient proof  of  irresponsibility. 

There  is  no  definite  pathological  condition  which  we  can 
properly  say  belongs  to  it,  except  perhaps  in  those  cases  where 
we  have  evidence  of  injury  to  the  brain  structure  from  inflam- 
matory disease,  mal-development,  or  traumatism.  And  these 
instances  are  largely  in  the  minority,  and  when  excessive  carry 
our  case  to  the  class  of  idiots  or  imbeciles  in  which  we  have 
predominant  ethical  defects  or  primary  moral  weakness.  We 
can  and  should  in  these  cases  recognize  the  actual  intellectual 
impairment  which  prevents  the  individual  from  controlling  the 
natural  desires  common  to  the  brute  creation. 

Krafft-Ebing  has  classified  the  physical  and  psychical  evi- 
dence of  this  diseased  condition  as  follows : 

A  quick  reaction  to  all  influences,  whether  atmospheric  or 
those  of  disease;  special  inclination  to  various  functional  dis- 
turbances of  the  nervous  system  as  convulsion,  the  various  neu- 
roses, etc. ,  at  the  periods  of  development  and  decline  (dentition, 
puberty,  menstruation,  climacteric  period). 

There  may  be  a  very  early  development  of  puberty  and  a 
mental  precocity  with  slight  bodily  development.  The  sensory 
and  motor  fields  show  disturbances  by  hyperaBsthesia,  anes- 
thesia, paralysis  of  a  functional  type,  spasmodic  contractions  as 
chorea,  epilepsy,  or  epileptic  seizures.  The  sexual  organs  are 
either  functionally  abnormally  active  or  the  reverse,  leading 
to  masturbation  and  sexual  excesses  of  various  kinds. 

Similar  mental  disturbances  of  a  functional  character  are 
present.  Especially  noticeable  is  the  tendency,  on  slight  provo- 
cation, to  conditions  of  depression  and  excitement,  which  pass 
beyond  the  normal  expression  of  pleasure  or  joy.  Physiologi- 
cally all  are  subject  to  emotional  states  of  depression  and  exalta- 


REASONING   INSANITY.  241 

tion.  Women  at  the  menstrual  periods  and  during  pregnancy 
or  lactation,  and  males  are  likewise  subject  to  these  periodical 
changes.  At  such  times  there  is  especially  marked  and  noticed 
the  ability  to  undertake  a  great  amount  of  work,  at  other  times 
there  is  (in  both  sexes)  a  condition  almost  of  stupor  and  mental 
torpor.  Among  this  diseased  class,  however,  there  seems  to  be 
no  middle  ground.  In  the  exalted  period  there  is  a  constant 
ceaseless  activity  in  which  often  impulses  of  almost  an  "  imper- 
ative" nature  are  present.  The  opposite  condition  of  depression 
is  characterized  by  equally  intense  mental  pain  and  impulses 
to  suicide,  or  a  great  fear  of  becoming  insane.  A  special 
group  of  this  form  of  disease  is  that  class  where  the  ethical 
part  of  their  nature  seems  absolutely  absent.  Feelings  of  pity, 
right,  honor,  ordinary  courtesy  and  consideration  apparently 
do  not  enter  into  their  minds. 

The  imagination  is  active,  hallucinations  are  common,  and 
there  is  especially  noticeable  the  rapidity  of  their  association  of 
ideas.  In  art  and  science  they  may  show  themselves  as  inven- 
tive, but  the  mental  process  is  intuitive  rather  than  logical, 
and  is  rarely  persistently  followed  out.  There  is  constant  pres- 
sure, often  impulsive,  to  acts  eccentric  and  bizarre. 

Morel  has  described  them  as  acting  by  instinct  rather 
than  reason. 

There  is  a  contradiction  in  their  character — apparently  great 
mental  power,  even  genius,  with  inability  to  get  along  in  life ; 
they  are  the  victims  of  grand  schemes  constantly  formulating 
themselves  without  definiteness,  and  an  inability  to  reproduce 
them  accurately.  They  represent  often  our  class  of  reformers, 
religious  and  political,  and  go  to  make  up,  as  we  have  said,  a 
large  proportion  of  our  leaders  in  social  reform. 

The  physical  bearing,  the  manner  of  dressing,  the  egotism 
often  indicate  the  mental  condition.  This  mental  state  may 
remain  unchanged  for  years;  the  predisposition,  however,  on 
slight  provocation  to  insanity  is  self-evident.  Unfortunate 
financial  condition,  family  loss,  domestic  trouble,  failure  to 
obtain  political  preferment,  ill  health,  and  excesses,  venereal 
and  alcoholic,  may  be  the  exciting  cause. 

Among  the  first  of  the  various  subdivisions  of  this  class 
of  the  insane  that  we  shall  consider  is  reasoning  insanity ,  or 
folie  raisonnante. 


242  INSANITY — FISHER. 

It  may  assume  the  maniacal  form  or  the  melancholic,  but 
more  frequently  the  latter.  Their  acts  imply  a  controlling  in- 
terest, forcing  them,  despite  their  knowledge  of  the  character  of 
the  act  and  its  consequences,  and  often  their  fear  of  committing 
it,  to  do  it.  There  is  usually  an  absence  of  hallucinations  or 
delusions. 

Griesinger  defines  the  depressive  form  as  hypochondriacal 
melancholia,  the  French  authorities  as  folie  raisonnante  me- 
lancolique  (Tuke).  In  these  cases,  however,  there  is  a  distinct 
difference  from  melancholia,  either  in  the  acute  or  in  the 
chronic  form.  The  depression  is  more  of  an  emotional  charac- 
ter, and  rarely  gives  the  impression  of  delusions,  which,  as  we 
have  said,  are  usually  absent.  Again,  the  condition,  which  is 
generally  constant,  so  that  the  patient  feels  its  presence  whether 
at  a  place  of  amusement  or  alone,  is  not  always  as  intense  but 
occurs  paroxysmally  or  even  periodically,  as  during  menstrua- 
tion. It  differs,  again,  however,  from  so-called  periodical 
insanity,  although  closely  allied  to  it,  especially  in  its  etiolog- 
ical  and  pathological  relations.  Both  occur  in  hereditary  dis- 
ease, but  the  latter  has  a  more  typical  course  either  of  mania  or 
melancholia,  during  which  the  intellectual  faculties  are  affected. 

We  have  thus  under  this  head  reasoning  mania,  reason- 
ing melancholia,  reasoning  monomania,  for  it  seems  proper 
to  include  here  all  those  forms  of  mental  disorder  characterized 
by  desires,  often  obscure  and  impulsive  to  a  certain  extent, 
which  manifest  themselves  in  acts  often  cruel,  indecent,  or  fool- 
ish. The  individual  understands  what  he  is  doing  and  the 
true  relation  of  the  act,  in  its  social  and  legal  aspect.  He, 
however,  prefers  the  consequences  to  the  restless,  unhappy  state 
of  mind  which  exists,  until  he  has  carried  out  his  desire.  This 
mental  state  must  be  recognized  as  a  pathological  entity,  and 
belongs  to  the  legal  aspect  of  the  question  of  insanity  fully  as 
much  as  to  the  medical ;  in  fact  more  so,  as  it  rarely  comes  under 
consideration  except  in  so  far  as  the  acts  committed  offend 
against  the  law.  It  is  usually  in  regard  to  criminal  procedure 
that  we  meet  it. 

"  These  terms  are  given  to  each  particular  form  of  insanity : 
mania,  melancholia,  monomania,  respectively,  when  still  ac- 
companied by  reasoning  power,  though  the  ordinary  mental 
symptoms  are  evident "  (Tuke). 


MORAL  INSANITY.  243 

Moral  insanity  is  simply  a  division  of  the  form  just  de- 
scribed. We  have  to  do  with  mental  defect  especially  charac- 
terized by  the  absence  of  the  ethical  side  of  man's  nature.  This 
was  the  last  attribute  to  man's  mental  structure  which  we  re- 
ferred to  in  describing  the  process  of  development  of  the  mind. 
In  these  oases,  therefore,  we  find  loss  of  the  ordinary  feelings 
of  love  toward  family  or  mankind  in  general.  Ideas  of  honor, 
truth,  sacrifice  or  regard  for  others  are  absent.  Desire  is  the 
only  motive  for  all  their  acts ;  when  therefore  unrestrained  by 
fear  of  punishment  or  by  some  power  greater  than  their  own, 
there  is  no  limit  to  the  cruelty  or  evil  of  their  acts.  This  is  not 
infrequently  seen  in  the  great  tyrants  of  history,  as  Commodus 
and  Nero,  types  of  degeneratives  so  common  during  the  degen- 
erative periods  of  Roman  history  and  which  illustrate  this 
point.  Our  criminal  classes  belong  to  this  same  order. 

Investigation  has  shown  that  the  hereditary  taint  has  been 
carried  down  for  generations  with  the  same  tendency  to  crime 
as  other  forms  of  mental  disease.  There  is,  indeed,  intellectual 
defect,  although  not  necessarily  manifested  in  the  ordinary 
processes  of  thought.  It  is  observed  rather  in  the  lack  of  idea 
of  consequence,  the  apparent  disregard  for  those  things  which 
are  by  most  men  held  as  valuable,  i.e.,  respect,  position,  even 
wealth,  if  as  its  accompaniment  any  restrictions  are  added. 
This  form  of  insanity  is  not  infrequently  associated  with  sexual 
excesses  in  which  there  may  be  perversion,  the  pain  inflicted 
being  the  means  of  producing  venereal  excitement. 

Definition  of  Moral  Insanity. — A  disorder  which  affects 
the  feelings  and  affections,  or  what  are  termed  the  moral 
powers,  in  contradistinction  to  those  of  the  understanding  or 
intellect  (Pritchard).  The  diagnosis  depends  largely  on  the 
previous  history  of  the  individual.  The  fact  that  one  from 
several  children  under  the  same  moral  teaching  and  restraint 
has  always  shown  a  tendency  to  be  obstinate  and  unruly,  has 
been  beyond  control,  and  has  developed  tendencies  to  excesses 
of  all  kinds,  often  indeed  of  a  petty  nature,  as  thieving,  drunk- 
enness, etc.,  is  strong  evidence  of  congenital  defect. 

There  is  alu'ays  some  difficulty  in  distinguishing  such 
cases  from  those  which  merely  represent  depravity,  and  in 
which  punishment  and  discipline  are  salutary.  This  is  illus- 
trated again  and  again  in  our  reformatories.  The  former  class 


244  INSANITY — FISHER. 

are  incapable  of  being  reached  by  any  influence ;  training,  edu- 
cation, religion  making  no  change  in  them.  They  show  no  ap- 
preciation of  kindness  or  regret  for  their  acts,  which  they  may 
be  cunning  and  skilful  in  concealing  or  planning. 

The  depraved,  from  lack  of  proper  surroundings  and  educa- 
tion, will  usually  benefit  by  these  systems.  Delusions  are  usu- 
ally absent,  but  I  have  observed  in  a  number  of  cases  delusions 
of  persecution ;  nor  is  it  to  be  forgotten  that  the  so-called  psy- 
choses, as  melancholia  and  mania,  may  affect  these  defective 
persons,  running  their  usual  course,  leaving  them  perhaps  more 
demented  but  with  the  same  tendencies  as  before.  The  condi- 
tion is  essentially  an  incurable  one.  Its  degree  is  the  only  point 
of  interest  as  affecting  the  question  of  responsibility.  The  fol- 
lowing case  illustrates  it  very  well : 

A.  B.,  aet.  26,  male;  parents  healthy;  one  brother  very  musical,  in- 
terested in  nothing  else  ;  very  nervous ;  one  sister  very  similar  in  her 
disposition  and  also  very  musical.  The  patient  was  always  unruly, 
would  play  with  the  roughs  of  the  neighborhood  and  frequented 
saloons;  was  never  a  good  scholar,  but  was  good  at  figures  and  could 
keep  accounts  well .  At  the  age  of  17  was  arrested  for  maliciously  robbing 
a  grocery  shop.  There  was  never  at  any  time  any  need  of  his  stealing, 
as  he  had  a  good  home.  Was  sent  to  a  reformatory,  where  he  remained 
for  some  time,  and  showed  the  same  disregard  for  discipline  and  was 
constantly  guilty  of  mischievous  acts.  He  was  then  transferred  to  the 
asylum  at  Auburn  for  insane  criminals.  On  his  release  he  resumed  his 
former  habits  of  living,  associating  with  criminals  and  drinking  to 
excess.  He  passed  some  months  in  an  insane  asylum  again.  He  now 
has  delusions  of  persecution  ;  hears  voices  calling  him  opprobrious 
names.  Is  unable  to  escape  from  this  mental  state  and  at  times  becomes 
violent  in  his  effort  to  free  himself  from  his  supposed  oppressors. 

Impulsive  Insanity.— Under  this  head  we  are  dealing 
with  similar  mental  states  as  those  previously  described.  The 
mental  condition  is  not  difficult  to  recognize  as  the  act  defines 
it.  The  question  of  civil  and  criminal  responsibility  is  not  so 
easy.  We  are  on  the  borderland  of  sanity.  Here  again  care- 
ful investigation  will  usually  show  that  hereditary  influences 
are  of  the  greatest  importance  in  aiding  us  in  the  diagnosis. 

In  all  forms  of  insanity,  especially,  however,  where  we  have 
exaltation  or  excitement,  there  is  a  tendency  toward  impulsive 
acts;  even  in  melancholia  this  is  observed.  This  is,  however, 
due  to  the  loss  of  control,  induced  by  the  generally  impaired 


IMPULSIVE  INSANITY.  245 

intellectual  state.  There  is,  however,  in  impulsive  insanity  an 
irresistible  impulse  to  the  act,  a  feeling  that  the  act  must  be 
carried  out  in  order  to  satisfy  some  unexplained  motive  within 
the  individual,  and  which  no  fear  of  consequences  can  prevent 
his  carrying  out.  This  is  illustrated  by  the  case  of  a  school 
teacher  to  whom  reference  has  already  been  made. 

A.  B.,  aet.  45,  early  in  life,  at  the  age  of  puberty,  showed  signs 
of  sexual  perversion,  in  that  he  yielded  to  an  impulse  to  expose  his 
genital  organs  to  young  girls.  The  consequences  of  this  act  were 
fully  appreciated  by  him,  he  was  ashamed  of  it  immediately.  He  had 
always  shown  great  aptitude  in  his  studies,  graduated  from  a  univer- 
sity in  Germany,  and  had  good  opportunities  for  advancement  in 
life,  from  his  social  position  and  friends.  Again  guilty  of  a  like 
offence  against  society,  he  escaped  to  England,  where  his  acknowledged 
ability  as  a  teacher  soon  procured  him  a  good  position. 

After  procuring,  however,  a  comfortable  position,  the  anxiety  for 
his  livelihood  being  relieved,  the  same  impulse  seized  him,  and  despite 
his  knowledge  of  the  necessary  results  to  follow  and  the  disappoint- 
ment to  those  friends  who  had  aided  him,  he  was  again  guilty  of  a 
similar  offence.  Coming  to  this  country,  he  was  again  successful  in 
securing  occupation,  and  gained  the  respect  of  all  with  whom  he  came 
in  contact,  who  never  suspected  him  of  his  mental  disorder.  After  be- 
coming thoroughly  established  in  his  position,  and,  as  he  said,  all  strain 
and  anxiety  being  removed,  the  same  impulse  presented  itself.  He 
strove  by  all  means  possible  to  overcome  it.  Ordinary  sexual  inter- 
course gave  him  no  relief,  nor  was  the  same  pleasure  experienced.  He 
was  guilty  again  of  exposing  himself  in  a  public  place  to  little  girls. 

The  patient,  when  I  saw  him  soon  after  the  committal  of  another 
offence,  was  perfectly  cognizant  of  the  extent  of  his  crime  against 
order,  bewailed  his  condition,  and  threatened  suicide.  He  presented 
the  appearance  of  an  educated,  refined  gentleman,  and  yet  said  that  if 
he  knew  he  was  to  have  been  killed  the  next  moment  he  could  not 
have  prevented  himself  from  committing  the  act. 

Here  we  have  the  full  reasoning  power  of  the  individual  intact,  a 
full  knowledge  of  the  consequences  understood,  and  the  necessary  pre- 
cautions of  escape  taken.  The  only  element  absent  for  constituting  the 
act  that  of  a  responsible  being  is  the  motive.  In  this  last  every  motive 
for  not  doing  it,  existed.  Desire  alone,  and  that  certainly  a  morbid  one, 
is  the  only  explanation  of  the  act. 

While  in  a  medical  sense  this  is  a  sufficiently  explanatory 
reason  for  ascribing  the  cas«.  to  the  field  of  disease,  in  the  eye 
of  the  law  we  cannot  recommend  for  the  best  good  of  the  com- 
munity that  such  persons  should  be  held  as  irresponsible.  They 


246  INSANITY — FISHER. 

do  not  belong  to  the  borderland  cases  of  insanity.  The  condition 
is  purely  a  pathological  one,  still  punishment  should  be  meted 
out  to  them  in  order  to  conserve  the  best  interests  of  society, 
where  the  few  must  suffer  for  the  good  of  the  many.  Physi- 
cians should  take  this  view  of  the  matter  and  thus  aid  the  law 
in  coming  to  some  modified  ruling  in  regard  to  punishment  for 
such  crimes  against  decency  and  order. 

"  In  the  normal  condition  every  sensation  tends  to  translate 
itself  into  an  action,  but  this  tendency  is  restrained  by  the  ego 
which  intervenes,  perceives  the  sensation,  analyzes  it,  and 
finally  decides  for  or  against  the  accomplishment  of  the  act. 
The  equilibrium  between  the  tendency  to  the  act  and  the  re- 
straining power  of  the  ego  (determinism)  constitutes  the  normal 
condition  in  this  point  of  view.  The  impulse  results  from  a 
rupture  of  this  equilibrium. 

"  The  equilibrium  being  lost,  either  by  weakness  of  the  ego  or 
by  both  together,  it  follows  that  the  impulse  may  be  the  conse- 
quence of  one  or  other  of  these  conditions,  hence  it  occurs  in 
those  forms  of  alienation  in  which  it  is  observed.  Practically 
it  is  especially  in  the  emotional  neurasthenic,  the  degenerative 
conditions,  imbecility,  dementia  (enfeeblement  of  the  ego), 
acute  mania,  hallucinatory  insanities,  and,  finally,  in  epilepsy 
(mixed  state) ,  that  we  meet  with  impulsions. 

"Impulsions  may  be  divided  into  besetting  impulsions 
(obsessions)  and  reflex  impulses  (impulsions  properly  so-called), 
according  as  they  act  with  or  without  resistance  on  the  part  of 
the  individual.  They  may  also  be  divided  into  intellectual, 
emotional,  or  motor  impulses,  according  to  the  sphere 
affected. 

"  Motor  impulsions,  which  are  those  generally  referred  to  in 
the  clinic  when  we  speak  of  impulsions,  are  further  desig- 
nated by  the  morbid  acts  to  which  they  give  rise.  Thus  we 
speak  of  impulsion  to  theft  (kleptomania),  to  incendiarism 
(pyromania),  to  drink  (dipsomania),  to  murder,  suicide,  etc. 
At  one  time  there  was  a  tendency  to  consider  each  form  of  im- 
pulsion as  an  insanity,  a  special  monomania;  nowadays  that  is 
completely  abandoned,  and  it  is  generally  admitted  that  morbid 
impulse  is  only  a  symptomatic  element  of  insanity  that  may 
occur  under  different  characters  in  widely  different  conditions. " 
— E.  Regis,  "  Practical  Manual  of  Mental  Medicine." 


IMPULSIVE   INSANITY.  ^47 

I  have  quoted  this  author  at  large,  as  he  truly  represents  the 
present  status  of  opinion  in  regard  to  all  those  forms  of  mental 
disturbance  which  formerly  were  classified  as  distinct  forms  of 
insanity.  They  are,  as  shown  in  our  classification,  simply 
symptoms  of  an  insane  state,  coming  under  the  head  of  the 
degenerative  type,  in  which  the  emotional,  rather  than  the 
intellectual,  field  is  involved.  The  law  can  only  recognize  them 
in  so  far  as  they  correspond  to  the  generally  accepted  rulings  in 
regard  to  civil  and  criminal  responsibility.  The  practice  of  the 
courts  in  England  and  in  this  country,  following  the  trial  of 
McNaughton  in  1843,  has  been  that  every  man  is  presumed  to 
be  sane  and  to  possess  a  sufficient  degree  of  reason  to  be  respon- 
sible for  his  acts,  unless  it  can  be  clearl}'  proved  that  at  the 
time  of  committing  the  act  the  accused  was  laboring  under 
such  a  defect  of  reason  from  disease  of  the  mind  as  not  to  know 
the  nature  and  quality  of  the  act  he  was  doing,  or  if  he  did 
know  it,  that  he  did  not  know  that  he  was  doing  wrong. 

Under  these  rules,  which  may  be  taken  as  outlining  the  law 
on  this  subject  in  a  large  number  of  the  United  States,  the 
defence  of  irresistible  impulse  to  do  what  is  known  to  be  morally 
wrong  and  what  is  legally  a  crime  cannot  be  set  up;  for  if  the 
accused  was  conscious  that  the  act  was  one  which  he  ought  not 
to  do,  and  if  that  act  was  at  the  same  time  contrary  to  the  law 
of  the  land,  it  is  punishable. 

This  denial  of  the  right  of  a  person  who  knows  the  wrong- 
fulness  of  an  act  to  set  up  as  a  defence  that  he  was  under  an 
insane  and  irresistible  impulse  to  do  it,  has  given  rise  to  bitter 
denunciation  of  the  law  by  medical  writers  who  are  practically 
agreed  that  such  a  condition  of  the  mind  may,  and  not  infre- 
quently does,  exist,  and  who  maintain  that  a  person  in  such  a 
condition  is  as  helpless  to  refrain  from  his  act  and  as  irresponsible 
for  it  as  is  a  person  who  commits  a  crime  under  irresistible  physi- 
cal compulsion.  Acting  upon  the  assumed  truth  of  this  proposi- 
tion, the  courts  of  Scotland  and  those  of  a  number  of  the  United 
States  have  recognized  this  as  a  defence  in  criminal  actions.1 

All  forms  of  crime  may  be  committed  under  the  influence  of 
irresistible  impulse — homicide,  suicide,  arson,  theft,  and  various 
acts  indicative  of  sexual  perversion. 

1  F.  8.  Allen,  u  Insanity  before  the  Law. "    Johnson's  "  Universal  Cyclo- 
paedia," vol.  iv.     New  York,  1894. 
III.— 18 


248  ^INSANITY— PISHEB; 

We  may  have  also  melancholia  or  mania  associated  with 
this  condition,  and  more  rarely  delusions  and  hallucinations. 
It  is,  however,  not  in  these  latter  conditions  that  we  should 
consider  this  disease  as  an  entity.  In  fact,  the  only  safe  course 
is  to  follow  the  dictum  of  the  law  in  this  respect,  which  virtu- 
ally says  that  irresistible  impulse  is  no  defence  unless  a  symp- 
tom of  insanity.1  In  the  case  of  Flanagan  v.  People,2  Mark 
Flanagan  was  indicted  for  murder  in  the  first  degree,  for  killing 
his  wife.  The  defence  was  insanity.  Judge  Andrews  says : 

"  We  are  asked  in  this  case  to  introduce  a  new  element  into 
the  rule  of  criminal  responsibility  in  cases  of  alleged  insanity, 
and  to  hold  that  the  power  of  choosing  right  from  wrong  is  as 
essential  to  legal  responsibility  as  the  capacity  of  distinguish- 
ing between  them,  and  that  the  absence  of  the  former  is  con- 
sistent with  the  presence  of  the  latter. 

"  The  argument  proceeds  upon  the  theory  that  there  is  a  form 
of  insanity  in  which  the  faculties  are  so  disordered  and  de- 
ranged that  a  man,  though  he  perceives  the  moral  quality  of 
his  acts,  is  unable  to  control  them,  and  is  urged  by  some  mys- 
terious pressure  to  the  commission  of  acts,  the  consequences  of 
which  he  anticipates  but  cannot  avoid. 

"  Whatever  medical  or  scientific  authority  there  may  be  for 
this  view,  it  has  not  been  accepted  by  courts  of  law." 

In  the  case  of  People  v.  Walworth *  the  same  point  of  issue 
came  up  before  Judge  Davis. 

The  defendant,  Frank  H.  Walworth,  was  indicted  June  9th, 
1873,  in  the  court  of  Oyer  and  Terminer  for  the  killing  of  his 
father. 

The  evidence  showed  that  the  father  had  been  estranged 
from  the  defendant  as  well  as  all  his  family  for  some  years. 
The  defendant  in  an  altercation  shot  his  father,  but  asserted  that 
he  had  no  intention  of  killing  him.  Judge  Davis  gave  the 
following  opinion : 

"  If  it  be  satisfactorily  shown  that  the  accused  at  the  time  of 
committing  the  act  had  not  the  capacity  to  understand  what  he 
was  doing  and  know  the  consequences  of  his  act,  and  know  that 
it  was  wrong,  then  he  is  excused.  But  if  he  had  capacity  suf- 

1  People  v.  Coleman  (I. ,  p.  1) ,  Oyer      Court  of  Appeals  of  the  State  of  New 
and  Terminer  N.  Y.  County,  Dec.,       York  (vol.  52,  p.  469). 

1881.     Davis,  J.  3  New  York  Criminal  Reports,  vol. 

2  Reports  of  cases  decided  in  the      iv.,  p.  355. 


IMPULSIVE   INSANITY.  249 

ficient  to  know  the  legal  and  moral  character  of  the  act  he  was 
doing,  the  fact  that  he  alleges  that  he  had  not  the  control  of  his 
will  in  respect  to  it,  but  that  his  will  was  controlled  by  irresis- 
tible impulses,  is  no  defence." 

The  jury  found  the  prisoner  guilty  of  murder  in  the  second 


Simon  defines  an  irresistible  impulse  as  consisting  of  an 
imperative  necessity  which  the  patient  cannot  overcome  and 
which  leads  him  to  commit  some  act,  as  homicide,  suicide, 
arson,  or  theft. 

There  may  be  physical  signs  of  this  condition  at  the  time  of 
the  act,  as  marked  headache,  flushing  of  the  face,  palpitation 
of  the  heart,  etc.  All  these  symptoms  often  disappear  when 
the  desire  is  yielded  to.  There  may  have  been  a  long  and  pro- 
tracted struggle  to  overcome  this  impulse.  Often,  indeed,  the 
patient  may  confess  his  fear  of  doing  some  violent  act.  The 
writer  reports  the  following  case :  A  lady  who  had  married  a 
widower  with  one  child  by  his  first  wife  had  always  shown 
great  affection  for  the  child.  One  day  she  was  surprised  in  the 
act  of  choking  the  child.  She  had  shown  some  time  previous 
to  this,  signs  of  depression  and  preoccupation.  Later  she  had 
similar  attacks  of  violence,  both  suicidal  and  homicidal.  She 
ultimately  completely  recovered.  This  author  places  the  victim 
of  irresistible  impulse  especially  among  cases  of  mania,  melan- 
cholia, hysteria,  alcoholism,  and  epilepsy.  These  conditions 
are,  however,  different  from  the  form  under  consideration,  in 
which  the  impulse  stands  out  as  the  principal  and  often  the 
only  symptom  of  insanity.  I  would  make  an  exception  in  epi- 
lepsy, for  in  this  disease  we  find  very  frequently  this  condition ; 
in  fact,  on  investigation  we  may  find  that  we  are  dealing  with 
epileptic  insanity,  as  shown  in  the  following  case  reported  by 
Simon :  A  young  quarryman  had  set  fire  to  thirteen  quarries, 
barns,  and  buildings.  The  multiplicity  of  the  crimes,  the  iden- 
tity of  the  circumstances  attending  their  accomplishment,  and 
the  doubt  of  the  existence  of  a  motive  led  the  authorities  to  ask 
for  an  examination  of  the  mental  condition  of  the  accused  by 
Tardieu  and  Lase'gue.  They  declared  the  accused  impulsive 
and  irresponsible  and  recommended  his  commitment  to  an  asy- 
lum. An  epileptic  seizure  soon  after  explained  unmistakably 
the  cause  and  nature  of  his  impulses. 


250  INSANITY — FISHER. 

Homicidal  impulse,  homicidal  mania,  or  monomania  are 
terms  which  have  long  been  employed,  so  that  they  appear  to 
represent  distinct  forms  of  insanity. 

The  subject  has,  however,  been  pretty  well  threshed  out  in 
the  past  century.  Such  writers  as  Pinel,  Esquirol,  Clouston, 
and  Bevan  Lewis,  while  not  agreeing  in  all  particulars,  have 
established,  that  we  have  to  do  with  a  symptom  which  not  only 
belongs  essentially  to  the  degenerative  form  of  insanity,  espe- 
cially of  the  hereditary  type,  but  also  to  the  acquired  form. 

We  have  indeed  in  all  forms  of  insanity  tendencies  to  im- 
pulsive acts  either  homicidal  or  suicidal,  as  in  mania,  melan- 
cholia, alcoholism,  general  paresis,  etc. ;  but  these  are  not  con- 
sidered under  this  heading.  In  this  class  the  cardinal  symptom 
is  a  strong,  at  times  irresistible,  impulse  to  homicide.  This 
may  be  struggled  against  and  at  last  yielded  to,  as  in  the  in- 
stance of  impulses  referred  to  previously  in  other  relations. 
There  is  to  be  observed  here  also  the  feeling  of  satisfaction 
after  the  completion  of  the  act.  The  condition  is  often  preceded 
by  physical  excitement  resembling  the  aura  in  epilepsy.  In 
fact,  among  epileptics  we  find  during  the  interparoxysmal 
periods  tendencies  to  impulsive  acts. 

These  cases  are  unattended  by  hallucinations  or  delusions 
and  must  be  separated  from  this  class,  no  motive  being  present. 
The  manner  in  which  the  act  is  carried  out  does  not  indicate  a 
motive,  even  though  great  care  in  all  details  is  observed  and 
careful  plans  of  escape  from  the  consequences  are  laid.  It  is 
not  infrequent  that  the  individual  will  calmly  deliver  himself 
up  to  the  authorities,  confessing  without  emotion  the  act  com- 
mitted. Again  there  may  be  great  remorse  for  the  act.  Such 
acts  differ  from  those  due  to  the  fixed  ideas  of  melancholiacs 
who  commit  homicide,  as  in  these  cases  the  motive,  while  a 
false  one,  based  often  on  delusion,  is  apparent. 

Definition  of  Homicidal  Insanity. — A  fair  statement  of 
this  character  of  impulse  is  given  by  Tuke  "as  a  syndrome 
directly  connected  with  hereditary  moral  degeneration,  and 
essentially  characterized  by  the  desire  to  murder,  without  any 
intellectual  disorder  or  passion,  and  necessarily  requiring  as 
concomitant  mental  conditions  persistence  of  consciousness, 
anxious  struggle  against  the  besetting  impulse,  and  lastly,  in 
case  the  act  is  committed,  subsequent  moral  depression." 


HOMICIDAL   IMPULSE.  251 

The  existence  of  such  a  condition  cannot  be  denied;  the  phy- 
sician is  often  the  confidant  of  such  fears  of  his  patient.  A 
woman,  of  bad  hereditary  tendency,  would  come  to  me  and  cry 
and  bemoan  the  feeling  which  possessed  her,  that  she  would 
kill  her  husband  and  her  child.  This  idea  was  always  with 
her,  but  would  come  on  especially  at  times  almost  parox- 
ysmally,  during  which  periods  her  face  would  become  flushed 
and  she  experienced  a  general  feeling  of  congestion. 

This  element  of  mental  disease  should  be  acknowledged  by 
our  courts,  although  it  necessarily  requires  great  care  in  its  ac- 
ceptance when .  set  up  as  a  defence  for  criminal  acts.  Clouston 
records  a  letter  of  a  patient  of  his,  which  explains  well  this  com- 
plete possession  of  the  person  by  a  fixed  idea: 

"Mv  DEAR  SIR: — According  to  promise,  I  have  written  to  the  beet 
of  my  ability  what  I  feel  mentally.  God  alone  knows  my  feelings. 
They  are  truly  awful  to  know.  I  lived  in  continual  fear  of  doing 
harm  each  day.  I  had  not  a  moment's  peace  in  this  world."  (The 
patient  was  a  physician  and  continues :)  "I  was  afraid,  when  applying 
nitrate  of  silver  to  the  throat  of  my  patients,  that  I  would  push  it  down. 
.  .  .  When  I  sat  down  at  my  own  table  I  used  to  have  horrible  im- 
pulses to  cut  my  children's  throats  with  the  carving  knife,"  etc.,  etc. 

Such  accounts  could  be  multiplied  almost  indefinitely  in  the 
experience  of  any  alienist.  We  find  no  evidence  of  intellectual 
defect,  the  memory  and  judgment  are  not  impaired  except  in 
regard  to  this  fixed  idea.  As  one  patient  said :  "  I  must  be 
mad,  and  yet  I  can  do  everything  as  I  used  to.  I  can  read  and 
talk,  and  yet  I  feel  as  if  I  was  not  myself." 

Regis  sums  up  the  matter  very  well  as  follows:  "The  im- 
pulsion to  homicide  proceeds  in  an  identical  manner  by  inter- 
mittent and  paroxysmal  crises,  preceded  by  melancholic  prodro- 
mata.  The  patients  are  beset  with  the  fixed  idea  of  killing  this 
or  that  person — for  example,  a  child  they  adore.  The  sight  of 
that  child,  of  a  weapon,  a  knife,  arouses  their  obsession  and 
plunges  them  into  inexpressible  torment.  They  realize  that 
their  will  is  bending,  that  they  are  yielding  to  the  impulse,  and, 
filled  with  horror,  they  lament,  flee  from  home,  ask  aid  and 
protection  of  physicians,  not  hesitating  in  some  cases  to  have 
themselves  locked  up  in  order  to  escape  from  their  morbid  pen- 
chant." 

There  is  little  doubt  that  in  many  cases  suicide  is  committed 


252  INSANITY— FISHER. 

from  fear  of  committing  homicide.  This  dread  may  be  concealed 
for  years  from  others,  and  probably  the  cause  of  certain  mysteri- 
ous, unexplained  suicides  can  be  ascribed  to  this  morbid  mental 
condition. 

Suicide  and  Insanity. — This  occurs  in  various  forms  of 
insanity,  especially,  however,  in  melancholia.  It  is,  however, 
not  infrequent  in  mania,  epileptic  insanity,  general  paresis, 
alcoholism,  etc.  The  idea  that  suicide  always  indicates  insanity 
is  erroneous ;  that  a  large  number  are  insane  is  not  to  be  doubted, 
but  the  act  alone  cannot  be  accepted  as  a  sign;  the  motive 
must  always  be  sought  for,  and  if  sufficient  cause,  as  loss  of 
property  or  fear  of  disgrace,  is  discovered,  the  common  plea 
of  temporary  insanity  under  these  circumstances  cannot  scien- 
tifically be  accepted. 

Suicide  among  the  ancients  was  very  common,  and  it  is  re- 
ferred to  frequently  in  the  Bible — a  general  to  escape  from  the 
ignominy  of  defeat  would  frequently  kill  himself  on  his  own 
sword.  The  ancient  Greeks  did  not  regard  it  as  a  crime,  nor 
was  it  so  considered  among  the  Romans.  "  Seneca  held  that 
suicide  was  an  actual  duty  under  certain  circumstances,  as  in 
great  poverty,  slavery,  grief,  old  age,  or  hopeless  disease."  The 
frequency  of  suicide  markedly  increases  as  a  nation  advances  in 
civilization.  This  is  probably  dependent  upon  the  more  com- 
plicated relations  of  life  and  the  difficulties  of  self-support. 

Climate,  seasons,  time  of  day  have  their  influence:  out  of 
11,822  cases  in  four  years  in  Prussia,  from  1869  to  1872,  the 
greatest  number  occurred  in  the  night,  that  is,  in  the  early 
morning  hours.  The  influence  of  race,  religion,  culture,  sex, 
morality,  political  life,  city  and  country  life,  age,  celibacy, 
occupation,  intemperance,  heredity,  is  of  importance. 

Suicide  may  occur  in  those  who  have  shown  no  other  sign  of 
mental  disease.  It  is  frequently  threatened  in  melancholia  and 
in  neurotic  persons.  It  may  be  impulsive  or  deliberate.  The 
impulsive  form  may  occur  among  the  neurotic,  hysterical, 
maniacal,  alcoholic,  and  epileptic;  the  deliberate  form  occurs 
more  frequently  among  paranoiacs,  the  chronic  insane,  and 
melancholiacs.  In  children  it  is  almost  always  in  those  heredi- 
tarily affected  (see  Tuke,  "Psychological  Medicine"). 

Suicidal  Impulse.— Suicidal  mania  so  called  belongs  to 
the  same  category  of  mental  diseases  as  the  form  just  de- 


KLEPTOMANIA.  253 

scribed.  What  has  been  said  in  regard  to  hereditary  and  ac- 
quired degeneration  applies  equally  well  here. 

Kleptomania.— CLEPTOMANIE  (Fr.);  STEHLSUCHT  (Ger.) 

Definition. — An  irresistible  impulse  to  steal  (Tuke). 

This  condition  must  be  classed  among  the  neuroses,  and  is 
essentially  a  characteristic  of  defective  mental  development. 
We  must  make  a  sharp  distinction  between  it  and  the  tendency 
to  steal  or  appropriate  anything,  whether  valuable  or  not,  so 
commonly  observed  in  the  well-defined  forms  of  insanity. 

Imbeciles  and  idiots,  without  apparent  regard  or  knowledge 
of  consequences,  will  steal,  and  may  do  so  more  or  less  cun- 
ningly, avoiding  detection  if  possible.  They  usually  take  such 
things  as  would  naturally  please  them  or  satisfy  their  desires, 
as  food  or  clothing,  etc. ;  these  acts  generally  resemble  those  of 
children.  They  recognize  that  they  are  wrong  because  they 
have  been  punished  for  similar  offences,  but  they  have  no  feel- 
ing of  moral  responsibility  in  the  act. 

Again,  in  chronic  melancholia,  or  especially  in  chronic 
mania  associated  with  exaltation  of  the  ego  or  individual, 
the  appropriation  of  various  articles  to  ornament  the  person  is 
very  common.  There  is  no  special  impulse  or  longing  in  these 
cases ;  there  is  evident  intellectual  defect  or  there  may  be  a  delu- 
sion back  of  the  act.  Again,  in  the  earlier  stages  of  general 
paresis  stealing  is  not  uncommon,  and  persons  have  been  con- 
victed who  have  later  developed  all  the  typical  symptoms  of 
this  disease. 

Tuke  refers  to  six  cases  related  by  Dr.  Burman  in  the  Jour- 
nal of  Mental  Science,  January,  1873:  "All  were  convicted  of 
stealing  and  sent  to  prison,  and  in  all' of  them  general  paralysis 
became  manifest  soon  afterward."  We  must  make  a  careful 
distinction  between  a  symptom  of  insanity  and  a  condition 
which  stands  out  alone  as  a  mental  characteristic. 

The  tendency  of  the  past,  as  shown  in  the  writings  of  Marc, 
Marie,  Lasegue,  to  class  all  these  cases  as  types  of  insanity  with 
irresistible  impulse,  has  of  late  taken  the  opposite  direction. 
It  is,  however,  without  doubt  a  mental  state,  resembling  in 
kind,  but  not  so  intense  in  degree,  the  various  forms  of  mental 
disease  already  described  under  the  head  of  homicidal  and 
suicidal  mania.  We  find  an  absence  of  the  moral  sense  of 
wrong  committed  with  the  act.  The  only  fear  is  that  of  detec- 


254  INSANITY — FISHER. 

tion ;  there  is  no  apparent  loss  of  the  moral  aspect  of  other  ques- 
tions; the  intellect  is  unimpaired.  There  is,  however,  almost 
invariably  present  a  neurotic  disposition  and  not  infrequently 
an  hereditary  taint  of  insanity. 

One  lady,  long  under  observation,  moving  in  the  best  society,  and 
universally  respected  and  liked  for  her  versatility  and  pleasant  man- 
ners, lias  for  years  been  known  to  take  articles  of  value  from  the 
houses  of  friends  whom  she  has  been  visiting. 

The  motive  was  the  desire  to  have  the  article  which  struck  her 
fancy.  There  was,  however,  no  need  to  resort  to  such  means  of  ob- 
taining it,  as  she  could  amply  afford  to  purchase  it.  She  at  one  time 
said  that  ' '  she  could  see  no  harm  in  her  taking  it,  her  friend  would 
have  given  it  to  her  had  she  asked  for  it."  This  moral  obliquity  is  not 
uncommon. 

Another  lady  rarely  visits  the  city  in  her  shopping  tours  without 
returning  with  various  articles  which  she  has  abstracted  from  the 
various  store  counters.  At  certain  of  these  places  she  is  simply.watched 
and  the  various  articles  charged  up  against  her,  which  she  subsequently 
pays  for.  Many  of  these  articles  are  never  used  afterward,  but  simply 
accumulate.  This  patient  represents  more  closely  the  cases  of  irresis- 
tible impulse.  In  other  respects  there  is  no  evidence  of  mental  disease. 
She  is  an  estimable  wife  and  mother.  Many  similar  instances  are  daily 
reported  in  our  papers. 

The  question  of  responsibility  is  difficult  to  settle,  and  indeed 
most  cases  are  settled  by  some  arrangement.  The  absence  of 
any  real  motive,  the  knowledge  of  previous  acts  of  a  similar 
character,  the  history  of  hereditary  taint,  and  a  neurotic 
disposition,  seem  to  establish  the  proof  of  a  mental  weak- 
ness which  approaches  the  confines  of  insanity.  One  cannot 
say  that  punishment  should  not  be  inflicted ;  for,  as  in  other 
cases  of  mental  disease,  when  the  emotional  side  of  the  mental 
functions  is  more  involved  than  the  intellectual,  the  knowledge 
that  punishment  will  follow  such  acts  has  a  great  deterrent 
effect;  and  while  as  physicians  we  might  claim  immunity  for 
such  defective  individuals,  as  jurists  we  can  only  believe  that 
the  best  interests  of  society  are  subserved  by  holding  the  person 
responsible. 

Pyromania.  — MONOMANIE  INCENDIAIRE  (Fr.}\  FEUER- 
LUST,  BRANDSTIFTUNGS-MONOMANIE  (Ger.).  These  terms  all 
indicate  the  idea  of  a  fixed  impulse,  a  single  desire., 

Definition. — A  morbid  impulse  to  burn  (Tuke). 


PYROMANIA.  255 

There  is  less  evidence  of  impulse  of  a  so-called  irresistible 
character  in  these  cases  than  in  those  of  the  class  just  described, 
although  we  have  to  deal  with  the  same  more  or  less  morally 
and  intellectually  defective  type. 

These  acts  are  more  frequently  committed  by  the  young, 
about  or  before  the  age  of  puberty.  There  is  often  a  well-de- 
fined history  of  imperfect  mental  development,  difficulty  in  ac- 
quiring learning,  lack  of  ordinary  affection,  or  the  existence  of 
a  cruel  disposition.  It  has  been  noted  also  in  children  brought 
up  in  institutions,  where  probably  the  motive  has  been  revenge 
for  fancied  or  real  wrongs.  Again,  homesickness  has  been  often 
the  motive. 

While  frequently  there  is  discoverable  some  motive,  as  a  feel- 
ing of  hatred  toward  persons  who  have  perhaps  treated  them 
cruelly,  it  is  more  often  a  supposed  injury  than  a  real  one;  or 
even  love  for  some  one  may  be  the  motive,  the  attempt  being 
made  to  rid  them  of  their  enemies.  These  latter  cases  are  more 
often  homicidal  in  character.  Again,  in  cases  where  homesick- 
ness has  been  the  motive  of  the  act,  the  individual  thought  thus 
to  escape  or  be  sent  back  to  his  home. 

The  true  inconsequence  of  the  acts  is  perceived  in  that  no 
element  of  sorrow  is  experienced.  These  acts  are  similar  to 
special  acts  of  destruction,  as  breaking  windows,  destroying 
clothing,  which  have  been  performed  by  persons  of  this  class. 
There  is  often  a  desire  to  attract  attention,  to  be  explained  only 
by  a  morbid  exaltation  of  the  ego.  There  is  not  infrequently 
great  skill  and  cunning  shown  in  the  concealment  of  these  acts, 
or  even  shrewd  attempts  to  throw  the  suspicion  on  others.  This 
is  often  successful,  as  there  is  no  reason  to  suspect  them  person- 
ally, as  the  extreme  youth  of  the  individual  may  make  it  seem 
impossible  that  they  could  have  carried  out  the  plan  success- 
fully. There  often  is  an  hysterical  basis  in  many  of  these 
cases,  and  even  in  the  very  young  this  cannot  be  excluded. 
There  are,  however,  cases  again  where  the  mere  act  of  incen- 
diarism, the  pleasure  and  satisfaction  derived,  seems  to  be  the 
only  motive.  The  same  condition  is  observed  here  as  referred 
to  in  moral  insanity  or  impulses  toward  other  acts.  There 
may  be  a  long  struggle  to  resist  the  impulse,  which  finally 
overmasters  them,  and  there  is  also  usually  a  sense  of  quiet 
and  satisfaction  following  its  accomplishment.  It  is  not 


256  INSANITY — FISHER. 

unlike,  as  Lewis  has  stated,  the  quiet  following  an  epileptic 
seizure.  These  patients  resemble  epileptics  indeed  in  many 
mental  characteristics.  Lewis  makes  this  distinction :  "  In  the 
genuine  impulsive  forms  of  insanity  consciousness  is  never  so 
far  impaired  as  to  issue  in  forgetfulness  of  the  details  of  the 
homicidal  act.  When  such  is  the  case,  when  any  marked  ob- 
scuration of  memory  is  apparent,  we  may  presume  the  impulse 
to  have  been  of  epileptic  origin."  This  applies  equally  well  to 
all  impulses  of  the  so-called  imperative  type. 

We  must  be  careful  not  to  confound  the  tendency  to  impulse 
found  in  all  forms  of  insanity,  especially  melancholia  and  mania, 
with  this  form,  for  frequently  similar  acts  are  committed  by 
these  patients,  but  the  motive  is  usually  perceived  in  the  hallu- 
cination or  delusion  present. 

I  would  agree  with  Griesinger  in  objecting  to  the  term 
pyromania  as  defining  a  distinct  form  of  insanity,  but  this  ap- 
plies equally  well  to  all  this  class  of  impulses.  It  is  simply  a 
symptom,  which,  however,  occurs  so  often  and  so  uniformly 
among  these  defectives  that,  for  convenience'  sake,  usage  has  so 
firmly  established  the  term  that  we  cannot  well  place  it  aside. 
The  author  just  quoted  says:  "Away,  then,  with  the  term 
pyromania,  and  let  there  be  a  careful  investigation  in  every 
case  into  the  individual  psychological  peculiarities  which  lie  at 
the  bottom  of  and  give  rise  to  this  impulse.  The  grand  ques- 
tion in  foro  in  all  such  cases  must  ever  be  to  ascertain  whether 
there  existed  a  state  of  disease  which  limited  or  could  have 
limited  the  liberty  of  the  individual.  Sometimes  the  feeling  of 
anxiety,  hallucinations,  states  of  hysterical  exaltation,  in  other 
cases  the  actual  existence  of  a  nervous  disease  (epilepsy  or 
chorea),  render  probable  the  assumption  that  the  accused  has 
been  subject  to  some  passing  mental  aberration.  We  should 
not  forget  that  usually  very  little  is  wanted  to  interfere  with 
the  liberty  of  action  in  such  persons;  they  are,  for  the  most 
part,  young,  childish,  or  half -childish,  often  morally  and  intel- 
lectually weak,  silly,  and  suspicious  individuals.  The  incendi- 
ary act  often  appears  to  be  utterly  without  any  motive,  the 
feeble  ego  having  opposed  no  resistance  to  the  thought  of  the 
deed  which  suddenly  sprang  up."  Clouston  well  says  that 
these  cases  represent  "states  of  defective  inhibition."  "No 
doubt  the  theory  of  irresistible  impulse  is  liable  to  abuse,  and 


COPROLALIA.  25? 

to  be  applied  where  it  does  not  exist;  but  one  might  as  well 
assume  that  there  is  no  real  epilepsy  because  malingerers  and 
hysterical  girls  simulate  fits." 

Coprolalia — an  impulse  to  use  obscene  or  profane  lan- 
guage. We  not  infrequently  find  in  the  hysterical  and  in  the 
early  stages  ot'  acute  insanity  and  in  puerperal  insanity  the 
tendency  to  the  use  of  words  which  at  times  it  seems  impossi- 
ble that  the  individual,  often  refined  and  educated,  could  have 
ever  been  in  a  position  to  have  heard  or  learned.  This  may 
manifest  itself  especially  when  there  is  an  erotic  element  pres- 
ent in  the  disease.  Our  condition,  however,  is  distinct  from 
this:  it  stands  out  as  the  principal  or  only  symptom  of  disease. 
It  is  usually  observed  in  the  young  about  the  period  of  puberty 
or  earlier,  and  may  result  from  some  fright.  It  is  not  infre- 
quently associated  with  a  neurotic  predisposition  to  instability 
of  the  nervous  system.  The  child  may  be  very  intelligent  or 
the  reverse,  and  often  there  has  been  noticed  an  absence  of  the 
usual  moral  understanding  or  estimate  of  things.  Even  in 
these  patients  there  is  evidence  of  some  hysterical  taint  in  the 
history.  Many  such  cases  are  actual  forms  of  mental  disease 
developing  later  into  the  type  of  paranoiacs  or  showing  signs  of 
other  impulses. 

These  exhibitions  of  obscenity  are  often  paroxysmal  or  period- 
ical, resembling  in  many  aspects  epilepsy,  especially  when  there 
is  convulsive  excitement  present.  The  consciousness  is  never  in- 
volved, however,  and  a  strong  motive,  as  fear  of  punishment, 
may  be  sufficient  at  times  to  end  the  attack. 

A.  B.,  set.  10,  was  brought  to  me  by  his  mother  with  the  following 
history:  Family  history  negative,  except  that  there  was  a  strong 
nervous  element  in  both  parents.  The  boy  had  always  been  exceed- 
ingly bright  at  school,  although  not  as  easily  controlled  as  the  other. 
This  the  mother  ascribed  to  the  fact  that  he  had  never  been  made  to 
obey.  Following  a  severe  castigation  by  his  father  for  some  act,  he  be- 
came very  much  excited,  and  the  following  morning  went  out  in  front 
of  the  house  and  began  to  swear  in  a  most  excessive  way.  He  was  ap- 
parently conscious  of  his  acts,  but  appeared  to  be  in  a  very  excited 
state.  This  was  repeated  every  morning  and  at  no  other  time,  and 
usually  after  his  father  had  left  the  house.  His  sudden  return  with  the 
threat  of  punishment  was  often  sufficient  to  end  the  attack.  At  all 
otber  times  the  child's  language  was  very  proper.  He  usually  com- 
plained of  a  peculiar  feeling  in  the  head  just  preceding  the  attack,  and 


258  INSANITY— FISHER. 

said  he  knew  what  he  was  saying,  but  could  not  help  it.  Under  treat- 
ment these  attacks  became  less  frequent  and  finally  ceased.  The 
bromides  were  used,  as  the  attack  seemed  epileptoid  in  character. 


Morphiomania,  or  the  opium  habit,  consists  in  an  exces- 
sive desire  for  morphia.  It  resembles  dipsomania  in  regard  to 
the  irresistible  desire  for  this  drug.  The  will  power  seems  to 
be  absolutely  lost,  and  any  subterfuge  will  be  employed  to 
obtain  the  desired  stimulant.  In  extreme  cases  no  regard  for 
consequences  or  affection  for  others  has  any  influence  in  con- 
trolling these  persons. 

Again,  we  hold  here  that  in  the  majority  of  cases,  while  the 
provoking  cause  may  be  simply  the  taking  of  the  drug  to  relieve 
pain,  its  continuance  and  abuse  with  periodical  excesses  depend 
on  a  neurotic  state  which  is  due  to  an  inherited  degenerative 
nervous  organization;  in  other  words,  rarely  will  this  habit 
plant  itself  upon  an  otherwise  sound  organization. 

The  symptoms  manifest  themselves  in  the  first  place,  as  seen 
from  the  use  of  the  drug  in  ordinary  administration,  as  a  pleas- 
ant excitation,  an  increase  of  mental  action,  even  to  brilliancy, 
which  soon  passes,  where  large  amounts  are  taken,  into  a  con- 
dition of  apathy  and  mental  stupor,  and  finally  to  a  toxic  con- 
dition, as  shown  by  coma  from  which  the  patient  can  only  be 
aroused  with  difficulty,  soon  to  fall  back  into  his  previous  state 
of  unconsciousness,  associated  with  slow  respirations  and  slow 
pulse.  The  skin  is  usually  moist.  There  may  be  more  or  less 
tremor,  paresis,  and  ataxia.  The  walls  of  the  bladder  are  par- 
alyzed so  that  there  is  frequently  incontinence,  and  there  is  also 
a  paralysis  of  peristalsis.  No  special  symptoms  with  reference 
to  the  reflexes  exist.  The  secretions  in  all  the  organs  are  de- 
creased; in  extreme  cases  there  is  also  loss  of  sexual  power. 
The  physical  condition  gives  evidence  of  malnutrition,  and 
finally  there  may  be  even  emaciation;  the  hair  turns  gray,  the 
finger-nails  become  dry,  and  the  pupils  are  contracted  and  at 
times  are  unequal.  There  may  be  considerable  pain  of  a  neu- 
ralgic character,  which  is  widely  distributed,  suggesting  a 
neuritis. 

The  mental  symptoms  are  those  of  great  loss  of  energy  unless 
under  the  direct  influence  of  the  drug.  A  constant  habit  of 
procrastination  exists.  In  the  true  opium  habit,  one  rarely  has 


DIPSOMANIA.  259 

the  pleasurable  imaginations  observed  in  those  who  are  not 
habitues;  there  is,  however,  a  feeling  of  self-contentment  in- 
duced, which  takes  its  place — a  calming  of  the  whole  nervous 
system.  When  the  drug  cannot  be  obtained,  the  patient  be- 
comes very  tremulous,  is  subject  to  profuse  sweatings,  excessive 
cardiac  action,  and  a  feeling  of  impending  death.  There  is 
also  insomnia,  and  the  patient  may  even  pass  into  a  maniacal 
condition,  followed  by  intense  exhaustion,  and  not  infrequently 
by  death.  (Hallucinations,  usually  of  sight,  may  be  present.) 
The  final  results  are  those  of  dementia — loss  of  judgment  and 
of  memory,  the  moral  character  being  lowered.  There  is  a 
special  tendency  to  lying,  and  no  statements  which  such  pa- 
tients may  make  in  their  attempts  to  obtain  the  drug  can  be 
relied  on.  Forgery,  neglect  of  family  duties,  etc.,  are  not  un- 
common. Mania  is  often  marked  by  a  delusion  of  persecution 
and  exaltation,  not  unlike  paranoia ;  in  fact,  we  may  have  to 
do  with  that  disease  in  these  cases. 

Lead. — The  special  effects  of  lead  on  the  nervous  system  are 
largely  somatic  rather  than  psychical.  We  find  well-marked 
lesions  affecting  principally  the  peripheral  nerves,  causing 
paralyses  and  wasting  of  the  muscles,  especially  of  the  extensor 
group  of  the  upper  extremities.  Cord  lesions,  although  more 
rare,  are  present,  and  in  an  autopsy  made  by  me  well-defined 
lesions  involving  the  gray  and  white  matter  were  present.  This 
may  also  involve  the  cortex  cells  and  association  fibres  of  the 
brain,  resulting  in  a  mental  condition  in  which  the  more  prom- 
inent symptoms  are  those  of  lowered  mental  action,  loss  of 
memory,  headache,  and,  in  some  few  cases,  great  excitement  of 
a  maniacal  type.  Hallucinations  of  sight  and  of  the  other 
senses  may  be  present.  Convulsions  are  not  rare.  Depression 
is  a  not  infrequent  symptom,  and  if  the  patient  remains  still 
exposed  to  the  poison,  the  condition  advances  to  dementia. 
There  is  nothing,  however,  characteristic  of  the  condition  as 
far  as  any  special  well-defined  form  of  insanity  is  concerned. 

Dipsomania. — We  must  make  a  sharp  distinction  between 
the  class  of  drinkers  who  are  given  to  excess  only  periodically, 
and  those  in  whom  the  habit  is  continuous.  In  the  former  we 
recognize  a  mental  condition  similar  to  other  neuroses,  especially 
to  epilepsy.  In  these  cases  we  find  an  almost  irresistible  impulse 
to  satisfy  a  well-defined  craving  which  can  only  be  satisfied  by 


260  INSANITY — FISHER. 

the  use  of  alcohol.  Under  this  head,  we  would  refer  to  excesses 
in  the  use  of  other  drugs,  such  as  morphine  and  cocaine.  In  the 
chronic  habitual  drinker,  the  excess  is  more  apt  to  be  induced 
by  the  physical  condition  following  continual  abuse  of  alcohol, 
and  its  consequent  exhaustion,  resulting  in  a  demand  on  the 
part  of  the  system  for  a  stimulant.  In  both  instances,  the  final 
result  after  excessive  debauches  may  be  the  same,  that  is,  de- 
lirium tremens  often  follows,  or  a  maniacal  condition  lasting 
frequently  for  weeks  or  even  months.  In  dipsomania,  how- 
ever, the  condition  of  chronic  alcoholism  or  alcoholic  dementia 
does  not  usually  occur.  There  is  more  frequently  an  acute 
mental  disturbance  of  the  type  of  the  degenerative  diseases  such 
as  epileptic  insanity  or  paranoia ;  in  fact,  in  this  class  of  pa- 
tients hereditary  taint  is  marked. 

We  can  only  regard  dipsomania  as  a  symptom  of  mental 
disease,  or,  in  other  words,  as  a  sign  or  evidence.  As  we  have 
already  remarked,  it  occurs  in  the  class  of  so-called  degenera- 
tives,  those  affected  with  an  hereditary  taint  or  predisposition 
to  insanity.  It  belongs  to  the  same  type  as  moral,  impulsive, 
reasoning,  and  periodical  insanity. 

In  a  legal  sense  it  is  difficult  to  accept  it  or  the  above  as 
separate  forms  of  insanity  and  their  value  in  diagnosis  is  sim- 
ply as  one  of  a  chain  of  symptoms,  indicating  mental  disease. 

It  is  of  importance  to  establish  the  existence  of  the  tendency 
to  periodical  excesses,  as  it  may  prove  at  least  that  premeditation 
in  the  commission  of  the  act  was  absent,  and  also  may  be  ground 
for  a  lessened  degree  of  responsibility. 

Nymphomania  is  a  state  found  in  the  female,  the  most 
marked  feature  being  desire  to  satisfy  the  sexual  appetite  by 
irritation  of  the  clitoris.  It  is  a  form  of  insanity  when  carried 
to  great  excess,  in  which  eroticism  is  the  chief  feature.  Such 
individuals  rarely  obtain  pleasure  in  the  natural  manner ;  they 
have  a  morbid  tendency  to  self-gratification  in  this  direction. 
They  may  derive  a  morbid  pleasure  in  this  direction  from  objects 
of  art  or  pictures,  in  which  case  the  excitation  is  entirely  of  a 
ps3rchical  character.  We  would  also  place  this  form  of  disease 
among  those  of  the  so-called  degenerative  type,  in  which  heredity 
and  acquired  instability  are  important  etiological  factors.  It  may 
occur  at  various  periods  of  life,  not  rarely  even  at  the  climac- 
teric. It  is  found  especially  among  those  who  lead  a  solitary 


MANIA   TRAXSITORIA.  261 

life.  It  is  not  confined  to  the  uneducated  classes.  It  is  also 
observed  in  various  forms  of  mental  disease,  in  which  there 
is  a  loss  of  the  higher  faculties  of  the  mind  as  in  idiocy,  epi- 
lepsy, and  hysteria.  We  note  it  also  in  various  conditions  in 
which  delusions  take  a  prominent  part.  It  may  be  a  symptom 
in  various  spinal  diseases.  It  is  at  times  caused  by  certain  dis- 
eased conditions  of  the  genital  organs  and  by  inflammatory 
affections  of  the  uterus. 

Mania  Transitoria— transitory  mania;  die  transito- 
rische  Tobsucht. 

"  We  understand  by  transitory  mania  that  kind  of  acute 
frenzy  which,  developing  suddenly  and  rapidly,  soon  reaches  its 
climax"  (Tuke). 

It  is  usually  of  short  duration,  lasting  not  longer,  as  a  rule, 
than  twelve  hours,  and  passing  off  in  a  profound  sleep,  there 
being  no  recollection  of  the  attack  or  the  acts  committed.  It 
therefore  very  much  resembles  an  epileptic  seizure;  and,  in 
fact,  many  acts  committed  in  known  cases  of  epilepsy  asso- 
ciated with  mania,  either  preceding  or  following  the  convulsive 
seizures,  are  exactly  parallel  to  those  done  in  these  cases. 

We  must,  however,  as  Tuke  says,  distinguish  it  from  mania 
by  adopting  the  term  frenzy,  as  its  course  is  so  much  more 
sudden  in  its  onset  and  short  in  its  duration,  and  leaves  little 
or  no  trace  on  the  mental  state,  its  integrity  being  unimpaired. 
It  also  has  no  tendency  to  return,  differing  in  this  respect  from 
epilepsy.  It,  however,  stands  out  as  a  distinct  condition  by 
itself,  and  is  of  special  importance  in  a  forensic  sense,  as  the 
absence  of  preceding  symptoms,  or  any  marked  hereditary  in- 
fluence, makes  it  difficult  to  establish  as  a  defence  in  criminal 
cases,  especially  if  any  motive  for  the  act  is  discoverable.  In 
fact,  it  is  not  accepted  as  a  defence  in  court. 

It  is  difficult  to  find  any  definite  cause  for  the  condition ;  great 
excitement,  physical  exhaustion  and  mental  worry,  grief,  in- 
somnia, acute  fevers,  injuries  to  the  head,  no  doubt  have 
their  influence.  Again,  very  little  is  known  of  the  morbid 
changes  outside  of  congestion  of  the  brain,  which  is  an  uncer- 
tain condition,  and  is  not  infrequent  in  other  diseases  without 
producing  transitory  mania  or  frenzy.  We  do  not  include 
under  this  head  mania  resulting  from  alcoholic  excesses  or 
occurring  during  the  puerperal  state. 


262  INSANITY — FISHER. 

Clouston  believes  that  most  of  these  cases  are  epileptic  in 
character,  of  the  nature  of  the  mental  epilepsy  of  Hughlings 
Jackson,  or  of  the  so-called  epilepsie  larvee,  or  masked  epilepsy, 
of  Morel.  It  is  difficult,  as  has  been  said,  however,  to  think  of 
a  single  epileptic  seizure  occurring  without  cause,  and  not  being 
repeated  or  leaving  any  of  the  signs  of  disease  common  to  this 
well-known  neurosis. 

There  is  complete  unconsciousness  of  the  surroundings  and 
of  the  personality  during  the  attack.  The  patient  is  subject  to 
hallucinations  of  various  kinds,  both  of  hearing  and  sight,  and 
is  usually  violent  and  destructive,  often  homicidal.  These  cases 
resemble  those  of  impulsive  homicidal  mania.  Instances  are 
reported  of  persons  waking  from  sleep,  and,  probably  under  the 
influence  of  some  fixed  delusion,  showing  a  homicidal  tendency. 

Maudsley  also  rather  inclines  toward  the  opinion  that  the 
attacks  are  epileptic  in  character,  as  shown  from  the  following 
remarks  quoted  from  Lewis'  work  on  mental  disease,  but 
admits  that,  "  although  epilepsy,  masked  or  overt,  will,  I  think, 
be  found  to  be  at  the  bottom  of  most  cases  of  mania  transitoria, 
it  must  be  admitted  that  there  are  some  cases  in  which  there  is 
no  evidence  of  epilepsy  in  any  of  its  forms  to  be  found ;  but  it 
may  well  be  doubted  whether  a  distinct  insane  neurosis  is  not 
always  present  in  these  cases.  With  such  a  constitutional 
predisposition,  a  genuine  attack  of  acute  insanity,  lasting  for 
a  few  hours  only  or  for  a  few  days,  may  break  out  on  the 
occasion  of  a  suitable  exciting  cause,  and  during  the  paroxysm 
homicidal  or  other  violence  may  be  perpetrated.  After  child- 
birth it  sometimes  happens  that  a  woman  is  seized  with  a 
paroxysm  of  acute  mania  of  short  duration,  during  which  she 
kills  her  child  without  knowing  what  she  is  doing.  The  effect 
of  alcoholic  intemperance  upon  a  person  strongly  predisposed  to 
insanity,  or  upon  one  whom  a  former  attack  has  left  predisposed 
to  a  second,  is  sometimes  a  short  but  acute  mania  of  violent 
character,  with  vivid  hallucinations  and  destructive  tendencies; 
and  a  like  effect  may  be  produced  by  powerful  moral  causes, 
sexual  excitement,  and  other  recognized  causes  of  insanity" 
(Maudsley,  "  Responsibility  and  Mental  Disease") . 

Paranoia  is  a  form  of  insanity  which  comes  especially 
under  the  class  of  degenerative  diseases. 

It  is  essentially  characterized  by  a  delusion  or  delusions  of 


PARANOIA.  263 

a  fixed  and  systematized  character.  They  are  usually  indeed 
of  one  kind,  and  the  disease  has  perhaps  for  this  reason  been 
called  monomania.  This  is,  however,  an  unfortunate  terra,  as 
we  find  this  symptom  not  infrequently  in  other  forms  of  insanity, 
as  melancholia,  where  we  always  observe  decidedly  fixed  ideas 
of  depression.  The  term  delusional  insanity,  largely  used  by 
the  English,  is  also  not  to  be  recommended,  as  it  is  not  in  any 
way  descriptive  of  this  special  form.  The  main  fundamental 
characteristic  of  this  disease  is  a  delusion  which  has  become 
apart  of  the  belief  of  the  individual,  and  which  he  believes 
himself  able  to  explain  and  defend. 

Paranoia  is  usually  a  primary  disease,  that  is,  congenital  in 
its  origin — the  predisposition  to  the  disease  is  born  with  the 
individual;  the  exciting  cause  may  not  manifest  itself  until  later 
in  life.  "  The  patients  receive  its  germs  at  birth,  and  it  develops 
at  its  appointed  hour  under  the  influence  of  the  slightest  cause — 
for  example,  poverty,  difficulties  of  social  life,  disappointments, 
mortifi  ations,  conjugal  unhappiness,  the  menopause,  etc.  That 
is  to  say,  that  the  principal  cause  of  partial  insanity  is  heredity. 
It  is  well  known  ^hat  it  is  more  frequent  in  females,  celibates, 
and  especially  those  born  out  of  wedlock"  (Regis) .  The  term 
progressive  systematized  insanity  used  by  the  preceding  author 
explains  very  well  the  condition,  and  he  has  defined  it  as  fol- 
lows: "A  chronic,  essential  insanity,  without  disorder  of  the 
general  activity,  characterized  by  hallucinations,  especially  of 
hearing,  bjr  delusions  tending  to  become  systematized,  and  end- 
ing in  a  transformation  of  the  personality." 

The  intellect  is  rarely  much  involved.  In  all  other  relations 
the  individual  may  be  able  to  carry  on  his  business  in  life  with  or- 
dinary acumen ;  where,  however,  the  delusion  affects  his  particu- 
lar occupation,  it  will  be  found  running  through  all  its  course. 

This  class  of  patients  has  been  included,  therefore,  under  the 
head  of  the  partially  insane.  There  is  little  doubt  that  in  the 
general  question  of  right  and  wrong,  they  are  thoroughly  re- 
sponsible in  their  understanding  of  the  moral  issue  and  of  the 
consequences  of  their  acts  However,  in  a  particular  act,  if 
the  result  of  their  delusion,  it  is  not  so  much  a  question  of  their 
ability  to  control  their  actions,  as  that  they  do  not  attempt  to 
do  so.  Under  their  delusion,  which  may  in  their  changed  per- 
sonality appear  to  be  a  command  from  God,  whose  direc- 
III. -19 


264  INSANITY — FISHER. 

agent  they  may  consider  themselves,  the  question  of  the  right 
or  wrong  of  the  act  or  its  consequences  is  never  taken  into  con- 
sideration. This  condition  differs  from  the  so-called  irresistible 
impulse  of  the  former  class  which  we  have  been  considering, 
based  as  it  is  on  a  train  of  reasoning  often  logical,  though 
wrong  and  unreasonable  in  its  premises.  We  have  to  do  here 
with  a  class  of  the  insane  perhaps  the  most  dangerous  in  any 
community.  They  have  within  themselves  a  law  sufficient 
unto  themselves.  With  intellects  often  acute,  they  are  at  times 
patient  and  skilful  in  carrying  out  their  plans,  whether  to  re- 
generate the  world  or  to  remove  a  supposed  tyrant.  They  may 
conceal  their  delusions  from  others,  and  in  fact  are  usually  ready 
to  defend  themselves  against  the  accusation  of  being  insane. 
Many  cases  indeed  are  harmless  in  their  tendencies,  having 
simply  impracticable  schemes,  harmful  only  to  their  own  pros- 
pects in  life.  The  disease  is  essentially  a  chronic  and  incur- 
able one,  and  tends  slowly  to  dementia,  which  is  rarely,  how- 
ever, profound. 

As  one  would  expect,  from  what  has  been  said,  these  cases 
constantly  come  into  conflict  with  the  law,  and  perhaps  no 
form  of  insanity  has  led  to  more" protracted  and  heated  discus- 
sions, or  more  contradictory  statements,  by  various  well-known 
experts  in  insanity  in  regard  to  their  mental  soundness  and  re- 
sponsibilitjT.  The  trials  of  Oxford,  Guiteau,  and  Prendergast 
are  striking  examples.  There  can  be  no  question  of  the  insanity 
of  such  cases,  and  this  from  the  medical  standpoint  might  be 
considered  sufficient  ground  for  relieving  them  from  all  respon- 
sibility. But  in  law  other  questions,  of  policy,  the  welfare  of 
the  community,  etc.,  have  to  be  especially  considered.  To  per- 
mit the  idea  to  go  forth,  that  persons  known  to  be  capable  of 
reasoning  in  a  logical  manner,  and  who  are  cognizant  of  what 
is  going  on  as  reported  in  the  papers,  and  yet  have  long  been 
considered  in  the  vernacular  of  the  times  as  "cranks,"  neverthe- 
less will  not  be  held  responsible  for  their  acts,  would  probably 
lead  to  a  great  increase  of  such  crimes. 

These  individuals  are  greatly  influenced  by  the  fear  of  the 
law.  In  a  milder  way  in  our  asylums  the  restrictions,  placed  on 
this  class  of  patients  when  they  commit  any  overt  act,  restrain 
them  from  repeating  them.  The  execution  of  homicides,  when 
the  head  of  a  government  has  been  the  victim,  cannot  be  called 


PARANOIA. 


2*55 


a  "judicial  murder"  but  a  necessary  measure  for  the  prevention 
of  similar  acts  and  the  protection  of  the  government  and  the 
community  in  general. 

There  are  many  physical  signs  of  this  form  of  mental  dis- 
case.  The  Italian  school  has  especially  developed  this  subject. 

There  is  frequently  found  asymmetry  of  the  skull,  of  the 
face,  irregularities  of  the  jaw  or  palate,  of  the  nose,  ears,  and 
eyas.  These  are  not  always  present,  nor  can  we  say  that  any 
precise  statement 
of  uniform  irreg- 
ularities has  as 
yet  been  made. 
They  occupy 
about  the  same 
importance  a  t 
present  in  diag- 
nosis as  the  so- 
called  criminal 
type  of  brain 
does  in  pathology . 
Enthusiasts  have 
brought  a  great 
mass  of  statistics 
together,  but 
have  not  as  yet 
thoroughly  inves- 
tigated the  other 
side  of  the  ques- 
tion, i.e.,  the  existence  of  like  irregularities  among  the  sane. 
It  is  true,  generally  speaking,  that  beauty  and  sj'mmetry  are  not 
common  to  criminals  or  the  degenerative  insane  (see  Fig.  20). 

I  have  spoken  of  paranoia  as  essentially  a  primary  disease, 
not  a  secondary  one.  It  has  led  to  considerable  confusion  in 
our  understanding  of  this  disease,  that  certain  fixed  delusions, 
remaining  after  the  acute  stage  of  melancholia  or  mania,  have 
been  ascribed  to  paranoia.  The  whole  course  of  these  psy- 
choses, and  the  attending  dementia,  should  sharply  mark  them 
out  as  different  in  their  very  nature.  The  term  secondary 
monomania  could  be  well  used  in  these  latter  conditions. 

The  prognosis  in  paranoia  is  unfavorable;  no  cure  can  be 


Fio.  20.—  Paranoia. 


266  INSANITY — FISHER. 

accomplished.  However,  the  delusion  may  become  less  active 
and  the  individual  become  at  least  harmless.  Paranoiacs  are 
usually  unable  to  take  their  part  in  life,  and  frequently  become 
the  object  of  public  care  or  charity. 

The  subdivisions  of  the  forms  of  paranoia,  were  we  to  go 
into  the  various  special  delusions  which  exist  in  these  cases, 
would  be  very  numerous.  Classifying  them,  however,  under 
their  principal  headings,  we  would  make  the  following: 

The  typical  form  is  one  of  exaltation  with  delusions  of 
grandeur,  an  increase  in  the  feeling  of  importance.  There  may 
be  a  change  in  the  personality  so  that  the  simple  artisan,  the 
ordinary  workman  or  shop  girl,  feels  that  royal  blood  really 
flows  in  their  veins.  Again,  they  may  conceive  themselves  great 
generals,  or  reformers,  or  specially  appointed  messengers  from 
God.  It  is  interesting  to  watch  the  evolution  of  their  delusions, 
the  gradual  transformation  into  another  personality,  and  to  note 
the  slight  and  trivial  occurrences  which  are  all  conceived  as 
referring  to  themselves  and  adopted  as  explanations  of,  and 
indications  pointing  inevitably  to,  the  fact  that  they  are  what 
they  claim.  At  first  there  may  be  no  hallucinations,  although 
almost  invariably  they  appear  sooner  or  later.  This  is  shown 
in  the  following  case : 

A.M.,  set.  25,  male,  single.  Duration  of  disease  fourteen  years 
previous  to  admission  to  the  hospital  in  1892.  Has  the  usual  egotism 
of  this  class.  Has  the  delusion  of  possessing  great  wealth  (millions), 
and  that  the  title  of  Prince  von  Michael  has  been  conferred  on  him. 
Has  hallucinations  of  hearing,  one  voice  being  that  of  Jay  Gould,  to 
whom  he  had  written  letters  asking  to  be  adopted  as  his  son,  etc.  Is 
considerably  demented. 

The  estimate  which  friends  may  make  of  such  a  mental  condition  is 
shown  in  the  following  letter:  "I  think  A.  wants  to  get  a  living  with- 
out work.  He  thinks  he  is  remarkably  smart.  I  think  that  after  he 
finds  that  he  can't  humbug  you  with  his  aspirations  he  will  be  per- 
fectly sane."  Patient's  condition  has  not  changed  except  that  he  has 
delusion  of  persecution  (see  Fig.  20). 

Instead  of  a  change  of  the  personality  there  may  be  simply 
an  exaltation  of  the  existing  ego.  The  artist  becomes  in  his 
own  estimation  the  greatest  of  living  artists,  the  accountant  the 
one  most  expert.  It  is,  however,  more  frequent  for  this  exag- 
geration of  power  and  ability  to  be  applied  to  a  sphere  in  life 
apart  from  their  ordinary  occupation. 


PARANOIA. 


This  feeling  of  self -importance  may  manifest  iteelf  in  a  quiet 
self-assurance  which  nothing  can  shake,  and  no  discouragements 
alter;  or  it  may  show  itself  in  an  aggressive  form,  asserting 
itself  in  its  attempt  to  take  the  part  of  reformer,  whether  in  the 
political  or  theological  world.  This  evolution  is  one  of  gradual 
growth ;  many  things  have  occurred,  perhaps  at  long  intervals, 
suggesting  to  them  that  they  are  not  what  they  seem.  The  pe- 
culiar feelings  they  have  long  had,  and  the  hallucinations  or  illu- 
sions which  at  first  produced  only  some  slight  mental  confusion, 
finallj',  in  a  man- 
ner that  appears 
sudden,  manifest 
themselves  in  a 
fixed  delusion  in 
regard  to  their 
character  and  per- 
sonality. Their 
reasoning  now 
takes  on  a  more 
or  less  logical 
character,  which 
remains  the  same 
from  year  to  year. 
The  positiveness 
and  certainty  of 
their  convictions 
lead  finally,  as 
they  find  them- 
selves not  be- 
lieved in  by  others  or  unable  or  prevented  from  following  out 
their  plans,  to  the  stage  of  persecution,  which  invariably  early  or 
late  makes  its  appearance.  The  delusion  of  persecution  has 
been  defined  by  French  writers  as  a  special  form  of  insanity 
(Lasegue),  but  it  is  really  simply  a  stage,  as  we  have  said,  in 
this  form  of  systematized  delusional  insanity. 

L.  R.  (Fig.  21)  entered  hospital  May,  1874,  set.  51.  Duration  of  dis- 
ease approximately  twenty-five  years. 

Has  delusions  of  being  poisoned  by  his  enemies  with  lead  and  cop- 
per, and  also  of  being  infected  with  syphilis  and  phthisis. 

Patient  has  many  similar  delusions,  though  his  mind  is  active  and 
his  conversation  connected. 


Fio.  21.— Paranoia;  Delusions  of  Persecution  and  Grandeur. 


268  INSANITY — FISHER. 

Has  exaggerated  ideas  of  his  own  importance.  Is  at  work  (i.  e. ,  1876) 
in  making-  a  translation  of  Horace,  which  he  thinks  will  be  of  more 
practical  use  in  classical  schools  than  any  other.  Says  that  he  is  be- 
ing persecuted  as  all  great  men  from  Galileo  down  have  been.  Very 
slight  causes  excite  his  suspicions.  The  following  letter  was  written 
on  the  library  being  closed  for  reorganization: 

DEAR  SIR  : — Will  you  have  the  kindness  to  inform  me  whether,  as 
far  as  you  know,  I  have  been  supposed  in  my  projected  compilation  from 
Horace  to  be  in  any  way  trenching  upon  rights  of  Prof.  Chas.  Anthon, 
Jr.  (I  presume  the  author  of  the  part  I  was  using)  or  of  Gen.  Cessnola 
(who  is  said  to  be  writing  on  Cypress  and  early  Eastern  art),  or  any 
other  elsewhere  or  here  ?  I  cannot  see  how  such  a  thing  can  be  pos- 
sible ;  but  if  it  is  not  so,  let  me  speak  to  you  as  one  educated  man  to 
another  and  entreat  you  will  consider  how  much  I  must  suffer  in  my 
feelings — a  man  as  I  am  who  has  always  been  studious,  thinking,  in- 
dustrious !  at  being  stopped  in  my  preparation  of  a  treatise,  etc.,  etc.,  etc. 

In  1890  delusion  of  poisoning  continued  unchanged.  Says  is  about 
to  write  a  book  and  make  a  new  religion  which  will  change  the  destiny 
of  New  York  City. 

Patient  constantly  writes  letters  asking  for  protection.  L.  R.  is  ex- 
ceedingly well  read,  and  has  held  the  position  of  professor  in  some 
college;  his  education  has  been,  however,  irregular  and  unsystematic. 

The  delusion  of  persecution  may  be  present  in  various 
forms  of  insanity.  It  is  common  in  alcoholic  cases,  the  halluci- 
nations of  hearing  and  sight  being  usually  of  a  terrifying  char- 
acter, with  the  delusion  of  being  followed  or  hunted  down,  or 
of  a  conspiracy  formed  against  them  to  kill  them.  This  is  seen, 
again,  in  melancholia,  where  not  infrequently  we  also  find  the 
fear  of  being  killed  or  of  being  followed  existing  (Verfolgungs- 
wahri).  It  is  not  always  of  the  persecutory  character,  but  is 
often  the  result  of  the  various  hallucinations  and  illusions  re- 
sulting from  the  sensory  disturbances  common  to  this  disease. 

We  observe  it  not  Jess  often  in  mental  diseases  accompanying 
puberty,  great  fear  of  being  the  subject  of  some  conspiracy 
being  very  common.  In  all  these  instances  the  whole  course 
of  the  development  of  this  special  delusion  is  very  different 
from  its  logical  development  in  paranoia.  In  the  latter  form 
it  is  either  the  result  of  the  mental  confusion  or  depression  ex- 
isting, or  consequent  upon  the  hallucinations.  It  cannot  be 
said  that  we  have  any  form  of  insanity  where  the  only  ex- 
isting symptom  is  that  of  the  delusion  of  persecution — i.e., 
of  being  followed  from  place  to  place,  etc.  We  will  find  on 
careful  investigation  that  there  is  a  reason  in  the  minds  of 


PARANOIA. 


2G9 


these  patients  for  the  persecution ;  it  does  not  exist  as  an  entity 
inexplicable  to  them.  They  may  explain  it  on  the  ground 
that  they  have  possession  of  some  important  invention,  of  some 
secret  power  which  perhaps  the  Government  would  like  to  pos- 
sess; or,  again,  that  they  are  the  real  king  or  governor  of  the 
country,  which,  if  the  fact  were  made  public,  would  lead  to  the 
overthrow  of  the  impostor  who  now  is  in  power. 

G.  B.  (Fig.  22),  male,  set  53.  Duration  of  disease  twenty-seven  years. 
Patient  says  that  if  he  had  his  rights  he  would  be  high  king  of  the 
earth  of  the  Masons, 
and  also  that  he  is 
Christ,  the  Son  of 
God,  alias  G.  B.,  etc. 

The  character  of 
this  delusion  is  not 
unlike  those  seen  in 
chronic  mania. 

The  immediate 
cause  for  the  es- 
tablishment of  the 
delusion  of  perse- 
cution may  be  fail- 
ure to  succeed ;  es- 
pecially does  this 
show  itself  in  the 
professional  walks 
of  life.  The  worry 
and  mental  anxi- 
ety, perhaps  over- 
work and  strain,  may  result  in  a  more  or  less  sudden  delusion 
of  great  self-importance,  of  great  ability  in  their  special  lines 
of  occupation,  perhaps  as  a  painter,  a  physician,  or  a  banker. 

This  idea  of  a  conspiracy  against  them,  in  paranoia,  is  not  as 
a  rule  sudden  in  its  development :  it  is  a  gradual  process.  Many 
peculiar  things  have  occurred  which  the  patient  at  least  is  un- 
able to  understand.  These  occurrences  at  first  do  not  attract 
attention,  but  gradually  they  force  themselves  on  the  individual 
as  having  some  particular  meaning  especially  for  him.  This 
is  not  uncommonly  seen  in  the  ignorant,  and  the  very  fact  of 
this  ignorance  is  used  by  them  as  an  argument  in  favor  of  their 


Fio.  22.— Paranoia ;  Delusions  of  Grandeur  and  Persecution. 


270  INSANITY — FISHER. 

delusion  being  the  truth.  It  is  not  rare  for  them  to  entertain 
for  a  long  time  doubts  as  to  the  reality  of  the  delusion.  This 
was  plainly  seen  in  a  negro,  born  in  the  South,  who  had  had 
little  or  no  education.  He  had  been  brought  up  without  disci- 
pline or  training.  His  first  appreciation  of  anything  unusual 
was  hearing  his  name  called  at  night,  waking  him  up  from  his 
sleep.  He  at  that  time  and  subsequently  thought  it  was  simply 
a  part  of  a  dream.  Later  he  began  to  think  it  was  peculiar, 
and  on  investigation  found  that  no  one  in  the  house  could  pos- 
sibly have  called  him.  He  then  reached  the  conclusion  that 
it  was  the  voice  of  God  calling  him,  an  ignorant  negro,  to  be 
His  prophet  and  special  messenger  to  the  people  of  the  whole 
world.  His  personality  was  completely  changed ;  he  began  to 
study  out  passages  of  Scripture  especially  applicable  to  his  new 
vocation  and  to  assume  the  position  of  a  prophet.  His  confine- 
ment became  necessary,  and  this  seemed  to  him  the  opposition 
and  persecution  from  the  powers  of  darkness  which  were  natu- 
rally to  be  expected.  In  regard  to  all  other  affairs  he  was  intel- 
lectually as  able  to  carry  them  on  as  formerly.  His  commit- 
ment to  the  asylum  he  accepted  and  was  not  at  all  depressed 
by  it,  believing  absolutely  that  in  the  proper  time  God  would  pro- 
vide a  way  to  have  his  plan  carried  out.  There  is  an  appear- 
ance of  self-satisfaction  and  exaltation  and  personal  self-im- 
portance about  him  which  is  peculiar  to  these  cases.  He  sees 
and  laughs  at  the  pretensions  of  others  to  similar  aspirations, 
but  is  not  disturbed  at  all  by  any  doubts  as  to  his  position. 

This  acceptance  of  their  surroundings  without  opposition  is 
not  by  any  means  always  present.  In  fact,  in  almost  all  cases 
every  opportunity  is  taken  to  appeal  to  friends  or  the  public 
for  release  if  confined.  Epistles,  many  and  voluminous,  are 
sent,  especially  to  those  holding  official  positions.  The  case 
above  referred  to  was  arrested  for  addressing  letters  to  the 
President  and  for  attempting  to  obtain  an  audience  with  him. 

AMBITIOUS  PARANOIA  will  fall  properly  under  this  heading. 
There  are  always  delusions  of  grandeur  present.  They  not  infre- 
quently take  on  the  character  of  a  political  nature.  There  is 
a  belief  that  the  political  world  is  corrupt  and  needs  reforma- 
tion. They  are  especially  called  either  to  assume  high  office  or 
to  remove  those  in  power  for  the  purpose  of  allowing  others  to 
take  their  place. 


PARANOIA.  271 

There  is  little  doubt  that  many  of  the  members  of  the  vari- 
ous secret  organizations,  as  the  Nihilists,  Anarchists,  and  vari- 
ous religious  sects,  are  paranoiacs.  The  danger  from  such  per- 
sons to  the  community  is  seen  in  the  fact  that  intellectually  they 
are  capable  of  carrying  out  their  plans,  and  possessed  by  the 
delusion,  no  fear  of  consequences  can  prevent  them  from  attempt- 
ing to  carry  them  out. 

There  is  usually,  indeed,  in  these  cases  more  or  less  mental 
weakness  which  may  eventually  pass  on  to  dementia,  but  the 
progress  is  generally  slow.  The  lack  of  mental  balance  or  power 
is  evident  in  the  delusion  itself,  which  is  often  an  improbable 
or  impossible  belief.  Their  methods  of  reforming  the  world  or 
establishing  a  righteous  form  of  government,  being  foolish  in 
every  detail,  are  an  evidence  of  mental  weakness.  In  many 
cases  there  is  a  motive  for  the  acts  committed,  often  some  posi- 
tion being  sought  which  would  be  of  advantage  to  the  individ- 
ual himself.  The  fact  that  he  has  absolutely  no  knowledge  of 
the  duties  of  the  office  has  no  bearing  on  his  opinions  of  his 
ability  to  fill  the  place.  The  delusions  are  not  by  any  means 
always  single,  they  may  be  almost  numberless;  but  they,  aa 
a  rule,  pivot  around  some  central  delusion,  as  the  belief  in  their 
being  descended  from  the  royal  line,  or  that  they  are  prophets  or 
great  inventors,  etc.  This  development  of  new  delusions  was  well 
illustrated  in  a  patient  for  many  years  under  observation  in  the 
asylum,  in  whom  the  delusion  of  persecution  was  very  marked. 

Examples  of  political  paranoia,  where  the  element  of  self- 
interest  or  revenge  introduced  itself  along  with  undoubted  evi- 
dence of  insane  self -exaltation  and  a  belief  in  their  mission  to 
remove  certain  officials,  who  prevented  the  proper  carrying  on 
of  the  government,  are  shown  in  the  histories  of  Guiteau  and 
Prendergast.  In  both  instances  the  knowledge  of  the  character 
of  the  act  which  they  committed  was  full  and  complete,  and 
the  consequences  thoroughly  known.  However,  in  neither  case 
did  they  expect  to  suffer  these  consequences,  but  looked  forward 
to  the  applause  and  appreciation  of  the  public.  There  is  a 
marked  difference  in  the  motive  and  in  the  mental  reason- 
ing in  these  cases  from  the  form  of  insanity  included  under 
the  head  of  irresistible  impulse.  There  is,  as  we  have  previ- 
ously said,  however,  grave  doubt  whether  responsibility  can  be 
considered  as  absent. 


272  INSANITY — FISHER. 

QUERULANT  PARANOIA. — Das  Irresein  der  Querulanten  und 
Processkramer ;  Paranoia  litigiosa.  We  find  the  same  elements 
of  egotism  and  delusions  of  persecution  in  these  cases  as  in 
the  other  forms  of  paranoia.  They  are  always  in  some  form 
of  litigation,  either  on  their  own  account  or  for  some  one  else, 
or  for  some  class  or  principle.  It  is  not  infrequent  for  some 
cases  who  have  been  confined  in  an  asylum,  after  their  release, 
to  start  a  crusade  against  all  institutions.  Endless  suits  for 
inventions  and  patents  which  they  claim  have  been  stolen  from 
them,  are  instituted.  Numerous  letters  are  written,  judges 
are  appealed  to,  or  others  high  in  power,  as  the  President  or 
the  king,  are  written  to.  Their  egotism  is  usually  shown  by 
their  belief  in  their  own  methods  and  plans  of  obtaining  impos- 
sible results.  Without  understanding  legal  processes  they  may 
put  together  a  large  mass  of  high-sounding  words,  meaningless 
and  useless,  with  a  profound  belief  in  their  weight.  Not  suc- 
ceeding in  their  plans,  the  result  is  always  ascribed  to  the 
treachery  and  corruption  of  the  courts  and  judges  or  to  the 
general  failure  of  justice  in  this  world.  The  feeling  of  perse- 
cution soon  allies  itself  to  this  condition.  They  feel  them- 
selves martyrs,  their  opponents  have  used  bribery  and  other 
evil  methods  against  them.  There  is  always  present  a  certain 
absurdity  in  their  plans  giving  evidence  of  their  mental  weak- 
ness. The  persistence  in  their  beliefs  and  in  their  attempts  to 
carry  them  out  is  often  remarkable.  No  amount  of  work  or 
delay  or  number  of  defeats  seems  to  have  any  effect  in  discour- 
aging them.  A  lawyer  familiar  with  legal  processes  may,  as  in 
one  instance  under  observation,  carry  out  his  plans  with  con- 
siderable acumen,  observing  the  proper  legal  methods. 

The  inconsequence  of  some  of  the  charges,  the  absolute  fail- 
ure of  producing  any  creditable  testimony,  or  even  at  times  the 
failure  to  make  any  attempt  to  do  so,  is  very  striking  and  illus- 
trative of  mental  weakness.  At  times,  however,  such  para- 
noiacs  may  get  others  to  believe  their  statements  and  obtain 
their  support.  There  is  always  a  dangerous  element  in  these 
cases,  for  not  infrequently  they  show  evidence  of  violence  in 
revenge  for  their  supposed  injuries,  and  often  against  those 
holding  high  official  position.  This  may  take  the  form  of 
hatred  to  the  lawyer  or  judges  or  others  with  whom  they  may 
have  come  in  contact  or  against  an  unknown  official,  on  the 


PARANOIA.  273 

general  principle  that  all  are  corrupt  and  must  be  removed 
before  justice  can  be  obtained. 

The  general  type  of  paranoia  is  seen  in  all  these  cases;  the 
form  differs  only  in  the  line  which  the  delusion  happens  to 
take.  They  are  ready  and  often  cunning  in  their  defence 
when  on  trial,  never  for  a  moment  allowing  the  plea  of  insanity, 
protesting  their  sanity,  and  in  this  respect  resembling  especially 
the  political  and  religious  reformers.  Hallucinations  and  illu- 
sions are  rare  in  these  cases.  The  provocative  or  exciting  cause 
is  not  infrequently  based  on  some  actual  or  fancied  wrong  done 
them.  On  investigation,  however,  there  will  usually  be  found 
evidence  of  hereditary  disease  in  their  family  history,  or  they 
will  show  marks  of  physical  abnormalities,  or  at  least  they 
have  always  been  considered  eccentric  if  not  actually  insane  by 
those  who  have  known  them.  The  question  of  responsibility 
in  criminal  cases  of  this  class  presents  unusual  difficulties. 

The  law  is  not  uncertain  in  its  statements,  but  litigation  is 
frequently  protracted,  expert  testimony  varying  \\ith  the  num- 
ber of  experts  called.  The  jury,  left  in  doubt,  generally  decides 
on  its  own  impressions,  and  in  times  of  general  public  excite- 
ment usually  against  the  plea  of  insanity  and  consequent 
irresponsibility.  There  is  usually  little  doubt  of  the  act  having 
been  committed,  nor  is  any  attempt  made  to  conceal  it,  although 
at  times  plans  have  been  well  laid  for  escape.  The  egotism 
and  feeling  of  self-importance,  however,  rarely  permit  the  in- 
dividual to  remain  long  quiet.  The  almost  irresistible  desire 
for  notoriety  soon  leads  to  exposure,  and  not  infrequently  there 
is  a  voluntary  acknowledgment  of  the  act.  Conspiracy  is  rare; 
the  combination  of  others  with  them  in  their  plans  scarcely  ever 
occurs.  This  fact  alone  is  strong  evidence  of  their  insanity. 

RELIGIOUS  PARANOIA;  religious  insanity.— This  form  of 
mental  disturbance,  in  which  delusions  of  a  religious  character 
are  the  prominent  feature,  is  not  rare. 

S.  M.  (Fig.  23),  female,  set.  46.  Duration  of  disease  fifteen  years.  Pa- 
tient has  delusions  of  a  religious  character  ;  thinks  she  has  a  mission  to 
proclaim  the  rights  of  the  widows  and  orphans,  and  is  being  persecuted. 

Was  arrested  in  the  Cathedral  for  creating  a  disturbance.  Has  great 
desire  to  dress  in  a  showy  and  gaudy  manner.  Delusion  in  regard  to 
her  greatness  continues  to  increase,  and  she  has  become  more  affected 
in  her  manner  and  showy  in  her  dress. 


274 


INSANITY  —FISHER. 


The  expression  in  the  face  shows  clearly  the  absolute  feeling  of 
self -belief  and  satisfaction. 

We  observe  in  various  other  varieties  of  insanity  conditions 
in  which  hallucinations  and  delusions  of  a  religious  type  are 
prominent  features,  but  they  lack  the  systematized  logical 
process  of  thought  which  is  the  characteristic  feature  of  paranoia 


FIG.  23.— Paranoia;  Delusion  of  Grandeur  and  Persecution. 

in  general.  In  the  latter  the  onset  may  be  sudden,  but  is  in  fact 
rarely  so.  A  careful  history  will  develop  that  peculiarities  in 
mental  relations  have  been  observed  from  childhood,  perhaps  a 
close  concentration  on  one's  self,  a  condition  of  mental  reserve. 
It  is  true  that  there  are  exciting  causes,  as  perhaps  a  revival 
going  on  at  the  time  may  be  the  beginning  of  the  disease,  so 
that  its  onset  may  appear  acute  and  sudden.  Again,  financial 


PARANOIA.  275 

or  domestic  stress,  disappointment  of  the  affections,  overstrain 
from  excessive  study,  or  physical  causes,  such  as  the  develop- 
mental periods  of  puberty,  the  climacteric  period,  etc.,  may 
appear  as  the  direct  exciting  cause  of  the  disease.  These  are, 
however,  only,  as  we  have  said,  the  exciting  causes,  the  real 
disease  consists  in  the  hereditary  congenital  degenerative  state. 
It  is  especially  important  that  we  should  distinguish  this  form 
of  paranoia  from  the  ordinary  delusional  form  of  insanity  com- 
mon to  many  conditions  of  mental  disturbances,  as  in  paranoia 
we  have  to  do  with  a  chronic,  incurable  state,  often  a  most 
dangerous  form  of  insanity  so  far  as  the  peace  and  security  of 
the  community  are  concerned.  Delusions  of  an  imperative  char- 
acter exist,  leading  to  commission  of  acts  usually  not  impulsive 
in  character,  but  founded  on  well-defined  beliefs,  with  aims 
and  designs  of  a  far-reaching  character,  which  nothing  but  force 
and  repression  can  prevent  being  carried  out.  These  persons 
are  willing  to  die  the  death  of  the  martyr  for  the  sake  of  their 
belief,  and  possessing,  as  they  frequently  do,  considerable  men- 
tal ability,  perhaps  eloquence,  may  induce  others  to  believe  with 
them  that  they  are  the  special  agents  of  God  to  carry  on  His 
behests,  or  to  organize  religious  reforms  throughout  the  world. 
Many  prominent  figures  in  history  have  without  doubt  been 
paranoiacs.  The  crudity  of  the  delusion  depends  largely  on 
the  education  and  social  position  of  the  person  affected,  as  well 
as  on  the  manner  in  which  the  evolution  of  the  delusion  has 
become  gradually  and  fully  developed. 

Religious  paranoia  may  manifest  itself  among  the  ignorant 
as  well  as  the  learned,  among  those  living  in  the  quietude  of  a 
small  town  or  in  the  city.  It  is  not  rare  among  the  professional 
classes.  It  is  not  uncommon  in  the  ignorant.  In  this  respect 
it  is  similar  to  the  other  forms  of  paranoia  which  we  have  re- 
ferred to.  It  is  this  very  fact,  when  occurring  in  the  latter  class, 
which  doubly  confirms  them  in  their  belief  in  their  special  selec- 
tion by  God  as  his  divinely  appointed  messenger.  They  fully 
appreciate  their  ignorance  and  lowly  station  in  life,  and  reason 
that  they  could  not  possibly  of  themselves  have  such  visions 
of  God  or  the  Virgin  or  such  conversation  with  these  holy  per- 
sonages unless  they  had  been  chosen  of  God  hiniHelf .  This  trans- 
formation of  their  personality  is  usually  associated  with  exalta- 
tion, rarely  depression,  except,  perhaps,  in  the  beginning  when 


270  INSANITY — FISHER. 

more  or  less  mental  confusion  exists,  when  the  hallucination 
and  illusion  of  sight  and  hearing  are  more  or  less  novel  or  in- 
frequent and  have  not  as  yet  been  classified  and  evolved  into  a 
fixed  delusion.  There  is  almost  invariably  an  erotic  element  in 
these  cases,  but  it  is  not  the  primary  or  fundamental  form  of  the 
delusion.  We  have  indeed  a  form  of  paranoia  in  which  eroti- 
cism is  the  basis  of  the  delusion,  which  we  will  refer  to  later ; 
but  in  this  form  it  is  only  secondary,  as  we  often  find  in  various 
well-defined  forms  of  insanity,  as  melancholia,  mania,  epileptic 
insanity,  etc.  In  fact,  whenever  the  higher  ethical  powers  are 
in  abeyance  the  lower  sensual  nature  manifests  itself. 

Paranoia  is  rare  in  any  form  before  puberty — that  is, 
systematized  delusions  are  not  present  in  childhood.  Certain 
mental  and  physical  peculiarities  may  give  strong  indications 
of  its  future  development,  but  it  is  rarely  manifested  before  that 
period.  However,  at  this  time  and  during  other  developmental 
periods,  it  is  especially  apt  to  manifest  itself.  Under  fortunate 
circumstances  of  life,  wise  educational  care,  absence  of  mental 
strain,  a  paranoiac  may  never  have  his  delusions  developed :  suc- 
cess or  the  development  of  the  mind  in  other  directions  may 
entirely  overcome  the  inherited  tendency.  On  the  other  hand, 
if  the  paranoiac  becomes  a  priest  or  nun,  the  fixed  attention  on 
religious  subjects  may  result  in  this  form  of  insanity ;  not  indeed 
that  religion  tends  to  produce  insanity  of  a  religious  type,  but 
we  that  perhaps  find  more  paranoiacs,  as  yet  undeveloped  into 
those  with  systematized  delusions,  naturally  selecting  such  re- 
ligious separation  as  their  mode  of  life. 

Tuke,  in  the  "Dictionary  of  Psychological  Medicine,"  under 
the  head  of  religious  insanity,  describes  seven  forms.  These, 
however,  do  not,  properly  speaking,  all  belong  to  paranoia. 
Religious  delusions  may  be  classified  according  as  they — 

"  (1)  Accompany  the  mental  development  of  over-stimulated 
and  injudiciously  educated  children.  The  usual  form  is  morbid 
fear;  he  fancies  he  has  neglected  some  religious  duty,  and  he 
is  before  long  overwhelmed  by  remorse  for  imaginary  sins. 

"  (2)  Characterize  the  insanity  of  puberty.  Here  the  mental 
depression  and  fear  of  death  lead  to  the  desire  to  perform  some 
religious  act  as  penance. 

"  (3)  Are  caused  by  self-abuse.  The  patient  is  introspective, 
falls  into  the  delusion  that  he  has  committed  the  unpardonable 


PARANOIA.  277 

sin.     Auditory  hallucinations,  visions,  trances,  and  ecstasies  are 
common.     Suicide  and  fearful  self -mutilation  may  result." 

I  would  especially  confirm  the  views  of  Tuke  in  regard  to 
this  class.  While  among  masturbators  there  is  not  infrequently 
a  marked  degree  of  self-importance  and  exaltation  associated 
with  delusions  of  a  sexual  character  in  relation  with  the  Virgin 
or  Christ,  it  more  frequently  takes  on  the  form,  in  my  experience, 
of  depression,  in  which  their  condition  is  altogether  ascribed 
to  their  habits,  which  God  is  justly  punishing  them  for.  Many 
trivial  errors  of  childhood  will  be  recalled  and  self-accusations 
made,  which  take  a  far  more  important  position  in  their  minds 
as  the  cause  of  their  hopeless  condition  than  many  more  recent 
and  more  vulnerable  acts,  concerning  which  they  will  talk  with 
but  little  repentance  or  sorrow. 

A  young  woman  who  had  led  the  life  of  a  prostitute  for  several 
years  became  rather  suddenly  melancholic,  bemoaning  her  fate,  that 
she  had  committed  the  unpardonable  sin,  that  her  soul  was  lost,  etc., 
but  dwelt  especially  on  an  occurrence  probably  not  based  on  fact,  that 
she  had  attempted  while  a  little  girl  to  have  unnatural  relations  with 
a  New  Foundland  dog. 

All  these  cases  occurring  in  melancholia,  as  has  been  said, 
differ  from  the  systematized  religious  delusions  of  paranoia, 
and  complete  recovery  is  possible. 

"  (4)  Are  associated  with  (so-called)  paranoia.  Sexual  excit- 
ability is  often  associated  with  misapprehended  religious  duty." 

This  combination  in  a  neurotic  subject  has  repeatedly  led  to 
extravagant  ideas  and  the  foundation  of  fanatical  sects.  Texts 
of  Scripture  are  applied  personally,  and  nothing  is  too  absurd 
for  adoption  under  the  guise  of  superior  spirituality.  The 
author  has  reference  in  this  subdivision  to  the  form  of  religious 
paranoia  which  is  the  subject  of  this  chapter.  It  is  not  neces- 
sary that  religion  should  have  even  interested  this  class  previ- 
ously to  their  delusion.  The  casual  reading  or  hearing  of  a 
passage  of  Scripture  may  be  the  starting-point,  and  may  occur 
in  a  person  ignorant  not  only  generally  but  in  regard  to  the 
Scriptures  themselves.  They  not  infrequently  become  thereafter 
students  of  the  Bible,  selecting  and  memorizing  passages  which 
apply  to  their  special  delusion. 

"  (5)  Are  associated  with  epilepsy,  dementia,  and  general 


278  INSANITY— FISHER. 

paralysis.  In  epilepsy  Dr.  Kurd  says :  'There  is  never  or  rarely 
any  sense  of  religious  fear  or  unworthiness,  but  rather  a  sense  of 
satisfaction  in  the  performance  of  religious  duties.'  In  general 
paralysis  as  in  mania  there  may  be  extravagant  delusions  of 
religious  importance. 

"  (6)  Are  observed  in  melancholic  and  climacteric  insanity. 
Here  the  delusions  may  be  the  result  of  the  influence  of  the 
special  religious  training. 

"  (7)  Arise  in  chronic  mania  or  toxic  insanity.  These  delu- 
sions are  usually  of  an  exalted  character." 

In  conclusion  Tuke  well  says  in  regard  to  the  course  and 
determination  of  religious  delusions:  "As  they  are  frequently 
associated  with  the  insanity  of  pubescence  the  study  of  develop- 
mental insanities  bears  especially  upon  the  subject  of  this  article. 
The  religious  delusions  which  accompany  ma,sturbational  insan- 
ity are  not  necessarily  incurable.  They  are,  however,  liable  to 
become  persistent  and  are  not  readily  amenable  to  treatment. 
They  may  be  considered  incurable  whenever  the  patient  has 
reached  the  stage  of  religious  extravagance,  which  is  surely  in- 
dicative of  mental  deterioration. 

"  The  religious  delusions  of  paranoia  are  essentially  in- 
curable, being  the  legitimate  development  of  a  mental  twist 
and  the  outgrowth  of  an  abnormal  personality.  They  event- 
ually become  thoroughly  assimilated  by  the  mind,  an  integral 
part  of  its  constitution.  During  the  stage  of  persecution  they 
may  at  times  pass  from  the  mind,  but  after  the  stage  of  trans- 
formation they  cannot." 

I  have  quoted  somewhat  fully  from  Tuke,  as  he  clearly  de- 
fines the  delusions  of  a  religious  nature  as  they  appear  in  the 
various  forms  of  insanity,  and  differentiates  those  peculiar  to 
paranoia,  as  shown  in  his  fourth  subdivision. 

EROTIC  PARANOIA — Erotomania — a  form  of  paranoia  in 
which  the  delusion  pertains  to  love  of  the  opposite  sex,  and  is 
usually,  as  Krafft-Ebing  has  said,  directed  toward  one  in  a 
higher  station  in  life,  or  at  least  toward  one  who  has  given  no 
evidence  of  any  knowledge  of  that  person's  existence.  It  is 
essentialy  a  mental  distortion,  the  result  often  of  hallucinations 
and  illusions.  The  slightest  acts  are  given  a  significance:  a 
glance  is  taken  as  directed  toward  them,  etc.,  etc.  Notices  in 
papers  are  construed  into  reference  to  their  relations.  The 


PARANOIA.  279 

object  of  this  affection  may  never  have  been  seen  or  may  not 
be  known,  except  through  the  visual  hallucinations.  This  does 
not  in  any  way  affect  their  belief  in  the  existence  of  the  mutual 
love.  The  laborer  may  become  the  beloved  one  of  the  princess, 
indeed  he  may  be  sought  after.  There  are  always  present  evi- 
dence of  hereditary  taint,  signs  of  degeneration. 

The  course  of  the  disease  is  similar  to  paranoia  in  general, 
differing  only  in  the  special  delusion.  The  exciting  cause  varies, 
often  being  excessive  venery .  Visions  of  a  sexual  character  may 
be  present,  and  this  is  specially  so  where  the  delusion  has  refer- 
ence to  some  exalted  person,  perhaps  never  seen  except  in  public 
prints.  There  is  a  tendency  in  many  of  these  cases  to  develop 
a  delusion  of  a  changed  personality  to  correspond  to  their  exalted 
affections.  The  circumstantial  and  detailed  description  of  their 
own  personality,  and  their  description  of  the  relations  they  have 
with  their  imaginary  loved  ones,  are  remarkable.  This  grows 
in  distinctness  with  time  and  repetition  until  it  has  become 
thoroughly  systematized.  It  is  usually  later  that  the  delusion 
of  persecution  associates  itself  to  this  condition,  after  perhaps 
some  public  exposure  has  led  to  their  apprehension. 

There  may  be  religious  delusions  combined  with  the  eroto- 
mania, and  indeed  sexual  desire  may  not  be  present  to  any 
marked  degree.  There  is  little  attempt  at  .concealment,  nor  is 
there  any  shame  felt.  There  is  the  same  feeling  of  a  special 
call  to  fill  a  mission  as  observed  in  the  class  of  reformers.  The 
evidence  of  mental  weakness  is  apparent. 

There  is  another  class  of  these  cases,  however,  where  appar- 
ently there  are  no  hallucinations  or  illusions  and  in  which  the 
intellectual  field  is  but  little  involved.  The  delusion  is  simply 
one  of  being  loved  and  loving  one  who  has  shown  absolutely 
no  regard  for  them,  or  perhaps  is  not  even  conscious  of  their 
existence  until  their  presence  is  forced  on  them,  or  they  are 
followed  from  place  to  place,  or  various  signs,  letters,  etc.,  are 
constantly  giving  them  proof.  It  is  especially  here  that  the 
delusion  of  persecution  arises,  and  the  obstacles  put  in  the  way 
to  prevent  them  from  seeing  the  object  of  their  affection  are 
ascribed  to  a  conspiracy.  Never  is  the  object  of  the  affection  con- 
sidered a  party  to  this,  but  rather  also  the  victim.  This  at  least  is 
at  first  the  belief;  it  may  finally  take  the  form  of  hatred  to  the 
former  object  of  their  love,  and  result  in  a  desire  for  revenge. 
III.— 20 


280  INSANITY — FISHER. 

These  cases  are  often  dangerous  in  the  extreme,  following  up  their 
threats  with  skill  and  cunning ;  and  being  little  affected  mentally 
except  in  regard  to  this  one  fixed  delusion,  their  judgment  is 
good  in  all  other  respects.  There  is  usually,  however,  evidence 
of  some  mental  weakness.  It  is  often  most  difficult  on  examin- 
ation to  find  any  symptoms  indicating  insanity  Especially  if 
the  patient  is  at  all  suspicious  he  will  talk  pleasantly  and  in- 
telligently on  all  other  subjects,  arid  will  enjoy  his  success  in 
eluding  the  various  questions  put  to  him.  The  most  wary  may 
be  deceived  by  them,  and  even  the  subject  of  their  delusion 
may  be  so  mixed  with  known  facts  as  to  convince  many  who 
are  not  conversant  with  all  the  facts.  It  is  rare  that  they  will 
admit  that  they  are  subject  to  a  delusion  or  will  accept  the 
plea  of  insanity  as  a  defence.  However,  when  in  confinement 
they  may,  for  the  purpose  of  obtaining  their  liberty,  admit 
they  have  been  subject  to  a  delusion  which  they  no  longer 
entertain.  These  statements  are  always  to  be  received  with 
caution,  as,  from  the  opinion  already  given,  their  mental  state 
is  an  incurable  one.  The  recovery  from  a  delusion,  no  matter 
how  dangerous  in  its  character,  in  mania  and  melancholia  may 
be  permanent,  and  its  recognition  by  such  cases  is  often  the  first 
sign  of  a  permanent  restoration  to  mental  health. 

The  well-known  case  of  Dougherty,  who  labored  under  the 
delusion  that  a  celebrated  actress  entertained  feelings  of  regard 
for  him,  illustrates  what  has  been  said.  He  followed  her  from 
place  to  place,  even  to  Europe.  Every  unconscious  movement 
would  be  ascribed  to  some  secret  acknowledgment  by  her  of  his 
regard.  He  was  enabled  by  his  skill  as  a  telegrapher  to  obtain  the 
necessary  means  to  follow  out  his  plans.  Nothing  seemed  to  dis- 
courage him;  he  possessed  the  usual  feeling  of  exaltation  and 
self-satisfaction  peculiar  to  these  cases.  He  at  one  time  ac- 
knowledged that  his  opinion  in  regard  to  her  liking  for  him 
was  an  error,  but  this  was  only  for  a  purpose  of  his  own.  The 
dangerous  character  of  the  man  was  manifested  later  by  his 
murder  of  a  physician  in  the  asylum  to  which  he  had  been  sent. 
His  trial  for  this  act,  however,  resulted  in  conviction,  the  plea 
of  insanity  not  being  accepted.  There  is  no  doubt  that  accord- 
ing to  the  law  as  it  now  stands  the  conviction  was  a  just  one. 
A  clear  knowledge  of  the  right  or  wrong  of  his  act  existed  in 
the  mind  of  the  prisoner;  but  we  have  to  deal  with  a  person  who 


NEURASTHENIA.  281 

does  not  allow  that  question  to  arise  in  his  mind.  His  desire  is 
the  only  thing  which  he  thinks  of,  all  moral  and  physical  obsta- 
cles are  disregarded.  It  is  this  disregard  of  consequences  which 
is  the  strongest  evidence  of  their  insanity,  combined  as  it  often 
is  with  absolutely  impossible  methods  of  accomplishing  their 
ends.  The  question,  however,  of  their  responsibility  before  the 
law  is  one  that  really  belongs  to  the  field  of  sociology. 

INSANITY  FROM   CONSTITUTIONAL    NEUROSES. 

The  various  neuroses  are  described  in  books  on  diseases  of 
the  nervous  system,  and  I  shall  not  describe  them  except  in  so 
far  as  they  bear  on  mental  diseases.  Under  the  head  of  neu- 
roses are  included  the  so-called  functional  diseases,  which  show 
no  structural  or  organic  changes  in  the  organs  which  are 
affected.  We  find  the  same  conditions  in  the  nervous  system. 
There  is  indeed  some  change  due  to  malnutrition,  exhaustion,  or 
some  toxic  agencies,  but  as  3ret  what  these  are  no  investigation 
has  satisfactorily  settled.  As  advances  are  made  in  our  study 
of  disease  this  class  will  be  reduced  in  number,  as  from  the  very 
nature  of  things  disease  cannot  exist  without  an  adequate 
cause.  Epilepsy,  hysteria,  pursuing  as  they  do  a  developmental 
and  chronic  course,  must  be  due  to  some  definite  and  deep-seated 
lesion. 

Neurasthenia. — Nervous  prostration  represents  in  general 
a  lowering  of  the  tone  of  the  cerebro-spinal  system.  It  may  es- 
pecially involve  the  brain  or  the  cord,  in  which  case  the  symp- 
toms all  point  to  functional  rather  than  permanent  or  organic 
disturbance  of  function.  There  is  usually,  however,  an  affec- 
tion of  the  whole  nervous  system,  although  one  part  may  be  more 
involved  than  the  other.  We  may  find  almost  absolute  loss  of 
function,  an  apparently  sudden  inhibition  both  in  the  physical 
and  psychical  fields.  This  inhibition  often,  however,  disappears 
as  suddenly  as  it  arose.  We  see  all  the  evidence  of  vaso-motor 
changes,  temporary,  as  a  rule,  although  at  times  they  pass  on 
into  definite  chronic  states,  ending  in  special  neuroses  resem- 
bling, although  rarely  exactly,  those  previously  described. 

Neurasthenia  must  at  present  be  accepted  as  a  distinct  ner- 
vous state,  and  while  under  its  head  such  conditions  as  hysteria, 
hypochondria,  melancholia,  etc.,  may  be  falsely  included,  as 


282  INSANITY — FISHER. 

many  similar  symptoms  exist  in  all,  yet  despite  this  confusion 
careful  examination  will  show  that  we  have  to  do  with  a  class 
of  symptoms  which,  irregular  and  contradictory  as  they  may 
appear,  go  to  make  an  entity,  as  well  defined  and  positive  as 
other  diseases,  physical  or  psychical.  A  certain  opprobrium 
has  attached  itself  to  the  term  or  rather  to  the  individual 
with  the  disease,  as  in  the  case  of  hysteria,  as  if  the  patient 
were  capable  of  controlling  or  banishing  altogether  the  symp- 
toms he  complains  of.  There  is  also  considerable  confusion  in 
separating  these  latter  conditions  from  each  other.  This  is  not 
so  surprising,  as  they  have  many  symptoms  in  common,  and 
indeed  one  disease  may  engraft  itself  on  the  other  or  become 
associated  with  it. 

Foster  has  defined  neurasthenia  as  "  a  condition  appearing 
in  the  early  and  middle  periods  of  adult  life,  presenting  objec- 
tive symptoms  of  deranged  functions  of  the  nervous  system, 
slight  in  degree  but  definite  in  character,  and  persisting  for 
months,  for  years,  for  life.  There  is  inability  to  walk  more 
than  a  short  distance  without  fatigue ;  a  variable  increase  of 
myotatic  irritability  ;  headache ;  aching  or  pain  in  the  back  and 
legs,  and  spontaneous  sensations  of  tingling,  formication,  heat 
and  cold.  D}rspepsia,  constipation,  and  other  derangements  of 
the  functions  may  result  in  anemia.  There  is  a  mental  phase 
in  the  condition,  the  patient  being  irritable,  unable  to  pursue  a 
consecutive  train  of  thought,  or  there  may  be  a  cheerful,  egotisti- 
cal resignation  to  invalidism.  It  may  be  caused  by  emotional 
or  mental  strain,  worry,  fright,  etc." 

He  further  makes  several  subdivisions  which  more  or  less 
accurately  give  its  symptomatology,  i.e. — cerebral,  cerebro-car- 
diac,  cerebro-gastric,  cerebro-spinal,  gastric,  genito-urinary, 
neuralgic,  spasmodic,  spinal,  vaso-motor,  and  sexual  neuras- 
thenia. 

It  is  rare,  however,  that  we  find  any  one  of  these  forms  dis- 
tinct and  by  itself.  They  are  usually  associated,  the  cerebro- 
spinal  type  being  the  most  common,  with  perhaps  a  predomi- 
nance of  a  certain  class  of  sj7mptoms,  as  spinal  irritation  or  a 
feeling  of  mental  incapacity  and  fear  of  insanity. 

Neurasthenia  is  by  no  means  a  disease  peculiar  to  modern 
times  or  to  any  one  country.  It  has  been  described  by  the  older 
writers,  even  by  the  ancients.  It  has  only  come  more  into 


NEURASTHENIA.  283 

prominence  since  its  symptoms  have  been  more  clearly  grouped. 
There  can  scarcely  be  made  a  differential  diagnosis  between  it 
and  cerebral  and  spinal  irritation.  Its  symptoms  are  multitu- 
dinous and  variable,  but  all  point  toward  exhaustion  and  a  de- 
parture from  normal  reaction.  Their  interest  to  us  lies  in  the 
bearing  they  have  on  mental  disease,  either  as  prodromal  symp- 
toms of  distinct  psychoses  as  melancholia,  general  paralysis, 
epilepsy,  etc.,  or  in  their  relation  to  those  ill-defined  mental 
states  lying  in  the  so-called  borderland  of  sanity,  in  which  im- 
pulses more  or  less  imperative  manifest  themselves.  Here, 
perhaps,  belong  most  properly  all  those  peculiar  mental  disturb- 
ances which  express  themselves  in  fear  of  disease,  frequently 
of  insanity,  of  open  places  (agoraphobia),  of  closed  places  (or 
claustrophobia),  etc.  We  shall  describe  these  conditions  later 
under  this  heading.  These  symptoms  may  pass  beyond  mere 
eccentricity  into  permanent  states,  which  must  be  regarded  88  a 
true  degenerative  condition. 

Neurasthenia  may  be  regarded  as  a  degenerative  state,  at 
least  in  the  chronic  forms.  It  is  more  often  congenital  or 
hereditary  than  acquired.  We  have,  in  other  words,  a  predis- 
position to  disease,  a  soil  in  which  exciting  causes  as  worry, 
mental  strain,  shock,  excesses,  alcoholism,  etc.,  have  an  effect 
not  resulting  in  the  healthy.  The  most  common  exciting  causes 
are  overstrain,  physical  and  mental,  associated  with  domestic 
or  financial  loss.  Shock  from  an  accident,  whether  accom- 
panied by  actual  physical  injury  or  not,  may  precipitate  the 
sudden  or  gradual  onset  of  nerve  exhaustion.  Disappointment 
in  the  affections  or  in  the  attainment  of  some  much  wished- 
for  position  may  excite  in  a  constitution  predisposed,  either 
from  hereditary  taint  or  from  long-continued  overwork  to  dis- 
ease, this  tendency  to  an  absolute  collapse.  It  is  not  infre- 
quent to  find  such  conditions  result  in  unsuccessful  candidates 
for  high  political  position;  again,  in  the  young  after  the 
excitement  and  exhaustion  consequent  upon  the  severe  ordeal 
of  an  examination.  Shock  of  any  kind  is  a  very  common 
cause,  as  has  been  said.  The  frequent  trials  for  damages  in 
our  courts  have  done  much  to  develop  an  extensive  literature 
concerning  the  consequences  of  such  occurrences  on  the  nervous 
system.  Some  cases  of  interest  have  arisen  in  which  claims 
have  been  made  against  the  telegraph  companies  in  which  there 


284  INSANITY— FISHER. 

has  been  neglect  or  failure  in  conveying  the  proper  message, 
resulting  in  a  shock  to  the  recipient.  Death  may  result  in  some 
instances ;  truly  it  is  natural  to  expect  some  effect  tending  to 
disease  of  a  serious  nature. 

A  gentleman  under  my  observation  was  present  in  an  accident  on  a 
railway  in  France.  His  car  was  not  involved  in  the  wreck,  and  he 
was  very  active  in  rescuing  and  aiding  the  injured.  He  continued  his 
journey,  and  it  was  not  for  some  time  that  symptoms  of  a  nervous 
character  manifested  themselves.  He  became  timid  while  travelling, 
and  would  have  recalled  to  his  remembrance  all  the  horrors  of  the  scene, 
were  there  the  slightest  delay  on  the  train  he  was  travelling  on.  This 
gradually  developed  into  a  fixed  morbid  fear  of  travelling,  and  later  he 
became  a  distinct  example  of  neurasthenia. 

Exhaustive  diseases  associated  with  pain,  especially  if  much 
sleep  is  lost,  are  prone  to  result  in  this  disease.  Loss  of 
sleep  is  indeed  one  of  the  most  marked  symptoms  of  neuras- 
thenia; it  is  also  one  of  the  commonest  causes  of  it.  Venereal 
excess,  especially  masturbation,  is  often  the  basis  of  the  exhaus- 
tion of  the  nervous  system,  and  when  this  is  the  cause  it  gives 
rise  to  a  form  of  neurasthenia  peculiar  in  itself,  and  may  indeed 
be  the  origin  of  many  of  the  cases  of  sexual  perversion. 

The  symptoms  peculiar  to  neurasthenia  are  essentially  cere- 
bral and  spinal,  and  the  latter  are  in  fact  subordinate  to  the 
former. 

*  While  neurasthenia  is  protean  in  its  manifestations,  there 
are  still  certain  symptoms  rarely  in  default,  which  for  this 
reason  have  been  called  by  Charcot  neurasthenic  stigmata. 
These  are :  a  special  form  of  headache  (casque  neurasthenique) 
and  a  sensation  of  emptiness  in  the  head ;  insomnia  and  disturbed 
sleep ;  psychic  adynamia ;  motor  enfeeblement ;  spinal  hypera3s- 
thesia,  and  rhachialgia  with  points  of  election  (plaque  cervicale, 
plaque  sacree,  and  coccygodynia) ;  gastro-intestinal  atony ;  geni- 
tal and  vaso-motor  disorders"  (E.  Regis,  "Practical  Manual 
of  Mental  Medicine") . 

In  our  study  of  the  disease  especial  reference  only  will  be 
given  to  the  mental  symptoms.  Such  patients  complain  of  a 
feeling  of  loss  of  mental  power,  especially  the  power  of  concentra- 
tion upon  any  given  subject.  They  cannot  read  because  their 
attention  soon  wanders,  or  they  experience  great  fatigue.  They 
are  unable  to  carry  on  their  usual  business,  either  from  some 


NEURASTHENIA.  285 

cause  as  mentioned  above  or  a  fear  that  they  will  be  unable  to 
do  so  correctly.  An  almost  insane  dread  of  meeting  business 
or  social  friends  exists.  The  idea  of  an  appointment,  the  antici- 
pation of  it,  will  often  be  sufficient  to  start  up  a  train  of  symp- 
toms, in  which  there  is  aspecially  shown  a  loss  of  will  power, 
even  to  the  extent  of  absolute  motor  inability.  The  emotional 
state  is  also  very  much  affected,  as  shown  by  a  tendency  to  burst 
into  tears,  or  even  laughter;  this  is  not  really  based  on  any  true 
grief  or  joy,  but  seems  to  be  something  outside  of  themselves. 
There  is  usually  a  tendency  to  irritability  and  anger  on  slight 
provocation. 

This  state  is  fully  recognized  by  the  patients,  who  are  usually 
introspective  and  love  to  talk  over  their  various  mental  changes. 
Depression  even  to  extreme  melancholia  is  not  uncommon  as  . 
a  result  of  morbid  fear  of  losing  their  minds.  They  make  con- 
stant threats  of  suicide,  or  fear  that  they  will  commit  such 
an  act.  In  fact  such  attempts  are  often  made,  but  usually  with 
no  full  intention  of  carrying  them  out.  There  is  always  a  fixed 
idea  present  which  has  special  reference  to  their  mental  con- 
dition. They  constantly  assert  that  they  can  bear  any  amount  of 
pain  if  they  could  only  get  rid  of  the  peculiar  feeling  of  oppres- 
sion and  weight  in  the  head,  and  of  the  feeling  of  absolute  loss 
of  mental  power  and  ability  to  exercise  their  will.  Under 
special  excitement,  or  if  carried  away  by  the  necessity  of  action, 
or  even  in  extreme  pleasure,  they  find  themselves  capable  of 
carrying  on  plans  or  doing  things  involving  great  fatigue. 
The  reaction  in  these  instances  is  often  extreme  when  the 
necessity  for  exertion  is  removed. 

The  intellectual  faculties  are  rarely  involved,  the  memory  is 
not  impaired.  When  the  interest  is  awakened  they  will  remem- 
ber all  the  details  and  every  direction  given  by  the  physician, 
and  if  they  have  faith  in  him,  will  depend  on  and  carry  out 
with  exactitude  all  his  directions. 

Hallucinations,  illusions,  and  delusions  are  rare,  nor  do  we 
find  a  tendency  to  development  into  such  forms  of  mental  dis- 
ease characterized  by  them.  They  seem  to  be  subject  to  im- 
pulses, to  doubts  and  fears,  which  occur  suddenly.  Under  cer- 
tain impulses  they  may  be  able  to  walk  miles  without  fatigue; 
there  is,  in  fact,  rarely  any  actual  motor  weakness.  At  another 
time  the  sense  of  motor  weakness  is  so  extreme  that  they  may 


286  INSANITY — FISHER. 

collapse  before  going  half  a  block,  and  find  themselves  in- 
capable of  proceeding  another  step.  These  functional  motor 
disturbances  are  shown  also  in  various  spasms  of  the  muscles, 
especially  of  the  face;  or  of  the  eyes,  in  frequent  winking,  or 
of  the  corners  of  the  mouth.  This  may  indeed  involve  the 
whole  body.  This  is  especially  so  if  attention  is  drawn  to  it. 
It  becomes  indeed  a  habit,  at  first  voluntary,  but  later  it  becomes 
more  or  less  involuntary.  The  tremor  of  the  hands  is  often 
shown  in  their  inability  to  perform  any  act  requiring  skill ; 
especially  is  this  seen  in  writing.  The  mere  attempt  to  write 
excites  a  feeling  of  mental  and  physical  fatigue,  although  the 
ability  to  dictate  a  rational  letter  may  not  be  impaired. 

The  muscular  system  is  not  impaired,  unless  indeed  the 
health  has  been  so  much  affected  as  to  confine  the  patient  to 
the  house  or  bed. 

Associated  with  these  mental  and  motor  disturbances  there 
is  much  sensory  disturbance.  HyperaBsthesia  or  pain  exquisite 
in  its  character  may  affect  the  head,  and  involve  one-half  of  the 
cranium,  or,  as  is  more  common,  remain  limited  to  the  vertex 
or  base.  This  may  often  be  only  dull  in  character,  a  feeling  of 
weight  at  the  base  of  the  brain.  Pain  is  widely  distributed 
along  the  spine,  and  over  various  regions  as  the  heart,  kidneys, 
ovaries,  and  even  in  the  bones.  Pressure  may  elicit  consider- 
able pain,  sometimes  very  extreme.  Anesthesia,  loss  of  sensa- 
tion, is  not  uncommon;  a  feeling  as  if  the  parts  were  dead. 
This  may  follow  certain  lines,  as  one-half  of  the  body,  or  over 
given  areas.  Rarely  in  examination  do  we  find  any  objective  loss 
of  sensation  to  the  various  tests  of  heat,  cold,  pain,  or  touch. 

The  symptoms  are  largely  subjective.  Vaso-motor  disturb- 
ance is  common.  Sudden  congestion  or  analgesia  of  the  head  or 
spine  may  cause  vertigo,  a  sense  of  fulness,  or  a  tendency  to 
syncope.  The  pulse  corresponds  to  this  condition,  so  that  we 
find  marked  variations  in  it,  from  a  slow  to  a  rapid  one,  with 
intermittence.  These  attacks  are  accompanied  by  a  feeling 
of  impending  death. 

Insomnia  is  perhaps  one  of  the  most  characteristic  symp- 
toms, and  the  one  which  tends  to  aggravate  all  the  mental 
symptoms  defined.  Even  when  sleep  is  present,  it  is  usually 
accompanied  by  dreams  of  a  distressing  character,  and  there  is 
no  fee/ ing  of  rest  on  waking.  The  interest,  in  a  medico-legal 


NEURASTHENIA.  28? 

sense,  in  these  cases  arises  when,  perhaps,  unreasonable  antip- 
athy or  excessive  friendship  is  present,  which  has  influenced 
the  individual  perhaps  unduly  in  his  testamentary  capacity ;  or, 
again,  in  criminal  procedure  the  question  of  responsibility  may 
present  itself. 

Many  acts  of  these  cases  are,  as  we  have  said,  impulsive  in 
character,  often  imperative  indeed.  Not  infrequent!}*,  especially 
when  there  is  a  sexual  element  in  the  form  of  neurasthenia  we 
have  to  deal  with,  there  exists  an  almost  irresistible  tendency  to 
some  overt  and  often  indecent  act.  We  will  consider  this  in 
more  detail  under  a  special  head.  This  disease  belongs  to  the 
class  of  degenerations,  and  has  much  in  common  with  paranoia, 
especially  in  the  presence  of  a  fixed  idea.  It  is,  however,  not 
as  logical  in  its  development,  and  although  at  times  there  is  an 
accompanying  delusion  of  persecution,  it  is  rare.  The  fluctuat- 
ing character  of  the  symptoms,  the  physical  signs  of  physical 
exhaustion  and  pain,  are  absent  in  paranoia.  The  anxiety  and 
depression  are  quite  foreign  to  paranoia,  in  which  indeed  we 
usually  find  a  spirit  of  egotism  and  self -appreciation. 

The  prognosis  is  usually  good.  There  is,  however,  a  possi- 
bility of  termination  in  one  of  the  well-defined  mental  diseases, 
especially  mania  or  melancholia,  with  homicidal  and  suicidal 
intent. 

It  does  not  usually  take  the  form  of  insanity  with  delusions, 
but  rather  that  of  melancholia  with  complete  loss  of  hope  of  re- 
covery. There  is  usually  the  desire  to  recover,  but  the  constantly 
present  dread  of  becoming  insane  may  result  in  some  overt  act. 

Tuke  refers  to  neurasthenia  as  being  a  prodromal  stage  in 
general  paralysis.  This  may  be  so,  but  is  probably  rare. 

One  such  patient  has  been  under  my  observation : 

Male,  set.  27,  a  butcher  by  occupation.  His  history  was  negative,  ex- 
cept that  he  had  been  overworked ;  he  was,  however,  very  successful  and 
accumulated  considerable  money.  He  became  sleepless  and  finally 
anxious  about  himself,  and  unable  to  attend  to  his  business,  which  in- 
creased his  anxiety.  He  feared  that  he  was  losing:  his  mind.  A  year 
later  he  showed  the  symptoms  of  a  typical  case  of  general  paresis.  He 
became  happy  and  self-satisfied,  considered  himself  perfectly  well,  and 
in  no  way  troubled  himself  about  his  business. 

There  could  be  no  greater  contrast  than  that  between  the 
previous  mental  state  and  its  termination. 


288  INSANITY — FISHER. 

Hysterical  Insanity. — Hysteria  is  essentially  a  disease 
in  which  degeneration  is  the  most  prominent  feature.  We  are 
unable  to  point  out  the  pathological  changes  in  the  brain  which 
account  for  the  symptoms.  We  class  it,  therefore,  as  a  func- 
tional disturbance.  Perhaps  no  condition  involves  so  completely 
the  whole  nervous  system  as  hysteria.  It  manifests  itself,  there- 
fore, by  both  physical  and  mental  symptoms.  The  former  are 
multitudinous,  simulating  all  other  diseases.  The  multiplicity 
of  the  symptoms  is,  to  a  certain  extent,  a  point  of  diagnosis; 
their  shortness  of  duration  and  their  sudden  disappearance  are 
as  significant.  We  have  noticed  this  same  characteristic  in 
neurasthenia,  the  two  conditions  having  indeed  much  in  com- 
mon ;  often  indeed  we  find  them  combined. 

In  hyteria  we  have  to  do  with  great  instability  of  the  ner- 
vous system ;  a  slight  cause  may  initiate  marked  mental 
symptoms.  Despite,  however,  the  multiplicity  of  the  symptoms 
there  is  a  certain  uniformity  about  them,  which  more  or  less 
clearly  defines  them. 

The  line  between  hysteria  and  hysterical  insanity  is  not 
always  easy  to  draw.  We  find  the  emotions  more  affected  than 
the  intellect,  and  therefore  the  acts  are  of  the  impulsive  type. 

The  most  important  element  in  the  causation  of  hysteria  is 
heredity — either  of  hysteria  itself  or  the  various  neuroses  as 
epilepsy,  chorea,  etc.,  or  insanity.  It  is  not  rare  to  find  in  the 
descendants  of  the  insane  various  functional  diseases  of  the 
nervous  system  manifesting  themselves,  and  among  others  this 
form  of  nervous  instability.  The  exciting  causes  are  various — 
any  shock,  whether  traumatic  or  emotional,  as  fear,  domestic 
loss,  financial  stress,  disappointment  in  the  affections,  exhaus- 
tion from  disease,  as  fever,  loss  of  blood  inducing  anemia, 
chlorosis,  sexual  excess,  onanism,  etc. 

Hysteria  is  most  common  in  young  females  about  the  age 
of  puberty,  but  may  occur  in  the  more  advanced  in  life,  even 
ir deed  at  the  menopause;  or,  again,  in  children,  although  much 
more  rarely.  It  is  observed  also  in  men. 

The  typical  forms,  as  described  by  Charcot  and  other  French 
writers,  are  not  so  common  in  this  country  or  in  England. 
Such  cases  present  all  the  physical  signs  of  the  disease,  as 
hemianaBsthesia;  hemiplegia,  usually  unassociated  with  wasting 
of  the  muscles;  contractures,  tremors,  choreiform  in  character; 


HYSTERICAL  INSANITY.  88fl 

unilateral  loss  of  vision,  taste,  etc.  There  is  usually  also  great 
Taao-motor  disturbance,  cardiac  palpitation,  unilateral  sweating 
associated  with  heat  or  cold  of  the  extremities  This  class  of 
symptoms  is  often  very  definite,  but  usually  we  find  the  anses- 
thesia  is  but  partial. 

The  paralysis,  when  present,  whether  hemiplegic  in  type  or 
paraplegic,  is  too  absolute  and  complete  to  render  a  diagnosis 
as  a  rule  difficult.  Still  the  previous  history  of  other  attacks 
is  the  most  important  fact  in  establishing  an  absolute  diagnosis. 
Outside  of  the  general  physical  condition  which  we  have 
described  are  the  convulsive  seizures,  so  common  in  this  dis- 
ease. They  are  frequently  epileptoid  in  character,  and  when  so 
we  have  a  condition  called  hystero-epilepsy,  which  is  essen- 
tially hysteria,  however.  A  special  characteristic  of  these 
convulsive  seizures  is  that,  as  a  rule,  the  patient  appreci- 
ates their  onset  and  therefore  receives  a  warning  more  often 
than  in  epilepsy.  I  believe,  however,  that  these  attacks  are 
as  impossible  to  check  on  the  part  of  the  individual  as  are  true 
epileptic  seizures.  They,  however,  are  usually  able  to  get  to 
a  place  of  safety  before  the  onset  of  the  attack,  although  this 
is  not  always  the  case.  The  convulsions  in  hysteria  of  the 
milder  or  more  usual  form  differ  from  those  of  epilepsy  in 
that  they  are  irregular.  There  may  be  rapid  clonic  convulsion, 
limited  to  one  side,  or  one  hand,  or  to  both  feet ;  more  rarely 
there  is  a  sudden  fall,  followed  by  clonic  and  tonic  convulsions. 
A  complete  loss  of  consciousness  is  rare.  Patients  will  gener- 
ally remember  what  has  occurred,  and  recall  those  who  have 
been  present.  Following  the  attack,  as  a  rule,  there  is  not 
present  the  tendency  to  sleep  which  usually  occurs  in  epilepsy. 

A  distinct  mental  state  is  present,  which  manifests  itself  by 
excessive  talking,  crying,  or  laughing,  showing  that  cerebral 
excitement  is  present.  Especial  emotional  states  may  show 
themselves  by  the  attitude  assumed  by  the  patients,  as  that  of 
prayer,  of  fear,  etc.  These  attacks  may  continue  for  several 
hours,  and  are  not  infrequently  followed  by  a  mental  condition 
of  confusion,  lasting  usually  but  a  few  hours  or  again  for  days. 

The  severe  form  or  hysteria  major  is,  as  I  have  said,  rare 
in  this  country.  Charcot  describes  three  stages  of  the  convul- 
sive attacks,  first  the  epileptoid,  resembling  very  closely  an 
ordinary  epileptic  seizure;  second,  one  in  which  we  have  ex- 


290  INSANITY — FISHER. 

treme  opisthotonos,  pleurosthotonos,  or  emprosthotonos ;  and  a 
third  stage  in  which  there  is  less  of  the  convulsive  character 
but  mental  symptoms  are  more  marked. 

There  is  excitement,  as  shown  by  the  tendency  to  talk  or 
sing,  or  to  assume  special  attitudes  indicative  of  certain 
emotions.  There  is  little  difference  in  their  forms  except  in  the 
character  of  the  convulsive  seizures.  We  may  find  the  convul- 
sive stage  entirely  absent,  there  being  only  successive  attacks  of 
mental  excitement,  a  true  maniacal  seizure,  which  may  require 
restraint.  These  attacks  may  occur  several  times  during  the 
twenty-four  hours  and  continue  for  weeks.  We  frequently 
observe  a  religious  or  an  erotic  element  in  their  conversation 
and  their  attitudes.  There  is  no  absolute  loss  of  consciousness 
of  what  they  are  doing  or  saying,  although  it  is  beyond  their 
control.  They  are  frequently  obscene  in  their  language,  and 
show  signs  of  lasciviousness. 

These  acute  attacks  of  hysterical  mania  may  be  absent,  there 
being  simply  a  mental  condition  which  by  its  general  symp- 
toms of  emotional  instability,  unreasonableness,  selfishness, 
jealousy,  and  tendency  to  quarrel  with  every  one,  defines  itself 
as  hysteria. 

In  women  all  these  states  are  increased  at  the  menstrual 
epochs;  especially  is  this  the  case  when  sexual  ideas  are  present. 
There  may  be  excessive  masturbation  at  these  periods.  This 
element  increases  and  prolongs  the  mental  excitement.  This  is 
shown  by  the  following  case : 

Miss  L.,  aet.  17,  a  modest  and  accomplished  young  woman,  is  subject  at 
her  menstrual  periods  to  attacks  maniacal  in  character.  She  becomes 
suddenly  excited,  usually  at  night,  and  is  aroused  from  her  sleep  by- 
some  fright ;  she  cries  out,  talks  upon  innumerable  subjects,  has  no 
convulsions,  but  has  to  be  restrained  owing  to  her  incessant  movements. 
She  has  such  a  sense  of  genital  irritation  that  she  resorts  to  masturbation, 
which  she  is  unable  to  refrain  from.  These  attacks  are  followed  by 
a  condition  of  extreme  exhaustion,  lasting  several  hours  to  several 
days,  in  which  she  seems  to  be  unable  to  appreciate  what  is  going  on 
around  her.  These  attacks  may  pass  into  cataleptic  or  trance  states, 
lasting  for  days  and  weeks. 

In  an  Italian  boy  brought  to  the  hospital  in  an  apparently  uncon- 
scious state,  we  watched  carefully  for  any  sign  of  simulation  or  fraud. 
There  seemed  to  be  almost  complete  anaesthesia — a  needle  could  be 
passed  through  the  fleshy  part  of  his  leg  or  arm  without  apparent 


HYPOCHONDRIACAL  INSANITY.  291 

feeling  on  his  part.  Any  position  in  which  his  arm  or  leg  was  placed 
remained  fixed  for  a  long  time,  no  matter  how  uncomfortable  it  might 
be.  Carefully  watched,  he  would  lie  for  hours  in  the  same  position,  the 
respirations  being  shallow  and  infrequent.  There  seemed  to  be  no  de 
sire  for  food,  which  was  never  voluntarily  taken.  Having,  however, 
stopped  feeding  him  by  force,  and  all  food  having  been  removed,  he 
was  observed  one  night  to  rise  from  his  bed  and  get  some  articles  of 
food  from  tables  of  the  other  patients. 

This  case  corresponds  to  those  which  have  been  reported  of 
the  trance  state,  fasting  mania,  etc.  Careful  investigation  will 
usually  show  that  there  is  more  or  less  simulation  and  fraud 
connected  with  them.  There  is  without  doubt  a  true  condition 
of  partial  loss  of  consciousness  similar  to  the  hypnotic  state. 

In  the  constitutionally  hysterical  temperament,  which  is  a 
fixed  condition  and  in  which  paroxysmal  seizures  are  absent, 
melancholia  is  more  common  than  mania.  Suicidal  impulses 
are  common ;  attempts  are  frequently  made  or  at  least  threatened. 
They  may  indeed  be  carried  out,  though  rarely.  These  pa- 
tients become  very  depressed  and  possessed  with  the  fear  of  go- 
ing insane,  or  indeed  of  killing  themselves  or  others.  Halluci- 
nations or  delusions  are  rare,  nor  is  the  depression  of  the  same 
character  as  in  melancholia.  There  is  not  unusually  present  the 
feeling  of  self-condemnation.  In  children  hysterical  attacks  are 
not  uncommon  and  may  be  associated  with  epileptic  seizures. 
We  may  observe  true  hysterical  contractures,  anaesthesia,  par- 
alysis, etc. 

The  attacks  of  crying,  laughing,  vomiting,  barking,  using 
obscene  language,  etc.,  are  essentially  hysterical.  There  is  fre- 
quently present,  even  in  these  young  cases,  simulation  or  at  least 
exaggeration.  , 

It  is  among  this  class  we  find  cases  of  pyromania,  or,  again, 
when  a  sexual  element  is  present,  accusations  of  assault  may 
be  falsely  made.  In  fact  many  cases  of  impulsive  insanity,  so 
called,  have  a  hysterical  basis. 

Hypochondriacal  Insanity. — In  this  disease  we  have  a 
condition  which  has  passed  beyond  the  feeling  of  anxiety  and 
depression  in  regard  to  some  bodily  disease  they  may  have,  to  a 
fixed  idea  which  cannot  be  removed.  It  resembles  in  many 
respects  neurasthenia,  and  yet  differs  from  it  in  that  there  is 
greater  concentration  on  the  personal  condition.  The  same 


292  INSANITY — FISHER. 

may  be  said  in  regard  to  melancholia ;  in  both  we  have  marked 
depression,  but  in  the  latter  it  is  caused  by  the  thoughts  or  de- 
lusions which  may  be  present  in  the  mind,  while  in  hypochon- 
dria it  is  due  to  the  actual  or  imagined  disease  of  some  organs 
of  the  body.  In  most  of  these  cases  there  is  a  special  delight  or 
at  least  a  feeling  of  necessity  to  describe  all  the  individual 
symptoms  of  their  disease.  The  tongue,  pulse,  digestion,  etc., 
are  carefully  and  anxiously  observed. 

The  condition  is  generaUy  observed  in  those  with  a  predis- 
position to  disease  of  the  nervous  system,  especially  those  heredi- 
tarily affected.  It  may  lead  to  a  mental  condition  which  com- 
pletely inhibits  all  ability  to  do  anything  except  to  think  and 
talk  of  their  illness.  The  depression  may  become  so  extreme  as 
to  lead  to  suicide.  We  at  least  observe  great  loss  of  will  power 
and  inability  to  concentrate  the  attention. 

Many  of  these  fixed  ideas  of  hypochondria  refer  themselves 
to  sensations  in  the  brain.  Every  feeling  of  fulness  or  pain  in 
the  head  is  dwelt  upon.  There  is  a  feeling  of  complete  inabil- 
ity to  fix  the  attention  on  anything.  Reading  or  writing  causes 
complete  exhaustion  or  pain  at  the  vertex  or  more  usually  at 
the  back  of  the  neck. 

Subjective  sensations  are  common.  The  patient  will  com- 
plain that  he  can  feel  the  blood  ah1  coming  away  from  his  brain. 
He  feels  certain  that  he  will  become  insane,  that  his  brain  is 
dead,  and  so  forth.  These  feelings  are  not  infrequently  ex- 
cited by  what  has  been  read,  especially  is  this  so  if  masturba- 
tion has  been  practised  at  any  time.  This  class  of  patients  cor- 
responds closely  to  those  of  sexual  neurasthenia. 

The  most  bizarre  yet  fixed  beliefs  may  exist,  however. 

A  young  man  under  my  observation  maintained  that  one-half  of  his 
face  was  constantly  getting  smaller.  This  prevented  him  from  keep- 
ing at  his  work,  and  finally  he  went  voluntarily  into  an  asylum  for  a 
year.  During  this  period  careful  measurements  were  taken,  which  con- 
clusively showed  that  there  was  no  difference  between  the  two  sides 
of  his  face.  He  remained  under  my  care  for  some  time,  but  no  argu- 
ment could  convince  him  of  the  truth  of  the  facts. 

Hypochondriasis  in  connection  with  the  digestive  organs  is 
very  common — there  may  be  fixed  ideas  of  disease  of  the  stom- 
ach or  intestines.  There  is  frequently  a  feeling  that  the  physi- 


EPILEPTIC   INSANITY.  293 

cian  is  deceiving  them.  The  depression  is  often  excessive,  pre- 
venting all  attempts  at  occupation.  Sleep  and  general  nutrition 
are  interfered  with.  Any  new  disease  is  readily  taken  up  by 
some  of  these  cases. 

Suicide  is  not  rare.  Hypochondriasis  in  regard  to  the  sex- 
ual organs  is  frequently  present  in  the  young,  more  especially 
among  men.  There  is  usually  a  history  of  masturbation.  The 
fear  of  im potency  soon  arises,  the  organs  are  felt  to  be  under- 
going atrophy ;  the  penis  is  usually  felt  to  be  cold.  This  may 
occur  about  the  time  when  marriage  is  contemplated  or  may 
have  no  reference  to  it.  It  was  clearly  illustrated  in  a  patient, 
a  professional  man,  who  gave  a  history  of  marked  venereal 
excess  of  all  kinds.  He  had  married  and  had  nine  children,  but 
was  possessed  with  the  fixed  idea  that  his  organs  were  under- 
going atrophy.  The  importance  of  the  mental  condition  con- 
sisted in  the  depression  associated  with  it  and  the  tendency  to 
suicide. 

EPILEPTIC    INSANITY,     OR    MENTAL    DISEASE    IN 
EPILEPSY. 

I  would  here  follow  the  definition  given  by  W.  Bevan  Lewis 
in  his  recent  work  on  mental  disease,  viz. :  "  Epileptic  insanity 
is  that  form  of  mental  derangement,  in  the  antecedent  history, 
the  oncome,  and  further  development  of  which  we  recognize  an 
intimate  connection  with  the  epileptic  neurosis." 

Cullere  defines  epilepsy  as  a  convulsive  neurosis  character 
ized  by  intermittent  attacks  of  short  duration  and  variable  in- 
tensity, and  accompanied  by  a  sudden  loss  of  consciousness  and 
generally  by  mental  disease  (see  Cullere,  p.  419). 

The  tendency  of  epilepsy  is  toward  dementia.  The  vari- 
ations in  its  course  are  those  found  in  all  mental  disease — that  is, 
the  periods  of  excitement  and  of  depression  either  alternating 
the  one  with  the  other  or,  almost  as  in  circular  insanity,  one 
following  the  other.  There  is  likewise  a  special  tendency  to 
hallucinations,  illusions,  and  delusions,  but  they  have  nothing 
about  them  which  is  characteristic  of  epilepsy  proper.  Any 
distinction  between  epilepsy  per  se  and  epileptic  insanity  is 
difficult,  if  not  impossible,  since,  pathologically,  we  have  the 
same  ill-defined  condition  present  in  which,  as  Lewis  has  well 


294  INSANITY — FISHER. 

said,  the  question  must  often  be  asked  in  an  asylum,  why  is 
such  a  patient  confined?  Indeed,  we  find  many  in  whom  epi- 
leptic seizures  occur  only  at  long  intervals  and  whose  condition 
in  the  interparoxysmal  state  is  apparently  normal,  yet  during 
the  paroxysms  they  are  maniacal,  melancholic,  or  are  pos- 
sessed of  some  strong  delusion,  and  are  not  infrequently  subject 
to  marked  hallucinations  and  illusions  of  the  special  senses, 
either  preceding  or  following  the  seizure. 

In  our  study  of  epileptic  insanity  we  must  proceed  on  the 
same  lines  as  in  that  of  the  neurosis  itself;  in  fact,  insanity  is 
a  mental  condition  to  which  all  epileptics  are  liable,  and  prob- 
ably no  cases  exist  in  which  there  is  not  more  or  less  mental 
impairment  present.  This  subject  is  one  of  great  importance, 
because  perhaps  no  line  of  defence  is  more  frequently  adopted 
than  the  claim  that  there  has  been  a  history  of  epilepsy  in  the 
individual  under  examination.  It  is  certainly  very  difficult  to 
come  to  a  conclusion  as  to  whether  at  the  time  of  the  commis- 
sion of  the  act  the  person  was  influenced  or  under  the  control 
of  some  fixed  delusion  which  was  well  defined  at  the  time. 

It  is  perhaps  advisable,  where  a  positive  history  of  epileptic 
seizure  is  obtainable,  to  mitigate  the  punishment  for  the  crime, 
while  not  allowing  the  criminal  to  be  held  as  absolutely  irre- 
sponsible. 

While  some  examples  of  great  mental  brilliancy  no  doubt 
present  themselves  to  the  experience  of  all  among  epileptics,  the 
great  majority  show  at  least  some  evidence  of  moral  or  mental 
deterioration.  In  this  disease,  as  in  other  forms  of  insanity,  we 
find  the  higher  moral  qualities  are  the  ones  first  affected,  so  that 
on  the  ethical  side  of  the  character  the  loss  is  most  marked.  The 
patient  becomes  more  or  less  brutal,  the  face  often  shows  a  loss 
of  the  finer  elements,  and  the  emotional  state  becomes  so  unsta- 
ble that  the  individual  is  uncertain,  impulsive,  and  suspicious. 
As  a  diagnostic  point  of  a  true  epileptic  seizure  perhaps  the  most 
important  is  the  suddenness  of  the  onset  of  the  attack,  associ- 
ated with  complete  loss  of  consciousness  and  convulsive  seizures, 
general  or  localized.  The  complete  loss  of  the  reflexes,  as  seen 
in  the  pupil,  in  the  conjunctival  response,  and  knee  jerk,  as 
well  as  the  loss  of  reflex  control  over  the  bladder  and  rectum, 
causing  unconscious  urination  and  defecation,  are  additional 
points  of  value  in  the  diagnosis.  No  one  of  these,  however,  can 


EPILEPTIC   INSANITY.  2'J5 

be  held  as  of  supreme  importance;  their  association  is  princi- 
pally of  value. 

We  have  considered  two  forms  or  groups  of  epileptics :  those 
in  whom  the  symptoms  are  dependent  upon  a  general  nervous  dis- 
order— in  other  words,  so-called  idiopathic  epilepsy — and  those 
whose  disorder  depends  upon  some  local  brain  lesion,  either  trau- 
matic or  degenerative.  The  first  class  more  properly  belongs  to 
mental  disease,  although  in  the  second  class  the  symptoms  are 
often  not  dissimilar  from  those  observed  in  the  neurosis  proper. 

The  first  group  will,  therefore,  present  in  many  instances  a 
bad  hereditary  history,  so  that  either  in  the  parent  or  collateral 
branches  epilepsy  or  other  neuroses — insanity  or  alcoholism — 
will  be  present;  in  fact,  the  descend  ants  of  epileptics  themselves 
may  present  these  various  disorders  rather  than  that  special 
neurosis.  The  proportion  of  insane  in  our  asylums  with 
epilepsy  as  a  cause  is  very  large.  In  England,  out  of  14,336  pa- 
tients admitted  to  the  various  asylums  in  the  year  1887,  there 
were  1,294  epileptics,  of  whom  777  were  men  and  517  women, 
or  about  nine  per  cent.  The  appearance  of  epileptic  seizures 
among  the  insane  is  of  very  frequent  occurrence,  especially  in 
general  paresis ;  the  distinction,  however,  between  the  neurosis 
proper  and  these  irregular  attacks  is  to  be  observed.  The 
maniacal  condition  may  precede  the  epileptic  seizure  or  may  fol- 
low it.  It  very  often  precedes  the  attack.  For  several  hours, 
days,  or  even  weeks  a  peculiar  mental  state  may  be  observed  in 
these  patients  which  is  noted  by  the  attendants  as  premonitory 
of  a  series  of  attacks.  They  may  be  of  the  nature  of  hallucina- 
tions, and  often  those  associated  with  the  special  sense  of  smell 
or  taste,  or  of  hearing  or  sight.  Not  infrequently  the  same  kind 
of  hallucinations  precedes  each  attack,  and  this  is  especially  in- 
dicative of  some  localized  lesion  as  the  seat  of  the  disease. 
Delusions  may  follow  and  be  founded  on  these  hallucinations, 
and  it  is  especially  on  this  account  that  these  patients  are  danger- 
ous. The  wildest  mania  may  be  the  result;  it  is  more  usually 
homicidal  than  suicidal  in  type.  There  is  a  special  tendency 
to  the  so-called  form  of  moral  insanity  in  these  cases.  The 
most  purposeless,  impulsive,  and  cruel  acts  are  committed  by 
them  at  times;  indeed,  the  crimes  resemble  not  infrequently 
those  committed  by  paranoiacs  which  from  time  to  time  startle 
the  world.  As  a  rule,  they  have  no  recollection  of  the  acts  com- 
III.—  21 


296 


INSANITY — FISHER. 


mitted  on  returning  to  consciousness  a  double  consciousness 
existing  in  many  of  these  cases. 

F.  M.  (Fig.  24),  set.  45,  female  (colored),  has  tendency  to  become  ex- 
cited and  maniacal.  Expression  of  the  face  indicates  sullenness  and 
obstinacy. 

In  the  milder  forms  of  mental  aberration  long  journeys  have 
been  taken  by  such  persons,  and  even  business  has  been  trans- 
acted without  there  being  any  observable  peculiarity  in  their 
actions,  and  on  returning  to  consciousness  they  have  been  sur- 
prised at  their 
new  surround- 
ings. One  should 
be  cautious  in 
forming  opinions 
in  regard  to  the 
statements  made 
by  the  patient ; 
the  motive  must 
always  be  care- 
fully investigat- 
ed, as  this  disease 
may  be  claimed 
simply  as  a  cloak 
for  various  cri  mes 
which  have  been 
committed.  Al- 
coholism must 
also  be  excluded. 
Automatic  acts 

apparently  committed  in  the  dream  condition  may  be  frequently 
observed  after  an  attack  of  epilepsy,  even  of  a  mild  character. 
In  other  cases  mental  disturbance  may  appear  to  take  the  place 
of  a  true  convulsive  seizure,  and  is  then  called  "  masked  epi- 
lepsy." More  frequently,  however,  these  mental  disturbances 
follow  or  precede  a  true  epileptic  seizure. 

Idiocy  is  not  present  in  ordinary  epilepsy  except  when  due  to 
organic  changes  seen  in  infantile  forms ;  but  here  there  is  gener- 
ally associated  some  form  of  paralysis,  either  hemiplegia  or  di- 
plegia  of  cerebral  origin,  along  with  convulsive  seizures.  This  is 


FIG.  24.— Epileptic  Mania. 


EPILEPTIC  INSANITY.  297 

dependent  upon  actual  destruction  of  the  cortex  surface  of  the 
brain,  or  upon  the  presence  of  cystic  degenerations  consequent 
upon  a  preceding  inflammation,  or  upon  direct  injury  and  com- 
pression of  the  brain  substance  by  a  meningeal  hemorrhage, 
occurring  most  frequently  during  a  prolonged  and  tedious  deliv- 
ery or  from  forcible  compression  with  the  forceps.  More  rarely 
the  condition  is  one  of  intracerebral  hemorrhage.  In  these 
patients  there  is  usually  dementia  in  varying  degrees.  The 
epileptic  seizures  do  not  differ  in  character  or  in  response  to 
treatment  from  those  observed  in  the  idiopathic  form.  The 
question  of  responsibility  in  relation  to  crime  would  rarely  be  in 
doubt,  as  the  evidence  of  the  disease  would  be  well  shown  by  the 
palpable  conditions  present. 

In  reports  of  cases  under  my  own  observation  there  was  evi- 
dence of  marked  degenerative  changes  in  the  conformation  of 
the  skull,  actual  measurement  invariably  showing  in  hemiplegic 
cases  a  diminution  in  the  size  of  the  skull  on  the  affected  side, 
while  the  brain  f requently  exhibited  marked  atrophy  and  shriv- 
elling of  the  convolutions,  thinning  of  the  cortex,  and  dilatation 
of  the  ventricle  on  the  same  side,  with  secondary  degenerations, 
extending  especially  in  the  motor  tract  into  the  spinal  cord. 

While  the  idiopathic  cases  do  not  show  such  definite  brain 
lesions,  still  there  is  quite  commonly  a  general  affection  of  the 
brain  of  a  degenerative  type ;  and  while  we  do  not  to-day  hold 
as  positive  any  special  change  in  the  frontal  lobes,  or  in  the 
temporal  lobes,  as  formerly  stated  by  Meynert,  still  in  the  cor- 
tex, especially,  according  to  Lewis,  in  the  third  layer,  the  nerve 
cells  are  not  infrequently  degenerated  and  their  nuclei  rilled 
with  pigment,  and  the  cells  themselves  the  seat  of  vacuolation. 
We  also  find  increase  of  connective  tissue  and  involvement  of 
the  association  fibres.  While  many  similar  conditions  are 
found  in  other  degenerative  forms  of  mental  disease — and  there- 
fore we  are  unable  to  speak  of  definite  lesions  peculiar  to  epi. 
lepsy — still  we  are  certain  of  this  much,  that  disease  is  present, 
and,  in  fact,  is  never  absent  on  microscopical  study  of  the  brain. 

All  forms  of  insanity  have  certain  varieties  of  symptoms  in 
common — the  change  in  the  individual  and  concentration  of  the 
attention  on  the  ego.  We  next  observe  some  alteration  in  the 
feelings  and  thoughts  and  actions,  and  finally  dementia.  In 
epileptic  insanity  we  have  all  these  functions  more  or  less  in- 


298  INSANITY — FISHER. 

volved,  and  in  a  hundred  cases  which  I  made  the  subject  of 
study,  in  none  were  these  conditions  absent.  It  is  always  diffi- 
cult to  get  an  accurate  history  of  these  patients. 

One  element  observed  in  almost  all  cases  is  what  might  be 
called  "religiosity."  It  is  of  an  emotional  type,  and  is  perhaps 
more  common  among  women.  The  attention  to  prayers  and 
desire  to  attend  religious  services  are  very  marked ;  however,  it 
seems  to  be  merely  a  superficial  feeling,  as  any  remorse  for 
acts  committed  while  in  this  state  is  entirely  absent,  and  indeed, 
when  interrupted  in  some  specially  brutal  act  following  an  ex- 
pression of  a  high  moral  character,  no  appreciation  of  the  dis- 
crepancy is  apparent. 

Cloustou  states  that  epileptic  insanity  is  not  so  common 
among  women  as  in  men,  nor  does  it  respond  so  readily  to  treat- 
ment by  the  bromides.  One  feature — the  suicidal  impulse — 
seems  to  have  been  in  my  experience  more  frequent,  especially 
among  women,  than  is  commonly  recorded.  Cullere  and  Clous- 
ton,  however,  report  several  such  cases.  In  regard  to  treatment, 
the  same  course  should  be  observed  as  in  the  neurosis  itself. 

Among  criminals  guilty  of  the  minor  offences,  as  petty  lar- 
ceny, etc.,  epilepsy  is  very  common.  We  here  find  a  bad  her- 
editar}r  history ;  but  among  burglars  or  forgers,  whose  crimes 
are  against  property,  mental  disease  in  general,  as  well  as 
epilepsy,  is  rare. 

As  seen  from  our  remarks  on  the  character  of  the  attack  in 
epilepsy  we  must,  especially  in  epileptic  insanity,  distinguish  be- 
tween the  mental  conditions  immediately  preceding,  during, 
and  following  the  convulsive  seizures,  and  during  the  intervals 
of  the  attacks. 

This  is  of  great  importance  in  a  medico-legal  sense ;  and, 
again,  great  care  must  be  used  to  ascertain  whether  attacks  of 
mania  at  times  take  the  place  of  convulsive  attacks.  In  speak- 
ing of  transitory  mania  we  referred  to  several  writers  as  hold- 
ing the  opinion  that  the  condition  in  reality  is  an  epileptic  seiz- 
ure. The  diagnosis,  however,  depends  largely  on  the  fact  of 
well-known  previous  seizures,  and  also  as  to  whether  the  act  was 
committed  just  previous  to  an  epileptic  seizure  or  following  one. 
During  the  intervals  between  the  seizures  the  mental  condition 
seems  to  be  one,  in  many  cases  at  least,  in  which  dementia  is 
»Tuke,  "Psych.  Med." 


EPILEPTIC   INSANITY.  299 

not  present,  and  in  which  the  individual  is  fully  conscious  of  all 
his  acts.  In  these  cases,  therefore,  we  must  carefully  search  for 
some  motive  for  the  act.  If  that  is  not  present  and  the  act  is  of 
the  impulsive  type,  it  is  probably  dependent  on  an  hallucinatory 
condition  due  to  the  disease.  The  complete  loss  of  memory  of 
all  the  particulars  of  the  act  until  informed,  if  deception  in  this 
respect  can  be  excluded,  is  also  of  much  diagnostic  value.  Re- 
morse for  the  act  will  also  be  present  when  there  is  not  con- 
siderable mental  weakness.  Among,  however,  the  cases  where 
the  character  has  been  changed,  although  no  well-defined  con- 
dition of  dementia  is  present,  this  feeling  of  remorse  majT  be 
absent.  This  is  not  infrequently  seen  in  hystero-epileptics  and 
in  those  whom  the  attacks  consist  mostly  in  transient  or  partial 
loss  of  consciousness,  without  convulsive  seizures.  Here  we 
find  a  mental  weakness  indeed,  but  not  so  extreme  but  what 
the  full  knowledge  of  right  and  wrong  can  be  appreciated. 
There  seems  to  be  rather  an  absolute  disregard  of  the  ethical  or 
moral  side  of  the  question,  and  the  only  repressive  agency  is 
the  fear  of  punishment. 

Simulation  of  epilepsy  has  been  referred  to  especially  among 
the  criminal  classes  and  among  prisoners. 

The  diagnosis  in  regard  to  the  character  of  the  seizure  is 
often  a  very  difficult  one — the  presence  of  the  reflex  response  on 
the  part  of  the  conjunctiva,  and  the  response  to  light  on  the 
part  of  the  pupils,  indicate  almost  surely  that  the  attack  is  not 
truly  epileptic.  The  thumbs  are  usually  turned  into  the  palms 
in  true  epilepsy,  but  this  is  not  always  the  case.  When  simu- 
lation is  suspected,  it  is  important  to  watch  for  any  appearance 
of  suspicion  on  the  part  of  the  personator,  and  again  we  often 
find  that  the  attacks  are  most  severe  and  frequent  in  the  ma- 
lingerer when  he  is  under  observation.  In  a  true  epileptic  seiz- 
ure the  onset  is  sudden,  generally  without  warning,  and  no 
recollection  of  the  events  occurring  during  the  seizure  is  present. 

The  prognosis  in  epilepsy  is  unfavorable  as  far  as  a  cure  is 
concerned,  and  this  is  of  considerable  importance  in  regard  to 
the  legal  aspect  of  these  cases.  Months  and  in  rare  cases  years 
may  intervene  between  the  convulsive  and  maniacal  seizures. 
It  is  especially  here  that  there  may  exist  doubt  as  to  the  diag- 
nosis. We  may  have  the  condition  called  by  Morel  e*pilepsie 
larvee,  in  which,  as  we  have  said,  the  convulsive  seizure  is  re- 


300  INSANITY — FISHER. 

placed  by  a  maniacal  state.  Falret  describes  this  form  as  fol- 
lows: The  invasion  of  the  morbid  phenomena  is  sudden,  the 
acts  are  instantaneous  and  of  exceptional  violence,  the  halluci- 
nations are  usually  of  a  terrifying  character,  there  is  also  abso- 
lutely no  recollection  of  acts  committed.  A  peculiarity  in  these 
attacks  is  that  if  they  are  repeated  the  same  phenomena  occur 
in  the  same  order.  This  is  the  case  in  the  ordinary  convulsive 
seizure,  the  psychical  convulsion  being  analogous  to  the  physical 
one.  In  this  respect  numberless  cases  could  be  cited  of  mania- 
cal attacks  of  violence,  especially  homicidal,  just  preceding 
or  more  usually  following  epileptic  seizures.  In  these  instances 
there  is  no  doubt  of  the  mental  condition  and  absence  of  respon- 
sibility. It  is,  however,  often  difficult  to  make  a  differential 
diagnosis  in  the  milder  cases,  in  which,  after  perhaps  an  attack 
of  the  petit -mal  type  in  which  there  has  been  simple  obscura- 
tion of  consciousness,  for  so  brief  a  period  as  not  to  have  been 
observed  by  others,  the  patient  goes  on  with  what  he  was  doing 
or  carries  out  some  plan  or  piece  of  business  with  apparent  cor- 
rectness, and  yet  afterward  has  no  recollection  of  the  acts. 
The  following  case  illustrates  this : 

A  lady,  unmarried,  set.  40,  had  been  subject  to  epileptic  seizures 
for  a  number  of  years.  Most  of  her  attacks  were  of  a  mild  type,  of 
which  she  herself  would  be  absolutely  unconscious.  On  one  occasion, 
while  sitting-  at  the  breakfast-table  in  a  hotel,  she  suddenly  seized  the 
newspaper  of  a  gentleman  sitting  opposite  and  went  to  her  room.  She 
had  no  recollection  of  the  act,  and  was  surprised  to  find  herself  in 
her  room  with  the  paper.  On  another  occasion  she  transacted  con- 
siderable business  involving  the  receiving  of  various  sums  of  money, 
apparently  attracting  no  attention  as  to  her  mental  condition  and 
performing  her  work  correctly.  Following  these  transactions,  she 
had  no  recollection  of  seeing  the  various  persons  from  whom  she  had 
received  the  money.  Her  acts  were  automatic,  although  in  these  in- 
stances of  a  character  with  which  she  was  perfectly  familiar.  Tfiere 
was  evidently  in  her  case  a  dual  existence. 

CHOREA  IN  INSANITY. — Chorea  is  a  disease  with  a  special 
motor  disturbance.  Under  this  head  we  would  only  consider 
the  well-known  neurosis  in  which  we  find  motor  disturbances, 
hardly  convulsive  in  character,  but  marked  by  a  condition 
of  incoordination.  We  refer  to  the  so-called  Sydenham  dis- 
ease in  contradistinction  to  the  condition  found  in  defective 


PUERPERAL  INSANITY.  301 

brain  formation,  such  as  is  seen  in  the  imbecile  or  in  cerebral 
hemiplegia  the  result  of  meningeal  hemorrhages,  inflamma- 
tory affections  of  the  cortex,  or  porencephalus.  Here,  there 
are  indeed  choreiform  movements,  but  the  special  condition  is 
a  mental  defect  dependent  upon  structural  defect. 

Chorea  is  a  disease  most  commonly  of  childhood,  especially 
in  its  acute  form ;  the  more  chronic  form  occurs  in  adults.  We 
also  see  it  during  pregnancy  with  special  mental  symptoms. 
Huntington  described  a  form  which  is  hereditary  in  certain 
families,  associated  with  marked  mental  symptoms  of  the  type 
of  dementia. 

In  children  the  disease  runs  an  acute  course,  varying  from 
three  weeks  to  as  many  months,  with  a  tendency  to  periodical 
semi-annual  or  annual  returns.  The  mental  symptoms  are 
those  of  excitability,  instability  of  temper,  and  an  hysterical  con- 
dition. There  is  also  a  considerable  impairment  of  memory. 
The  patients  are  excessively  emotional,  being  subject  to  attacks 
of  laughing  and  crying,  and  prone  to  impulsive  acts.  Illusions, 
especially  at  night,  are  not  infrequent. 

We  have  already  referred  to  the  paroxysmal  attacks  of  what 
has  been  termed  coprolalia  and  echolalia  in  which  there  seems 
to  be  an  irresistible  impulse  to  the  use  of  profane  and  indecent 
language,  or  again  to  especial  attacks  of  obstinacy,  the  child 
being  determined  to  do  what  it  wishes,  often  being  destructive 
and  violent,  in  fact  maniacal.  Chorea  occurring  in  adults,  es- 
pecially in  young  women,  is  often  violent  and  uncontrollable,  and 
there  is  indeed  great  cerebral  excitement,  resembling  mania. 
It  is  usually  chronic  in  its  course.  A  hysterical  basis  often 
seems  to  exist  in  these  cases. 

PUERPERAL  INSANITY. — We  would  here  include  all  those 
mental  disturbances  occurring  during  or  following  gestation. 
There  is,  as  Morel  has  well  said,  no  special  form  of  insanity 
peculiar  to  the  puerperal  state.  The  usual  forms  are  melan- 
cholia and  mania  with  hallucinations  and  delusions,  which  do 
not  differ  from  these  conditions  under  other  circumstances. 

The  causes  are  first  heredity,  the  exhaustion  consequent  on 
the  condition  of  pregnancy,  fright,  previous  attacks,  illegiti- 
macy, alcoholism,  sepsis,  etc. 

During  pregnancy  it  is  common  to  find  unusual  conditions 
of  feeling,  longings  often  for  special  articles  of  diet.  Some 


302  INSANITY — FISHER. 

women  are  cheerful  only  when  pregnant,  others  again  are 
always  depressed.  The  usual  form  is  that  of  melancholia  with 
suicidal  tendencies.  A  milder  condition  resembling  hysteria  is 
common.  There  may  be  marked  aversion  to  the  husband  or  an 
irresistible  impulse  to  produce  abortion  in  some  way,  the  most 
moral  and  conscientious  woman  during  these  periods  being  ab- 
solutely regardless  of  all  moral  obligations.  It  is  not  unusual 
to  observe  almost  any  of  the  various  forms  of  the  so-called  im- 
pulsive insanities,  such  as  a  tendency  to  theft  or  to  the  excessive 
use  of  alcohol;  or,  again,  there  may  be  marked  eroticism.  This 
mental  condition  may  pass  away  at  the  time  of  labor,  but  is 
more  apt  to  continue. 

INSANITY  OF  DELIVERY  is  usually  of  the  maniacal  type  and 
is  probably  due  to  excessive  pain  (as  I  have  seen  in  some  cases), 
or,  again,  to  the  delay,  since  many  instances  occur  in  a  tedious 
labor.  This  is  more  apt  to  occur  in  the  primipara.  There  is 
often  during  the  first  few  days,  before  or  during  the  establish- 
ment of  the  flow  of  milk,  a  marked  maniacal  condition,  dur- 
ing which  infanticide  may  occur. 

INSANITY  FOLLOWING  SEPSIS  usually  occurs  within  a  few 
days  after  delivery  and  is  associated  with  high  temperature. 
In  these  cases  we  find  a  maniacal  condition  as  a  rule,  with  mut- 
tering delirium,  a  constant  agitation  dependent  often  on  hallu- 
cinations and  delusions. 

In  puerperal  insanity  per  se,  not  dependent  on  septic  con- 
ditions, the  onset  is  usually  later,  the  direct  cause  is  often 
mental — that  is,  due  to  anxiety  or  worry,  or,  again,  due  to  physi- 
cal exhaustion.  There  is  usually  an  absence  of  high  temperature. 
We  may  have  mania  with  great  excitement  requiring  restraint, 
or  there  may  be  marked  melancholia  in  which  there  may  be 
aversion  to  the  husband  and  the  child.  Both  these  states  may 
pass  on  into  more  or  less  chronic  conditions  in  which  delusions 
of  suspicion  are  common,  and  impulses  usually  of  a  suicidal 
nature.  The  majority  of  cases,  however,  recover. 

INSANITY  OF  LACTATION  is  usually  of  a  depressive  type. 
We  have  melancholia,  usually  subacute  with  delusions  of  self- 
condemnation  and  suspicion.  There  may,  however,  be  acute 
mania.  The  cause  that  is  the  direct  one  is  exhaustion,  so  that 
we  find  it  especially  among  the  weak.  I  have  observed  it  also 
especially  of  the  melancholic  type,  among  women  who  have 


INSANITY   AT  THE   MENOPAUSE.  303 

suckled  their  children  beyond  the  usual  time  in  order  to  avoid 
becoming  pregnant  again.  This  is  not  an  uncommon  practice 
among  the  poor. 

The  crime  most  peculiar  to  these  conditions  is  homicide. 
During  pregnancy,  however,  the  peculiar  longings  and  desires 
may  manifest  themselves  by  theft,  dipsomania,  or  infanticidal 
tendencies. 

Savage  refers  to  a  condition  of  transitory  mania  occurring 
within  the  first  few  days  after  delivery,  in  which  the  woman 
may  injure  herself  or  her  child,  being  perfectly  unconscious  of 
her  act. 

This  may  occur  where  there  has  been  much  exhaustion,  or 
in  cases  where  there  has  been  marked  cerebral  excitement  due 
to  illegitimacy.  In  puerperal  insanity  of  the  ordinary  type 
homicide  or  infanticide  is  the  most  usual  crime. 

INSANITY  AT  THE  MENOPAUSE  is  usually  of  the  depressive 
type,  that  is  melancholia.  It  is  usually  subacute  in  character. 
The  patients  become  anxious,  sleepless,  lose  interest  in  affairs, 
and  have  a  fear  of  impending  evil.  They  are  unable  to  apply 
themselves  to  their  ordinary  occupation.  They  feel  that  their 
family  no  longer  has  any  regard  for  them.  They  become  sus- 
picious, the  fidelity  of  the  husband  is  suspected,  intense  jealousy 
of  a  most  unreasonable  character  may  be  present.  Suicidal 
tendencies  may  develop.  It  is  not  unusual  also  at  this  period 
to  have  a  complete  change  in  the  character  of  the  individual 
occur.  They  may  become  inclined  to  excessive  use  of  alcohol 
or  other  drugs,  they  may  manifest  impulsive  tendencies  to  theft, 
or  become  erotic.  The  most  constant  symptom  is,  however, 
that  of  depression,  in  which  suicide  is  threatened  and  may  in- 
deed be  carried  out.  They  become  essentially  selfish  and  de- 
manding, any  inattention  leading  to  reproaches  of  neglect. 
This  may  pass  into  a  chronic  state  of  dementia  with  delusions. 
There  may  often,  however,  be  re-establishment  of  health  after  a 
few  years. 

This  condition  occurs  in  men  also,  but  is  more  rare.  There 
is  nothing  especially  characteristic  in  the  form  of  the  insanity 
which  occurs  at  this  period.  It  is  simply  that  at  this  special  time 
of  life,  when  certain  changes  are  occurring  in  the  body  itself, 
the  brain  is  liable  to  disturbances  affecting  its  integrity.  It  is 
therefore  a  critical  epoch  in  the  life  history  of  women. 


304  INSANITY — FISHER. 

INSANITY  OF  PUBERTY  implies  a  mental  disturbance  occur- 
ring at  an  important  transitional  period  of  the  organization. 
It  is  especially  liable  to  take  place  where  there  exists  a  pre- 
disposing cause,  as  heredity  or  a  neurotic  disposition.  The  ex- 
citing causes  are  various — fright,  grief,  mental  strain  from 
overstudy,  and  as  a  physical  cause,  masturbation.  It  is  more 
frequent  in  females  but  not  unusual  in  males.  There  is  almost 
always  a  great  concentration  on  the  ego,  leading  to  habits  of 
introspection.  It  may  take  the  form  of  depression  or  exaltation. 
In  the  former  we  observe  the  usual  condition  of  self-condemna- 
tion with  a  marked  tendency  to  suicide.  This  is  often  due  to 
the  belief  that  habits  of  self-abuse  have  alienated  them  from  God 
and  that  forgiveness  is  impossible.  Such  patients  become  sus- 
picious ;  they  think  every  one  is  aware  of  their  sin  and  regards 
them  with  aversion.  They  are  subject  to  hallucinations,  espe- 
cially of  hearing,  in  which  they  imagine  that  they  are  called  by 
the  most  obscene  names,  or  that  they  are  accused  of  acts  of  the 
most  indecent  character. 

In  the  maniacal  state,  which  may  at  times  be  very  violent, 
they  frequently  have  a  feeling  of  great  self-importance,  consid- 
ering themselves  capable  of  carrying  out  great  schemes.  These 
ideas  of  importance  often  cover  many  fields,  either  in  religion, 
art,  literature,  or  business.  They  are  impatient  of  all  restraint 
and  yet  are  unable  to  apply  themselves  long  at  any  work.  De- 
lusions of  persecution  are  not  rare. 

We  observe  also  in  these  cases  impulsions  often  of  an  irre- 
sistible character.  There  may  be  a  marked  erotic  element  pres- 
ent, leading  to  indecent  exposure  or  open  masturbation.  In 
young  girls  this  may  lead  to  indecent  proposals,  and  in  the  lat- 
ter we  usually  find  an  increase  of  all  these  symptoms  at  the 
menstrual  epoch. 

The  prognosis  is  not  unfavorable  except  when  there  is  a  bad 
hereditary  history. 

The  following  case  will  illustrate  this  condition  as  occurring 
in  a  young  boy : 

A.  B. ,  set.  17,  family  history  negative.  The  patient  had  overworked 
and  over-studied  and  had  always  shown  himself  very  ambitious  to  suc- 
ceed. His  studies  had  to  be  carried  on  at  a  night  school,  as  he  worked 
by  day.  He  was  also  a  very  regular  attendant  at  the  church  meetings, 
frequently  speaking  at  the  meetings.  He  suddenly  became  quite 


RHEUMATIC   INSANITY.  305 

changed  in  all  his  habits,  was  aggressive  and  boastful.  He  no  longer 
went  to  his  work,  but  claimed  that  he  felt  that  he  could  become  a 
great  preacher  or  architect,  or  in  fact  anything  he  wished  to  try  for. 
He  was  irritable  and  at  times  violent,  striking  hLs  mother  if  she  did 
not  do  as  he  wished.  This  condition  passed  later  into  one  of  conf  usional 
insanity,  in  which  he  seemed  to  lose  all  idea  of  time  and  place,  and  in 
which  from  time  to  time  he  would  become  excited  and  destructive. 
This  patient  made  a  complete  recovery. 

A  second  case  with  a  not  dissimilar  history,  in  which,  however, 
there  had  been  excessive  masturbation  as  the  exciting  cause,  had  sexual 
desires  of  an  unnatural  character.  He  was  evidently  in  great  mental 
distress,  and  would  remove  all  his  clothing  and  beg  the  attendants  to 
have  relations  with  him  in  an  unnatural  manner.  This  case  also  made 
a  good  recovery. 

Many  of  these  cases  correspond  to  the  type  of  raasturbational 
insanity.  However,  while  we  find  it  present  often  as  an  excit- 
ing cause,  it  may  again  only  be  one  of  the  symptoms  of  disease. 
It  necessarily  acts  as  an  effective  cause  in  continuing  the  mental 
disturbance. 

INSANITY  IN  CONNECTION  WITH  RHEUMATISM  seems  to  de- 
pend on  either  the  bigh  temperature  or  an  overwhelming  of  the 
system  with  the  special  poison. 

We  not  infrequently  observe  in  articular  rbeumatism  a  dis- 
appearance of  the  articular  symptoms,  and  tbe  onset  of  cerebral 
excitement  resembling  acute  mania.  There  may  be  at  tbe  time 
a  very  high  temperature,  usually  higher  than  we  find  in  mania 
grave.  The  patient  is  delirious  and  is  subject  to  illusions  and 
delusions. 

Tbere  is,  however,  nothing  characteristic  in  the  mania 
which  occurs  in  tbese  cases ;  tbere  seems  to  be  simply  a  metas- 
tasis of  the  poison  from  the  joints  to  the  brain  and  its  meninges, 
resulting  in  excitement  and  delirium.  It  is  rare  that  perma- 
nent or  chronic  mental  disease  results.  It  is  more  unusual  for 
depressive  conditions  to  result. 

The  following  case  illustrates  mania  occurring  in  tbe  course 
of  acute  rheumatism,  witb  a  fatal  ending : 

A.  R,  set.  35,  was  admitted  to  the  hospital  with  acute  articular 
rheumatism.  He  passed  into  a  state  of  acute  delirium  with  hallucina- 
tions and  delusions.  The  temperature  rose  at  times  to  105°,  and  he  died 
from  exhaustion  on  the  fifth  day.  There  was  nothing  to  distinguish 
the  case  in  its  course  from  acute  mania.  The  autopsy  showed  nothing 
but  acute  congestion  of  the  cortex  of  the  brain. 


306  INSANITY — FISHER. 

GOUT  IN  ITS  RELATIONS  WITH  INSANITY  is  especially  ob- 
served in  the  general  diathetic  state  rather  than  in  the  acute  con- 
ditions. In  the  former  it  is  usually  of  the  depressive  type.  It  is 
rare  that  delusions  are  present,  but  there  is  often  a  well-marked 
suicidal  tendency.  Such  patients  are  suspicious  and  irritable 
and  there  is  present  a  fear  of  some  impending  evil.  These 
cases  are  more  liable  to  occur  in  advanced  adult  life,  and  may 
be  explained  on  the  ground  of  the  general  arterial  degeneration. 
A  well-defined  attack  of  gout  affecting  the  extremities  will  often 
clear  up  the  mental  state.  Among  the  young,  with  hereditary 
gout,  which  has  never  expressed  itself  localty  except  in  various 
signs  of  malnutrition,  indigestion,  etc.,  there  may  be  mental 
symptoms,  usually  of  the  nature  of  melancholia,  which  have  been 
described  under  the  head  of  cerebral  neurasthenia.  There  is, 
however,  at  times  observed  in  acute  gout  a  metastasis  from  the 
inflamed  joint  to  the  brain  and  vice  versa;  its  reappearance  in 
the  joint  may  relieve  the  brain  affection.  These  acute  states 
may  assume  the  form  of  mania.  There  is  no  doubt  of  the  close 
connection  of  this  condition  with  the  direct  overwhelming  of 
the  brain  itself  with  the  special  toxic  poison. 

PHTHISICAL  INSANITY. — In  phthisis  among  the  insane  it 
has  long  been  noticed  that  certain  mental  symptoms  character- 
istic of  the  disease  are  present,  and,  in  fact,  have  a  good  deal  to 
do  with  the  progress  of  the  disease.  For  a  long  time  back  the 
hopeful  character  of  this  class  of  patients  has  been  referred  to ; 
even  after  periods  of  suffering  and  exhaustion  we  find  them 
still  believing  and  hoping  that  ultimate  recovery  will  occur. 
Perhaps  in  no  other  disease  do  we  find  this  condition  so  promi- 
nently present.  Many  diseases  of  different  organs,  as  of  the 
stomach  and  liver,  frequently  only  of  a  functional  type,  will 
produce  absolutely  contrary  mental  states — marked  depression, 
loss  of  interest  in  general  affairs,  hopelessness  in  regard  to  re- 
covery— in  fact,  many  of  the  symptoms  are  such  as  we  see  in  the 
so-called  functional  psychoses,  as  for  instance  mania  and  melan- 
cholia. It  is,  therefore,  not  surprising  that  the  ancients  ascribed 
to  various  organs  in  the  body  the  seat  of  diseases  of  the  mind. 

In  the  etiology  of  insanity,  tuberculosis  or  phthisis  has 
been  cited  as  a  prominent  factor.  In  certain  families  it  not 
rarely  results  in  insanity,  or  the  descendants  of  the  insane  may 
have  phthisis.  Again,  not  infrequently  certain  members  of  the 


PHTHISICAL   INSANITY.  30? 

family  will  suffer  from  phthisis,  while  others  have  some  form 
of  mental  disease.  Atavism  is  also  not  infrequent. 

We  have  considered  in  this  relation  phthisis  as  a  cause  of 
insanity,  and  phthisis  as  occurring  among  the  insane.  The 
class  of  patients  in  which  the  first  division  may  be  considered 
will  give  us  the  symptoms  of  disease  as  seen  in  the  so-called  de- 
generative type  of  mental  disease;  therefore  it  is  not  infrequent 
among  paranoiacs  and  those  subject  to  the  various  neuroses, 
such  as  epilepsy,  chorea,  neurasthenia,  hysteria,  etc.  The  sec- 
ond division,  in  which  phthisis  is  an  intercurrent  disease  in  an 
already  established  mental  derangement,  is  more  frequently 
found  where  exhaustion  or  loss  of  nutrition  is  a  marked  feature, 
and  therefore  it  is  observed  in  melancholia  and  dementia  from 
whatever  cause.  Many  writers  describe  phthisical  insanity  as 
a  special  form  of  disease,  while  others,  again,  maintain  that 
there  is  no  special  difference  in  the  symptoms  from  those  gen- 
erally recognized  in  insanity. 

An  examination  of  patients  with  phthisis  must  be  carried 
on  with  great  care,  as  not  infrequently  it  will  run  a  very  insidi- 
ous course,  the  mental  condition  obscuring  the  ordinary  signs 
of  the  disease,  so  much  so,  indeed,  that  where  phthisis  is  pres- 
ent and  insanity  occurs  in  its  course,  there  is  an  apparent  im- 
provement in  the  patient.  The  cough  is  no  longer  troublesome, 
and  expectoration  is  apparently  decreased ;  and  so  marked  is  this 
change  that  many  have  held  the  opinion  that  the  course  of  the 
phthisis  has  been  checked  by  the  addition  of  mental  disease. 
This,  however,  can  hardly  be  the  case.  The  improvement  con- 
sequent upon  relief  of  the  exhausting  symptoms  may  seem  to 
lead  to  a  general  improvement  in  the  patient.  Again,  some 
have  claimed,  for  instance,  in  dementia,  that  the  appearance  of 
phthisis  has  improved  the  mental  state;  but  this  is  probably  ex- 
plained by  the  rise  of  temperature  causing  some  increase  in  the 
circulation  of  the  blood  in  the  brain,  and  in  that  way  clearing 
up  the  mental  torpor.  In  almost  every  case,  however,  when 
the  disease  approaches  the  final  stages  the  course  is  most  rapid ; 
in  fact,  statistics  would  lead  us  to  believe  that  the  duration  of 
the  disease  is  shorter  among  the  insane  than  among  the  sane. 
Phthisis  is  also  more  common  among  the  insane  than  among 
people  in  general.  The  idea  of  improvement  of  the  patient  by 
the  intercurrence  of  phthisis  is  not  to  be  accepted.  Certainly, 


308  INSANITY — FISHER. 

as  in  other  diseases,  such  as  typhoid,  or  in  cases  of  injury  or  of 
extensive  inflammation,  we  do  notice  for  the  time  being  an 
apparent  improvement  in  the  mental  state,  and  while  these  con- 
ditions remain  active,  often  in  a  case  of  extreme  dementia  or 
melancholia,  the  patient  is  much  more  active  mentally  than 
previously.  On  the  conclusion  of  these  acute  conditions  the 
previous  symptoms  return  with  increased  severity,  and  it  is  evi- 
dent that  there  has  been  no  permanent  improvement. 

The  special  symptoms  ascribable  to  phthisical  cases  seem  to 
be  those  of  suspicion ;  hallucinations  and  delusions  are  not  un- 
common, the  tendency  being  to  a  morbid  state  in  which  the 
patients,  from  fear  of  poison  or  from  suspicion  of  those  around 
them,  refuse  to  take  food  or  medicine.  There  is  frequently  also 
a  suicidal  tendency,  melancholia  being  the  type  of  the  disease, 
associated,  as  we  have  said,  with  marked  suspicion.  Some  writ- 
ers go  so  far  as  to  claim  that  all  cases  which  have  a  well-defined 
delusion  of  suspicion  are  ultimately  the  subjects  of  phthisis. 
In  rare  instances  we  find  the  opposite  condition — of  grandeur 
and  a  general  feeling  of  well-being.  We  should  be  suspicious 
here  of  general  paresis,  for  it  is  not  uncommon  to  find  among 
these  patients  phthisis  either  as  an  hereditary  taint  or  as  an  in- 
tercurrent  disease.  It  often  passes  unrecognized,  and  in  fact 
the  symptoms  may  run  a  course  in  which  there  is  no  indication 
of  the  existence  of  the  disease  until  the  final  stages.  Many  of 
these  patients  continue  at  their  work,  or  are  out  and  around 
within  a  week  or  two  of  their  death. 

A.  B.  (colored),  male,  general  paresis ;  family  history  negative ; 
phthisis  of  an  intercurrent  nature,  possibly  hereditary.  As  far  as  the 
pulmonary  disease  was  concerned,  the  illness  was  of  only  a  few  weeks' 
duration.  The  post-mortem  revealed  extensive  tubercular  disease  of 
the  lungs.  The  symptoms  were  of  the  usual  type  of  general  paresis. 

In  our  present  institutions,  with  the  better  attention  to  sani- 
tary arrangements,  there  is  far  less  phthisis  than  was  formerly 
seen,  the  percentage  being  decidedly  lower.  The  element  of 
hopefulness  is  not  often  so  frequently  seen  as  among  the  sane. 
Strictly  defined,  phthisical  insanity  should  not  be  considered  as 
a  special  form  of  disease.  The  character  of  the  hallucinations 
and  delusions  is  not  sufficiently  distinctive  to  properly  consti- 
tute a  special  type  of  insanity.  There  is  this  much,  however, 


PERIODICAL   INSANITY.  30ft 

in  regard  to  all  these  oases :  in  the  insane  exposure  often  does 
not  have  the  same  deleterious  effect  in  causing  pulmonary  or 
other  disease  as  we  find  among  the  sane;  but,  on  the  other 
hand,  as  all  forms  of  mental  disease  generally  lead  to  a  low 
trophic  state  of  the  body,  they  are  specially  prone  to  phthisis,  a 
proper  nidus  for  the  bacillus  being  ever  present. 

PERIODICAL  INSANITY  is  that  form  in  which  attacks  of 
mania  or  melancholia  occur  at  more  or  less  regular  intervals, 
the  intervening  periods  being  free  from  all  mental  disturbance. 
There  is  nothing  peculiar  in  the  attacks,  the  principal  interest 
is  from  a  medico-legal  aspect,  in  regard  to  the  complete  remis- 
sion of  all  symptoms  during  the  intervals.  Melancholia  is  more 
frequent  in  this  form  than  mania.  Clouston,  in  his  description 
of  the  disease,  includes  circular  insanity  under  the  same  head. 
In  the  latter  disease  we  have  alternating  conditions  of  mel- 
ancholia and  mania,  the  first  completing  its  course  and  often 
passing  without  intermission  into  the  second  form.  There  is 
usually  a  periodicity  in  these  attacks  also;  often,  as  in  periodical 
insanity  of  melancholia  or  mania  alone,  intervals  of  months  or 
years  intervening  between  the  seizures.  There  is  indeed,  as  I 
have  said,  generally  a  complete  return  to  a  normal  mental  state, 
but  there  may  be  observed  some  alteration  in  the  character. 
The  person  is  not  precisely  the  same. 

Marce  divides  periodical  and  circular  insanity  into  three 
forms: 

1.  La  folie  intermittente  simple  (periodical  insanity).  2. 
La  folie  a  double  forme,  consisting  of  an  attack  of  mania  and 
melancholia  with  a  lucid  interval.  3.  La  folie  circulaire,  a 
form  in  which  the  attacks  are  continuous  without  an  interval. 

Esquirol  records  a  case  of  a  merchant,  set.  40,  of  a  neurotic 
disposition,  who  each  fall,  for  four  years,  had  an  attack  of 
mania,  a  spontaneous  recovery  taking  place  in  the  spring.  This 
patient  ultimately  recovered.  During  the  intervals  between  the 
spring  and  autumn  he  resumed  his  business. 

A  case  of  acute  melancholia  has  long  been  under  my  observation, 
the  attack  recurring  about  once  a  year  for  the  past  six  years.  The 
onset  is  sudden,  and  came  on  first  at  the  age  of  puberity.  The  recovery 
is  always  as  sudden  as  the  onset.  During  the  intervals  the  patient,  a 
young  lady,  returns  to  her  family  and  resumes  her  usual  occupation. 

The  prognosis  is,  as  a  rule,  unfavorable  as  far  as  the  ulti- 


310  INSANITY — FISHER. 

mate  cure  is  concerned,  as  there  is  usually  an  Hereditary  ele- 
ment present. 

HYPNOTISM  is  a  subject  concerning  which  much  has  been 
written  for  many  years.  Mesmer,  in  the  Eighteenth  Centurj^, 
brought  it  prominently  before  the  public,  but  the  evident  char- 
latanry and  often  fraud  which  were  present  in  his  methods  led 
to  the  abandonment  of  its  consideration  by  responsible  scientific 
investigators.  Braid,  of  England,  in  1844,  in  his  paper,  de- 
scribed the  condition  most  fully — in  fact,  little  of  importance 
has  been  added  to  our  knowledge  of  it  since.  He  also  first  used 
the  name  hypnotism.  Since  that  time  the  subject  has  been 
investigated  by  various  writers  in  France,  as  Charcot,  Marie, 
Gilles  de  la  Tourette,  and  others,  and  in  Germany  and  England 
by  Berger,  Senator,  Bramwell,  and  Tuckey.  Early  in  the  cen- 
tury surgical  operations  had  been  performed  with  success  while 
the  patient  was  under  the  influence  of  hypnotism. 

Hypnotism  has  been  defined  (Foster's  "  Encyclopaedic  Medi- 
cal Dictionary")  as  "  an  abnormal  state  into  which  some  persons 
may  be  thrown,  either  by  a  voluntary  act  of  their  own,  such  as 
gazing  continuously  and  with  fixed  attention  on  some  small, 
bright  object  held  close  to  the  eyes,  or  by  the  exercise  of  another 
person's  will;  characterized  by  suspension  of  the  will  and  conse- 
quent obedience  to  the  promptings  of  'suggestion'  from  with- 
out." The  activity  of  the  organs  of  special  sense,  except  the  eye, 
may  be  heightened  and  the  power  of  the  muscles  increased. 
Perfect  insensibility  to  pain  may  be  induced  by  hypnotism,  and 
it  has  been  used  as  an  anesthetic.  It  is  apt  to  be  followed  by 
severe  headache  of  long  continuance  and  by  various  nervous 
disturbances.  On  emerging  from  hypnotism  the  hypnotized 
person  usually  has  no  remembrance  of  what  happened  during 
its  continuance,  but  in  many  persons  such  a  remembrance  may 
be  induced  by  suggestion. 

About  one  person  in  three  is  susceptible  of  hypnotism,  and 
those  of  an  hysterical  or  neurotic  tendency  (but  rarely  the  in- 
sane) are  the  most  readily  hypnotized.1  Charcot  regarded  it  as 
an  "  artificially  produced  morbid  condition  or  neurosis,  because 
there  is  not,  so  far  as  we  know,  any  anatomical  lesion,  but  hav- 
ing none  the  less  its  definite  laws." " 

1  C.  J  Braid,  Month.  Jour,  of  Med.        2  Tuke  :  "Dictionary  of  Psychol. 
Sci.,  July,  1853.  Medicine." 


HYPNOTISM.  3H 

There  are  various  methods  of  establishing  this  condition :  the 
early  one  employed  by  Braid,  in  which  the  subject  is  requested 
to  fix  the  attention  on  some  bright  object  which  is  usually  placed 
above  the  eyes  in  a  position  to  cause  fatigue  (Voisin  follows 
this'  plan),  or  pressure  over  the  eyelids  effects  the  same  re- 
sult, the  suggestion  being  made  repeatedly  that  they  wiU  soon 
fall  asleep,  etc.  Self -hypnotism  is  also  possible  by  fixing  the 
attention  on  some  object.  The  principle  is  evidently  the  attempt 
to  place  one's  self  entirely  under  some  one  single  influence  and 
thus  become  oblivious  to  all  other  surroundings. 

Most  healthy  individuals  can  with  practice  allow  themselves 
to  be  hypnotized ;  and  the  reverse  is  also  true,  they  can  prevent 
it.  In  some  hysterical  temperaments,  and  also  in  the  insane, 
their  inability  to  fix  their  attention  on  any  one  thing  makes 
hypnotizatiou  impossible. 

After  considerable  practice  a  bright  light  or  a  mere  nod  may 
be  all  that  is  necessary  to  establish  this  state.  Charcot  has  de- 
scribed three  conditions  into  which  those  hypnotized  pass :  cata- 
lepsy, lethargy,  and  somnambulism.  In  all  three  states  sugges- 
tion is  possible,  and  it  is  in  reference  to  this  latter  condition  that 
of  late  the  subject  has  become  of  importance  in  legal  medicine. 
While  many  acts,  often  foolish  in  character,  will  be  carried  out 
by  the  subject  upon  suggestion,  it  is  doubtful  whether  a  crime 
such  as  murder  would  be  committed.  The  following  cases, 
which  have  been  reported,  will  explain  the  position  which  hypno- 
tism to-day  holds  as  a  ground  for  defence  in  criminal  procedures. 

J.  M.  Baldwin '  says,  in  regard  to  criminal  suggestion,  that 
"  cases  have  been  tried  in  the  French  courts  in  which  evidence 
for  and  against  such  influence  of  a  third  person  over  the  criminal 
has  been  admitted.  The  reality  of  the  phenomena,  however, 
is  in  dispute.  The  Paris  school  claims  that  criminal  acts,  which 
are  just  as  certain  to  be  performed  by  him  as  any  other  acts,  can 
be  suggested  to  the  hypnotized  subject.  While  admitting  the 
facts,  the  Nancy  theorists  claim  that  the  subject  knows  the  per- 
formance to  be  a  farce,  gets  suggestions  of  the  unreality  of  it 
from  the  experimenters,  and  so  acquiesces.  This  is  probably 
true,  as  is  frequently  seen  in  cases  in  which  patients  have  refused, 
in  the  hypnotic  sleep,  to  perform  suggested  acts  which  shocked 
their  modesty,  veracity,  etc." 

1  Johnson's  "Universal  Cyclopaedia,"  1894,  p.  463. 
III.—  22 


312  INSANITY— FISHER. 

The  undoubted  fact  that  such  a  control  is  temporarily  pos- 
sible was  made  the  basis  of  a  curious  legal  defence  in  the  trial 
of  a  French  woman,  Gabrielle  Bompard,  for  complicity  in  the 
murder  of  one  Gouffe.  At  this  trial  in  November,  1890,  her 
counsel  endeavored  to  secure  her  acquittal  by  introducing  evi- 
dence to  show  that  she  was  an  hypnotic  subject,  and  took  part 
in  the  murder  under  the  hypnotic  compulsion  of  her  confederate, 
Michel  Eyraud.  The  court,  however,  refused  to  allow  any 
testimony  on  this  head  to  be  presented. ' 

A  very  interesting  case  is  reported  by  A.  Motet.2  The 
"  Chambre  des  Appels  de  Police  correction  elle"  reversed  the  de- 
cision of  the  "  Tribunal  de  premiere  instance"  condemning  Emile 
D.  to  three  months'  imprisonment.  He  had  been  arrested  for  in- 
decent acts  in  a  public  urinal.  D.  protested  his  innocence.  Dr. 
Mesnet,  under  whose  care  D.  had  been  in  the  Hopital  St.  An- 
toine,  and  who  knew  him  to  be  subject  to  spontaneous  attacks 
of  somnambulism,  with  others  was  able  to  obtain  a  new  trial,  on 
the  ground  that  D.  was  irresponsible  during  these  mental  states. 

The  avocat-general,  M.  Bertrand,  said  that  it  was  necessary, 
if  D.  passed  into  this  mental  condition,  to  prove  its  existence  at 
the  time  of  his  arrest.  Permission  being  granted  to  hypnotize 
the  defendant,  he  was  asked  to  undress  himself,  which  he  im- 
mediately did,  but  when  roused  from  the  hypnotic  state,  had  no 
remembrance  of  his  acts.  The  decision  was  based  on  the  ground 
of  irresponsibility. 

I  would  refer  to  the  following  articles  on  the  subject : 

"Hypnotism,"  Moll,  Albert,  Berlin,  1890.  Juridical  Re- 
view',  Jan. ,  1890  (contains  trial  of  Eyraud  and  Bompard) .  "  Bib- 
liographie  des  modernen  Hypnotismus,"  Dessoir,  Berlin,  1891. 
Contemporary  Review,  Oct.,  1890,  " Hypnotism  and  Crime." 
A.  T.  Innes,  "  Der  Hypnotismus  in  seiner  psychol.  Beziehung 
und  forensischen  Bedeutung,"  Schapira,  Berlin,  1893. 

CEREBRAL     DISEASES     WITH     CONSTANT     PATHOLOGICAL 
CHANGES    OR   ORGANIC    PSYCHOSES. 

Under  this  heading  fall  all  those  diseases  of  the  brain  in 
which  there  are  mental  disturbances,  dependent  upon  definite 

'"The     International     Cyclopae-          2  Annales  d '  Hygiene  Publique  et 
dia, "  New  York,  1893,  p.  763.  de    Medecine    Legale,     iii.    serie, 

tomev.,  Paris,  1881,  p.  214. 


ACUTE  DELIRIOUS   MANIA.  313 

lesions  of  the  brain  and  its  membranes.  In  all  the  other  forms 
of  insanity  which  we  have  described,  with  the  exception  of  de- 
mentia, there  have  been  no  definite  changes,  outside  of  impaired 
nutritional  states,  whose  exact  relation  to  the  disease  itself  it 
was  possible  to  predicate. 

In  these  organic  psychoses,  however,  we  find  destruction  or 
impairment  of  the  cells  of  the  cortex,  associated  with  changes 
in  the  connective  tissue  and  the  blood-vessels,  which  are  amply 
sufficient  to  establish  a  basis  for  the  statement  that  insanity  is 
essentially  a  disease  of  the  brain — allowing  us  by  inference  to 
positively  conclude  that  the  so-called  functional  forms  of  in- 
sanity and  those  dependent  on  degenerative  states  are  likewise 
the  result  of  disease  of  the  brain,  as  the  symptoms  are  similar 
in  character ;  that  is,  they  consist  in  departure  from  the  normal 
reaction  of  the  various  faculties  of  what  we  call  mind,  one  on 
the  other.  Even  here,  however,  all  is  not  clear,  for  various 
similar  lesions  of  the  brain  substance  and  its  membranes  may 
exist  without  producing  mental  disease.  We  constantly  see 
inflammation  of  the  membranes  of  the  brain  and  the  cortex 
itself,  or  even  destruction  of  the  brain  substance  by  disease  or 
traumatism,  which  does  not  result  in  mental  disturbance,  so  that 
we  are  forced  to  accept  the  subdivision  of  this  class  of  insanity, 
as  stated  by  Krafft-Ebing,  as  consisting  of  brain  disease,  with 
predominating  mental  disturbance. 

The  explanation  of  this  apparent  anomaly,  that  in  all  cases  of 
disease  of  the  cortex  cells  we  do  not  get  like  mental  symptoms, 
remains  for  the  future  investigator  to  give  us. 

The  tendency  at  present  is,  therefore,  to  study  the  cells  them- 
selves in  their  normal  and  pathological  states,  which  may  finally 
lead  to  a  discovery  of  those  special  cortex  cells  of  the  brain  which 
carry  on  the  mental  processes,  and  enable  us  to  differentiate  them 
from  those  which  are  the  source  of  motor  and  sensory  function. 

The  first  disease  under  consideration  in  this  class  of  organic 
insanities  will  be : 

ACUTE  DELIRIOUS  MANIA. — Synonyms:  Delirium  grave; 
typhomania. 

We  have  to  do  with  a  condition  in  which  there  is  great  ex- 
citement and  violence  associated  with  extreme  exhaustion  and  a 
high  temperature. 

It  differs  essentially,  therefore,  from  any  other  form  of  in- 


314  INSANITY — FISHER. 

sanity  in  that  we  have  associated  a  high  temperature.  Acute 
mania,  as  described  under  our  heading  of  functional  psychoses, 
bears  no  resemblance  to  it  in  its  clinical  course,  it  being  essen- 
tially a  non-febrile  state,  even  the  greatest  amount  of  violence 
rarely  leading  to  an  elevation  of  temperature  of  more  than  a 
degree.  The  marked  degree  of  exhaustion,  the  evidence  of 
some  real  illness  being  at  the  back  of  the  delirious  state,  is  not 
present  in  ordinary  mania.  As  in  the  latter,  there  is  frequently 
present  an  appearance  of  great  vitality,  at  least  in  the  early 
stages.  The  course  of  the  disease  is  essentially  different,  death 
usually  occurring  within  five  to  ten  days.  It  suggests  from  the 
beginning  some  severe  febrile  state,  due  to  some  cause  of  infec- 
tion. We  have  to  do  with  a  distinct  disease,  an  entity,  and 
not,  as  suggested  by  Regis,  a  higher  degree  of  mania. 

Acute  delirious  mania  is  essentially  an  acute  disease  of  the 
brain,  characterized  by  high  temperature  and  extreme  exhaus- 
tion, accompanied  by  hallucinations  of  sight  and  hearing,  and 
delirium. 

The  causes  are  predisposing  and  exciting.  Among  the  first 
is  hereditary  tendency  or  a  neurotic,  unstable  disposition. 
It  is  usually  a  disease  of  adult  life  from  twenty-five  to  fifty,  and 
affects  both  sexes  about  equally.  Women  at  the  climacteric 
period  are  especially  liable  to  it.  It  is,  however,  one  of  the 
rarer  forms  of  insanity.  Extreme  exhaustion  from  overwork, 
especiaUy  of  a  mental  character,  shock  from  domestic  and  finan- 
cial losses  are  exciting  causes.  It  may  follow  or  accompany 
typhoid  fever  or  pneumonia  or  rheumatism.  It  is,  as  Bevan 
Lewis  well  says,  a  disease  especially  marked  by  the  rapid  dis- 
integration, both  mental  and  physical,  of  the  patient. 

The  onset  of  the  disease  may  be  and  usually  is  sudden,  mark- 
ing itself  by  acute  delirium  in  which  hallucinations  are  present. 
The  patient  requires  restraint.  This  may  be  preceded  by 
symptoms  of  a  mild  character,  as  of  irritability,  sleeplessness, 
and  headache.  In  the  early  stages  of  rheumatism  and  miliary 
tuberculosis  passing  into  acute  delirious  mania,  the  mental 
symptoms  may  entirely  obscure  the  physical  signs  of  the  dis- 
ease. The  patient  soon  passes  into  a  low  muttering  delirium 
and  is  unconscious  of  his  surroundings,  with  no  after-memory  of 
the  passing  events.  There  seems  to  be  a  feeling  of  terror,  and 
fear  with  a  desire  to  escape ;  the  face  is  flushed,  the  pupils  con- 


ACUTE   DELIRIOUS   MANIA.  315 

tracted  or  dilated,  and  the  body  bathed  in  a  profuse  perspiration. 
There  is  from  the  first  rapid  wasting;  the  tongue  is  dry  and 
coated  and  the  pulse  frequent  and  Mnall. 

There  is  every  sign  of  extreme  bodily  illness.  The  temper- 
ature from  the  beginning  is  usually  high  and  continues  to  rise 
to  105°-10G°  before  death.  The  course  of  the  disease  is  rapid, 
death  usually  resulting  within  five  days.  The  emaciation  may 
be  extreme  despite  the  constant  feeding.  Recovery  at  times 
occurs,  leaving  little  after-effects,  although  there  may  be 
dementia. 

The  post-mortem  changes  are  often  very  inadequate  to  ex- 
plain the  violent  class  of  symptoms  which  have  passed  over  the 
patient  like  a  storm.  There  is  usually  evidence  of  excessive 
hypersemia,  which  probably  at  this  time  is  less  marked  than 
intra  vitam.  Krafft-Ebing  considers  the  changes  essentially 
due  to  hyperaemia  followed  by  venous  congestion.  There  is 
usually  considerable  increase  of  the  cerebro-spinal  fluid,  the  brain 
substance  appearing  cedematous.  The  cortex  is  found  to  have  a 
rosy  appearance  from  the  overfilling  of  the  capillaries.  The  pial 
vessels  are  marked  by  white  lines,  probably  due  to  stasis  in  the 
accompanying  lymph  tracts.  The  cortex  cells  are  usually  in- 
volved and  show  evidence  of  disintegration. 

It  would  scarcely  seem  probable  that  such  changes  could 
presage  the  beginning  of  general  paralysis,  although  this  has 
been  noted  by  some  writers. 

The  general  distinction  of  this  disease  from  the  other  forms 
would  seem  evident.  From  delirium  tremens  the  absence  of 
fever  in  the  latter  and  the  absence  of  the  extreme  exhaustion 
are  sufficient.  Should  it,  however,  be  complicated  by  an  acute 
disease,  such  as  pneumonia  or  meningitis,  it  is  more  difficult  to 
make  the  diagnosis. 

The  following  case,  which  proved  fatal  in  three  days,  and  in 
which  an  autopsy  was  obtained,  typically  represents  the  disease: 

R,  laborer,  aet.  about  35,  was  admitted  to  the  hospital  November 
19th,  1893.  During  the  night  of  admission  and  the  following  day  he 
was  very  delirious  and  had  to  be  restrained.  He  was  at  no  time  con- 
scious of  his  surroundings  nor  could  he  be  aroused  to  give  his  name. 
He  was  constantly  talking  in  an  unintelligible  manner  ami  at  times  be- 
came very  violent,  calling  out  as  if  in  great  fear.  There  was  constant 
twitching  of  the  extremities,  but  no  convulsions  occurred  at  any  time. 


Temperature. 

Respiration. 

9  A.M. 

100° 

18 

1  P.M. 

100° 

15 

5  P.  M. 

97" 

16 

9  P.M. 

99° 

18 

1  A.M. 

100° 

22 

5  A.M. 

102° 

28 

316  INSANITY — FISHER. 

The  temperature  never  rose  above  100°  until  November  21st,  the 
respiration  being  between  9-12.  On  the  21st  the  patient  passed  into  a 
state  of  low  muttering  delirium,  becoming  angry  and  combative  when 
disturbed.  The  following  is  the  chart  taken  at  that  time: 

Pulse. 
100 
104 
100 
104 
112 
126 

Death  occurred  8:45  A.M.  on  the  22d.  Toward  the  end  there  was  a 
constant  rise  in  the  temperature  and  increase  in  the  pulse  and  respira- 
tion. 

The  autopsy  showed  the  calvarium  adherent  over  the  convexity. 
The  pia  was  raised  up  from  the  cortex  by  a  serous  effusion,  and  there 
was  evidence  of  marked  capillary  congestion  of  the  cortex. 

GENERAL  PARESIS. — Synonyms:  General  paralysis  of  the 
insane;  Paralysie  generale,  meningite chronique  avec  aliena- 
tion ;  periencephalite  chronique  diffuse. 

It  is  a  chronic  disease,  as  the  various  synonyms  given  indi- 
cate, in  which  there  are  both  mental  and  physical  symptoms 
present. 

The  mental  symptoms  are  those  which  most  particularly  in- 
terest us  in  a  medico-legal  sense,  and  they  are  rarely  absent, 
although  in  some  few  cases,  outside  of  a  certain  degree  of  de- 
mentia, they  may  be  subordinate  to  the  physical  or  somatic 
signs  of  the  disease. 

It  is  essentially  a  disease  of  the  fully  developed  brain,  com- 
ing on  in  adult  life,  usually  between  the  ages  of  twenty-five  and 
fifty,  although  some  cases  in  childhood,  especially  where  there 
has  been  an  hereditary  history  of  syphilis,  have  been  reported, 
and  again  in  some  instances  it  has  occurred  after  the  age  of 
seventy.  The  course  of  the  disease  is  a  chronic  one,  extending 
usually  over  a  period  of  two  or  three  years,  but  it  may  termi- 
nate in  a  few  months,  and  in  certain  irregular  cases,  especially 
where  the  somatic  symptoms  are  more  prominent  than  the 
mental,  extend  even  to  fifteen  years.  It  is  a  disease  of  modern 
life  and  affects  men  more  frequently  than  women,  although  of 
late  years  it  is  found  much  more  frequently  among  women  than 
formerly.  This  may  be  explained  by  the  increased  anxieties 


GENERAL   PARESIS.  317 

to  which  the  latter  are  subjected  in  the  more  active  part 
now  assumed  by  them  in  business  relations  and  the  various 
professions. 

Heredity  is,  as  in  all  forms  of  insanity,  an  important 
element  in  its  causation,  it  being  present  as  a  factor  in  about 
thirty-three  per  cent,  of  all  cases.  It  is  rarely  directly  inherited, 
but  usually  occurs  in  those  whose  antecedents  have  a  history 
of  epilepsy,  chorea,  alcoholism,  phthisis,  or  in  which  the  children 
are  the  products  of  old  age  or  in  families  in  which  consanguinity 
in  marriage  has  existed.  Syphilis  is  perhaps  the  most  impor- 
tant exciting  cause,  it  being  claimed  by  many  writers  that  it 
always  exists  as  the  basis  of  every  case.  This  is,  however, 
probably  not  true.  Among  other  exciting  causes  is  found 
mental  worry,  especially  when  of  a  financial  character,  or  even 
the  struggle  for  existence.  This  is  observed  where  certain  races 
as  the  negro,  the  Chinese,  etc.,  come  in  contact  with  a  higher 
civilization,  although  in  their  own  native  surroundings  the  dis- 
ease is  very  uncommon.  Excesses  of  any  nature,  overwork, 
alcoholism,  venereal  excesses  have  an  active  part  in  its  causa- 
tion, so  that  we  commonly  find  the  disease  among  the  pro- 
fessional classes,  as  lawyers,  clergymen,  physicians,  brokers, 
merchants,  and  actors.  It  is  not,  however,  confined  to  any  class, 
affecting  the  highly  educated  and  the  ignorant.  It  is  a  dis- 
ease of  the  brain  characterized  by  a  more  or  less  rapid  disin- 
tegration, associated  with  inflammation.  It  is  this  latter  con- 
dition which  supports  the  theory  of  a  syphilitic  origin  of  the 
disease,  which  is  in  fact  present  in  the  majority  of  the  cases. 
However,  I  feel  convinced  from  careful  study  of  many  cases, 
both  in  hospital  and  private  practice,  that  in  not  a  small  propor- 
tion of  such  patients  that  element  can  be  excluded. 

The  course  of  the  disease  is  generally  described  as  passing 
through  certain  stages,  but  this  is  for  convenience  only,  as  there 
are  no  well-defined  periods  during  the  progress  toward  its  al- 
ways fatal  ending.  In  fact,  there  are  often  remissions  in  which, 
at  times,  recovery  seems  to  have  taken  place.  Especially  is  this 
observed  when  the  patient  is  removed  from  the  excitement  and 
strain  of  ordinary  life  to  the  quiet  and  regular  existence  of  hos- 
pital care.  The  course  is  rapid  or  slow  also,  depending  on  the 
frequency  of  epileptic  seizures,  one  of  the  common  symptoms  of 
the  disease.  When  these  are  present  to  a  marked  degree,  there 


318  INSANITY — FISHER. 

seems  to  occur  a  rapid  disintegration  of  the  mental  faculties  and 
a  tendency  to  physical  exhaustion  terminating  in  death. 

The  onset  of  the  disease  is  rarely  sudden,  although  it  may 
appear  so,  as  the  first  indication  of  the  disease  to  the  friends 
may  be  some  extravagant  act,  either  in  social  or  business 
relations.  Usually,  however,  if  the  patient  has  been  closely 
observed,  some  change  in  the  personality  will  have  been  noted. 
At  times  a  condition  of  depression  may  precede  the  actual  out- 
break of  the  disease,  or  there  may  be  some  excitement  ex- 
pressed by  irritability  or  obstinacy,  or  again  in  somatic  symp- 
toms, as  apoplectic  or  epileptic  seizures,  or  an  attack  of 
aphasia  lasting  a  few  hours  or  days.  These  prodromal  symp- 
toms are  usually  only  remembered  after  the  thorough  establish- 
ment of  the  disease. 

In  a  medico-legal  aspect,  according  to  Legrand  du  Saulle, 
general  paralysis  may  be  divided  into  four  distinct  periods,  a 
short  summary  of  which  I  will  give,  although  the  pathology  of 
the  disease  does  not  sustain  any  such  artificial  division  into 
periods. 

1.  "  Periode  prodromique,"  or  prodromal  period,  in  which, 
while  many  irregular  mental  or  physical  symptoms  may  be 
present,  they  cannot  be  distinctly  recognized  as  characteristic  of 
the  disease  except  in  the  light  of  its  future  development.     There 
may  be  indeed  for  several  months,  or  even  years,  a  combination 
of  characteristic  phenomena,  as  one  or  several  apoplectic  attacks 
with  loss  of  consciousness  and  passing  paralysis  of  the  arm  or 
leg,  or  temporary  aphasia.     More  important  is  the  change  in 
the  personality.      There  is  often  an  exaggeration    of  former 
tendencies.     There  is  usually  extreme  irritability,  or  again  de- 
pression.    There  is  also,  even  at  this  period,  an  impairment  of 
the  memory  and  an  evident  inability  to  perform  the  usual  work, 
even  that  of  the  most  routine  character.     About  this  period  there 
will  now  appear  the  feelings  of  self-satisfaction  and  expansive- 
ness  which  really  usher  in  the  so-called — 

2.  "  Periode  initiate,"  or  initial  period  of  the  disease.     This 
is  usually  expansive,  showing  exaggeration  of  the  ego,  but  may 
at  times  be  depressive,  the  patient  apparently  recognizing  his 
mental  condition.     The  delire  des  grandeurs  is,  however,  far 
more  frequent.     The  sense  of  well-being  is  thoroughly  estab- 
lished at  this  period — a  feeling  of  power  and  ability  to  do, 


GENERAL   PARESIS. 


319 


entirely  at  variance  with  the  actual  mental  weakness.  There 
is  an  exaggerated  idea  of  wealth  and  strength.  It  is  at  this 
period  that  speculations  of  the  wildest  character  may  be  under- 
taken. In  the  depression  there  is  constant  dread  of  approach- 
ing ruin ;  a  belief  that  acts  have  been  committed  which  have 
dishonored  them.  There  may  at  this  time  be  a  cessation 
of  the  progress  of  the  disease,  or  else  what  may  appear 
as  a  recover)-,  but  there  is  sooner  or  later  the  establishment 
of  the  full  physical  and  mental  signs  of  the  disease  in  the  so- 
called — 

3.  P£riode  d'gtat,  which  continues  for  months,   passing 
into  the  stage  of  complete  dementia,  i.e.,  the  fourth  stage,  or 

4.  PGriode  terminate. 

The  age  and  social  condition  of  patients  with  general  paresis 
is  shown  in  the  report  furnished  me  by  Dr.  Louis  C.  Pettit, 
of  the  New  York  City  Insane  Asylum,  of  one  thousand  and  six 
cases: 

AGE  AT  DEATH  IN  ONE  THOUSAND  AND  Six  CASES  OF  PARESIS. 


Age. 
21  

Cases. 
0 

Sin- 
gle. 
0 

Mar- 
ried. 

0 

Wid- 
owed. 

0 

Age. 
48  

i  hum 
...     27 

Sin- 
gle. 

7 

Mar- 
ried. 

17 

Wid- 
owed. 

8 

22    

1 

1 

0 

0 

49  

...     20 

1 

19 

0 

28 

2 

0 

2 

0 

50  

...     48 

6 

39 

8 

24 

1 

0 

1 

0 

51  

...     20 

5 

12 

3 

25 

13 

5 

M 

1 

52  

...     19 

4 

14 

1 

26  

9 

R 

1 

0 

58  

...     22 

3 

18 

1 

27 

7 

5 

9! 

0 

54  

...     14 

8 

7 

4 

28 

14 

5 

9 

0 

55  

...     25 

8 

17 

6 

29      ... 

17 

3 

18 

1 

56  

...     17 

2 

13 

2 

30 

22 

18 

9 

0 

57  

...       5 

1 

4 

0 

31 

..     21 

3 

17 

1 

58  

...     17 

4 

11 

2 

32 

32 

14 

18 

0 

59  

...       6 

2 

4 

0 

33 

24 

18 

11 

0 

60  

...     16 

2 

18 

1 

34 

27 

4 

23 

0 

61  

4 

0 

4 

0 

35 

58 

15 

88 

5 

62  

...       6 

1 

4 

1 

36 

38 

7 

37 

4 

63  

...      4 

0 

8 

1 

37 

87 

14 

£8 

0 

64    

...       6 

1 

2 

8 

88 

42 

16 

915 

1 

65  

...       5 

0 

4 

1 

39 

.   .     24 

4 

19 

1 

66  

...       7 

2 

4 

1 

40    .. 

70 

14 

58 

3 

67  

0 

0 

0 

0 

41 

34 

6 

fl8 

0 

68    

...       3 

0 

3 

0 

42 

.    ..     46 

13 

82 

2 

69  

...      4 

0 

4 

0 

43 

..     25 

7 

15 

3 

70  

...       0 

0 

0 

0 

44 

32 

8 

21 

3 

72  

...       1 

0 

1 

0 

45 

52 

9 

42 

1 

79  

...       1 

0 

0 

1 

4ft 

2ft 

5 

21 

2 

___ 

47.. 

33 

4 

27 

2 

Total.. 

.   1,006 

242 

701 

68 

Convulsions  387.     Syphilis  117. 


320  INSANITY — FISHER. 

It  is  possible  for  the  prodromal  period  referred  to,  in  which 
there  is  evidence  of  change  of  character  and  great  irritability 
with  a  tendency  to  exhibitions  of  anger  or  violence,  which  at 
this  time  is  often  bitterly  repented  of,  to  extend  over  a  number 
of  years.  The  actual  establishment  of  the  disease  is  marked 
intellectually  by  the  absence  of  all  feelings  of  regret  for  their 
acts  and  the  natural  feelings  of  anxiety  or  even  interest  in  their 
personal  affairs.  A  fatuous  state  of  contentment  takes  its  place, 
a  belief  that  mistakes  will  be  made  right  in  some  way.  Habits 
of  extravagance  are  established ;  purchases  of  articles  of  every 
variety,  often  useless  in  character,  are  made;  enterprises  are 
entered  into,  houses  built  without  regard  to  expense.  The  for- 
merly temperate  man  may  order  large  quantities  of  wine,  and 
during  periods  of  excitement,  which  are  often  paroxysmal  in 
character,  may  be  subject  to  excesses  in  drinking. 

Appropriation  of  money  or  property  may  take  place,  due  to 
the  expansive  ideas  of  the  patient,  his  belief  in  his  great  wealth 
or  his  numerous  plans  causing  him  to  utterly  disregard  the 
rights  of  others.  It  is  at  this  period,  therefore,  before  the  con- 
dition has  been  recognized  by  those  with  whom  he  comes  in 
contact,  that  questions  of  medico-legal  interest  may  arise.  It  is 
important  to  recognize  this  early  stage  before  fortunes  are  dis- 
sipated and  the  family  disgraced.  The  mental  change  from  the 
previous  condition  is,  therefore,  of  primary  importance.  At  this 
period,  also  usually  accompanying  or  following  close  upon  the 
intellectual  impairment,  appear  bodily  conditions  which  are  as 
positively  diagnostic  of  the  disease  as  those  affecting  the  mind. 
There  is  usually  at  an  early  stage  more  or  less  tremor  of  the 
muscles  of  the  face,  especially  of  the  muscles  of  the  mouth  and 
the  folds  of  the  cheek,  and  also  of  the  tongue.  The  speech 
becomes  thus  secondarily  affected  and  is  slow  and  clumsy — the 
ideas  may  flow  rapidly,  but  cannot  be  enunciated  clearly.  There 
is  not  true  aphasia,  and  there  is  no  loss  of  memory  of  words, 
but  there  is  marked  inability  to  coordinate  the  muscles  neces- 
sary for  articulation.  There  is  also  some  actual  paresis  of  the 
muscles  of  the  face,  giving  a  characteristic  blank  and  fatuous 
expression.  The  pupil^  are  also  soon  involved,  showing  in- 
equality, and  slowness  of  response  to  light,  but  retaining  the 
power  of  accommodation;  later  there  is  often  permanent  dila- 
tation or,  more  rarely,  contraction. 


GENERAL   PARESIS.  321 

Again  at  this  early  stage,  though  more  rarely,  there  may  be 
epileptic  seizures  at  considerable  intervals  of  time  apart,  or 
apoplectic  seizures  with  hemiplegia  rapidly  recovered  from,  or 
true  aphasia  of  a  transient  character.  This  latter  disturbance 
of  speech  is  entirely  distinct  from  the  slow,  clumsy  speech  pre- 
viously referred  to.  We  now  recogni/e  symptoms  dependent 
upon  disease  of  the  spinal  cord,  as  tremor  of  the  hands,  mani- 
festing itself  in  the  writing  or  in  any  delicate  work,  even  in 
dressing.  There  may  also  be  marked  ataxia  of  both  the  u]>- 
per  and  lower  extremities,  with  loss  or  exaggeration  of  the  re- 
flexes. Accompanying  all  these  mental  and  physical  symptoms  of 
disease,  as  an  undertone,  there  is  usually  a  constant  feeling  of 
well-being,  already  referred  to;  the  patients  are  always  feeling 
well,  and  this  even  continues  to  the  final  stage  of  dementia. 
There  may  be  increase  of  the  sexual  appetite;  in  this  early 
period  it  being  often  regarded  as  the  cause  of  the  disease  when 
in  reality  it  is  a  symptom ;  or  again  we  may  have  the  reverse 
condition.  No  disease  shows  such  complete  wrecking  of  all 
that  can  be  called  man  in  his  moral  and  intellectual  character- 
istics as  general  paresis.  Paroxysmal  attacks  of  mania  of  great 
violence,  usually  destructive  or  homicidal,  may  occur.  It  is  at 
this  period  that  remission  may  occur,  or  at  least  the  disease  may 
remain  stationary  for  months  or  even  years. 

The  so-called  third  stage  simply  emphasizes  the  symptoms 
already  detailed.  The  aphasia  becomes  more  marked,  until 
the  speech  is  almost  unintelligible,  and  the  ataxia  and  paralysis 
increase,  so  that  the  patient  is  confined  to  his  bed,  unable  to  feed 
himself.  The  delusions  of  grandeur  and  hallucination  continue, 
and  still  the  absolutely  helpless  patient  may  express  himself  as 
never  having  felt  better  in  his  life. 

Epileptic  seizures  are  at  times  very  frequent,  continuing  for 
hours,  and  are  usually  of  the  clonic  type,  without  loss  of  con- 
sciousness. These  are  dependent  upon  the  meningitis,  and  are 
often  the  direct  cause  of  the  death  of  the  patient  from  exhaus- 
tion. They  have  a  great  influence  in  increasing  the  demen- 
tia Apoplexies  may  cause  paralysis,  or  when  occurring,  as 
they  at  times  do,  in  the  parietal  and  occipital  regions  of  the 
brain,  cause  mind  blindness,  that  is,  a  loss  of  appreciation  of 
what  an  article  is,  or  its  use;  or  again  word  deafness  and 
word  blindness.  These  conditions  are  usually  temporary. 


322  INSANITY — FISHER. 

The  final  dementia  may  be  complete,  but  death  usually  results 
from  exhaustion  or  some  intercurrent  disease,  as  pneumonia, 
before  it  is  reached. 

The  course  of  the  disease  as  described  is  the  usual  and  typical 
one;  there  are,  however,  many  variations  which  occur  in  its 
onset  and  course.  It  is  always  fatal.  The  remissions,  how- 
ever, in  some  cases  are  often  of  long  duration,  for  a  time  mak- 
ing the  diagnosis  subject  to  question. 

In  certain  cases  again,  when  the  physical  signs  of  the  dis- 
ease are  well  defined,  but  the  mental  are  not  so  well  developed, 
there  may  be  considerable  difficulty  of  diagnosis,  especiall3T  as 
this  class  may  continue  long  beyond  the  usual  term  of  the  dis- 
ease. Again  in  the  so-called  spinal  type  the  earl}*  affection  of 
the  cord,  with  the  extension  of  the  disease  to  the  brain,  may 
make  it  at  first  difficult  to  give  a  positive  diagnosis. 

The  first  class  is  well  illustrated  in  the  following  case : 

A.  B.,  lawyer,  aet.  34;  family  history  negative.  Patient  had  con- 
tracted syphilis  in  early  life.  Married  and  had  several  healthy  children. 
Exciting  cause  of  disease,  financial  anxiety,  overwork,  and  grief  from 
domestic  affliction.  It  was  recollected  that  for  two  or  three  years  pre- 
vious to  my  examination  of  him,  he  had  become  very  irritable  and 
liable  to  outbursts  of  anger,  his  natural  temperament  being  mild  and 
agreeable.  This  was,  however,  ascribed  to  his  business  anxiety  and  in- 
somnia. The  first  symptom  ascribed  to  mental  disease  was  a  transient 
attack  of  aphasia,  lasting  a  few  hours.  This  was  followed  a  few  months 
later  by  a  second  attack,  after  which  there  seemed  to  be  a  permanent 
change  in  his  disposition .  He  no  longer  had  any  anxiety  in  regard  to  his 
business,  neglecting  to  appear  in  court  at  the  time  of  trial,  but  expressing 
no  regret  for  it.  He  became  placid  and  contented,  sleep  and  appetite 
improved.  Memory  for  present  wants  became  very  defective,  but  he 
would  relate  with  full  details  events  occurring  within  the  last  few 
years.  Was  perfectly  able  to  carry  on  accurately  the  routine  business 
of  his  office.  At  no  time  did  he  have  any  delusion  of  grandeur  or  any 
expansive  ideas.  Became  rather  careless  at  times  in  money -matters,  but 
at  no  time  extravagant.  His  speech  became  slow  and  clumsy,  and 
from  a  brilliant,  rapid  talker  in  court,  he  at  times  became  almost  unin- 
telligible. Such  catch-expressions  as  "  Around  tbe  rugged  rocks  the 
ragged  rascals  ran,"  were  impossible  to  him.  There  was  considerable 
tremor  of  the  several  muscles  of  the  face,  and  that  characteristic  flat, 
fatuous  expression  of  countenance  peculiar  to  general  paresis. 

He  at  times  is  subject  to  maniacal  attacks,  in  which  he  has  struck 
his  wife  and  children  ;  these  are  soon  over,  and  he  has  deepest  repent- 
ance for  his  acts.  As  a  rule  he  is  docile  and  easily  forgets  any  ill-feel- 


GENERAL   PARESIS.  323 

ing.  Has  at  no  time  had  any  convulsive  seizures,  or  been  subject  to 
hallucinations  or  delusions. 

He  has  relinquished  all  business,  and  although  regularly  going  to 
his  office  and  remaining  the  usual  time,  seems  to  have  no  appreciation 
of  the  fact  that  he  is  doing  nothing. 

Is  emotional,  a  sad  story  causing  him  to  burst  into  tears,  but  is  gen- 
erally in  a  happy  and  self-satisfied  condition  of  mind.  The  disease 
has  now  lasted,  with  very  little  change  except  a  slowly  increasing  de- 
mentia, for  five  years,  which,  with  the  previous  two  or  three  years 
which  were  a  part  of  the  disease,  makes  its  course  at  least  seven  years. 

In  this  form  the  physical  signs  of  tho  disease  and  dementia 
are  the  prominent  symptoms.  Another  patient's  history  ex- 
tended over  fifteen  years. 

The  onset  was  gradual  and  unexpected,  the  symptoms  being  alto- 
gether of  a  spinal  character.  However,  he  had  still  earlier  delusions 
of  an  expansive  character,  which  had  resulted  in  speculation  which  in- 
volved him  in  financial  ruin.  During  the  last  eight  years  of  his  life, 
while  under  my  observation,  he  had  no  delusions.  He  wa&  always 
happy  and  expressed  himself  as  perfectly  well.  There  was,  however, 
a  progressive  dementia,  interrupted  at  times  by  attacks  of  maniacal  vio- 
lence, in  which  he  had  an  intense  desire  for  alcohol. 

Complications. — Among  the  special  complications  peculiar 
to  this  disease  is  often  the  very  early  condition  of  failure  or 
loss  of  appreciation  of  moral,  ethical,  and  religious  questions,  so 
that  we  notice  men  and  women  commit  acts  opposed  to  the 
ordinary  customs  of  society,  often  in  public,  without  apparently 
any  appreciation  of  their  heinousness  or  any  regard  for  the  feel- 
ings of  others.  Combined  with  this  there  is  more  or  less  con- 
fusion of  ideas,  especially  in  regard  to  the  rights  of  those  around 
them,  whether  in  reference  to  their  comfort  or  to  their  property. 
Perhaps  one  of  the  most  important  signs  of  dementia  which 
manifests  itself  even  at  an  early  stage  is  to  be  found  in  this 
direction.  Long  before  there  is  any  marked  failure  of  mental 
power,  as  shown  in  the  occupation  or  daily  relations  of  life,  this 
partial  confusion  of  the  proprieties  is  seen  and  here  it  is  of  im- 
portance to  recollect  that  this  symptom  may  long  remain  un- 
recognized, and  probably  is  the  premonitory  sign  of  the  disease 
itself.  It  may  take  the  form  of  extreme  nervousness,  or  of  de- 
spondency, or  again  of  irritability,  or  lack  of  consideration  for 
others,  whether  in  regard  to  their  opinions  or  their  rights.  A 


324  INSANITY — FISHER. 

case  under  my  observation  first  presented  all  the  conditions 
common  to  neurasthenia  and  general  nervous  exhaustion,  with 
inability  to  attend  strictly  to  business.  There  was  marked 
hypochondria  with  reference  to  the  sexual  organs,  and  the  con- 
stant fear  that  he  had  contracted  some  imaginary  disease. 
This  was  followed,  much  to  my  surprise,  in  the  course  of  a  year 
and  a  half,  by  all  the  characteristic  phenomena  of  general  pare- 
sis. In  this  case  there  has  been  no  history  of  syphilis,  but  ex- 
cessive worry  in  regard  to  business,  and  his  apparent  appreci- 
ation of  his  inability  to  carry  on  his  business  with  his  former 
success  seemed  to  be  the  exciting  causes  of  the  disease.  A 
change  in  his  condition,  which  was  noticed  by  his  physician, 
was  supposed  to  be  the  beginning  of  improvement  on  his  part ; 
it  was,  however,  the  beginning  of  the  mental  derangement 
which  is  common  to  general  paresis.  At  this  time  he  began  to 
see  only  the  pleasant  side  of  things,  and  to  form  great  plans 
about  his  business,  and  he  seemed  to  have  no  longer  any  fear 
of  failure  in  his  enterprises.  The  extensiveness  of  his  schemes, 
with  their  impracticability,  drew  the  attention  of  his  business 
friends  to  his  mental  state,  and  when  utterly  unable  to  go  to 
business,  or  to  speak  intelligently  or  connectedly  about  his  busi- 
ness, he  was  as  much  over-sanguine  as  he  had  formerly  been 
despondent.  Few  cases,  however,  apparently  have  this  pro- 
dromal stage,  most  of  them  showing  first  more  or  less  mental 
excitement,  rather  than  a  prolonged  condition  of  general  ner- 
vous ill-health. 

The  differential  diagnosis  may  require  to  be  made  at  times 
from  alcoholic  dementia — a  fuller  description  of  which  will  be 
given  later — from  syphilitic  disease  of  the  brain,  from  acute 
mania,  and  from  paranoia,  where  there  may  be  ideas  of  gran- 
deur not  dissimilar  from  those  found  in  general  paresis.  The 
ambitious  ideas  of  paranoia  may  offer  special  difficulties  at  first 
in  the  way  of  diagnosis.  Intra-cranial  growths  are  not  likely 
to  lead  to  errors  in  diagnosis.  Disseminated  sclerosis  is  at  times 
most  difficult  to  distinguish  from  it;  but  here  we  have  the 
marked  tremor,  the  nystagmus,  the  peculiar  speech,  and  the 
rigid  and  almost  spasmodic  condition  of  the  lower  extremities, 
to  aid  us  in  making  the  diagnosis.  Both  diseases  may  occur  at 
an  early  period  of  life,  the  disseminated  sclerosis  as  a  rule  some- 
what earlier  than  general  paresis.  In  a  few  rare  cases,  general 


GENERAL    PARESIS.  325 

paresis  is  found  among  elderly  people,  and  under  such  circum- 
stances it  may  be  difficult  to  differentiate  it  from  senile  demen- 
tia. In  a  case  which  I  had  under  observation,  a  patient  with 
strong  religious  ideas  began  to  develop  considerable  excitement 
and  irritability  on  account  of  the  opposition  to  plans  which  he 
had  devised  for  the  union  of  all  religious  denominations. 
There  was  marked  tremor,  and  also  inequality  of  the  pupils,  and 
evident  signs  of  exhaustion.  It  looked  as  though  the  disease 
would  progress  rapidly,  but  on  removal  to  an  asylum,  the 
routine  of  the  institution  and  the  proper  regulation  of  the  diet 
and  of  all  his  actions,  along  with  the  needed  rest,  led  to  marked 
physical  improvement.  The  case  is  still  under  observation,  and 
it  is  probable  that  it  will  again  progress  rapidly  as  soon  as  the 
effect  of  the  change  in  the  patient's  surroundings  has  passed 
ofi*.  From  ordinary  epilepsy  and  apoplexy  there  should  be  no 
difficulty  in  differentiating  the  disease. 

In  legal  relations  general  paresis  comes  very  often  in  ques- 
tion. Especially  is  this  seen  in  the  early  stages,  before  the  dis- 
ease has  been  actually  suspected.  The  extravagance  in  expen- 
diture may  make  it  necessary  to  inquire  into  the  mental  state  of 
the  individual.  Again  the  question  of  responsibility  for  theft 
committed  (which  is  not  unusual  in  this  disease),  or  malfeasance 
in  office,  or  the  care  of  moneys  or  estate  may  arise,  or  even 
offences  against  decency,  for  erotic  tendencies  are  not  uncommon 
in  the  early  stages  of  the  disease.  As  we  have  seen,  maniacal 
attacks  with  homicidal  tendencies  may  also  occur. 

Remission  simulating  complete  recovery  often  comes  into 
question.  There  is  no  true  remission  in  this  disease.  The  later 
stages  of  the  disease  are  so  well  defined  that  the  question  of  re- 
sponsibility can  scarcely  arise.  I  would  refer  here  to  the  follow- 
ing case  in  which  the  probate  of  a  will  was  contested : 

Will  of  Kiedaisch,  13  N.  Y.  Supp.,  2,55. — Contested  pro- 
bate of  a  will.  Testator  was  confined  to  an  insane  asylum  in  1 886 
as  being  afflicted  with  general  paresis.  In  1887  ho  was  taken 
out,  and  in  1888  married  the  proponent.  It  was  not  objected  that 
he  was  incompetent  to  marry,  and  the  will  was  executed  shortly 
after;  in  1889  he  was  again  confined  to  the  asylum,  where  he 
died  in  1890.  During  the  time  he  was  not  confined  to  the  asy- 
lum he  transacted  business.  The  testimony  of  experts  was  con- 
flicting. Held,  that  the  testator  was  competent  to  make  a  will. 


326 


INSANITY — FISHER. 


FIG.  25.— General  Paralysis  during  Period  of  Excitement. 


The  following 
cuts  illustrate  the 
facial  expression 
in  general  paraly- 
sis, which  is  as 
distinctive  as  the 
mental  symptoms 
themselves : 

A.  B.  (Fig.25),aet. 

35,    male.     Patient 

had  all  the  charac- 
teristic symptoms  of 

believing   that    he 

possessed  great 

wealth    and   delu- 
sions of  grandeur. 

Death      occurred 

about    three  years 

from    beginning  of 

the    disease.       His 

brother  died  in  another  institution  of  the  same  disease,  just  preceding  the 

time  of  his  death. 

A.  B.  (Fig.  26),  female,  set.  44.  In  this  case  very  few  mental  symp- 
toms except  demen- 
tia were  present, 
and  the  diagnosis 
remained  sometime 
in  doubt.  The  phy- 
sical signs  were, 
however,  well  de- 
fined as  the  case 
progressed.  Marked 
tremor  of  the  face 
and  tongue  and  loss 
of  facial  expression. 
The  speech  was 
slow  and  clumsy. 
Epileptic  seizures 
were  frequent,  one 
passing  into  the  oth- 
er, and  were  chron- 
ic in  character. 
Death  followed  one 
FIG.  26. -General  Paralysis.  of  these  seizures. 


SYPHILITIC   INSANITY.  327 

SYPHILITIC  INSANITY  is  cerebral  syphilis  with  predominating 
mental  symptoms. 

It  depends  on  disease  of  the  cerebral  vessels,  which  may  be 
partially  or  completely  occluded.  We  find  gummatous  infiltra- 
tions in  the  walls  of  the  vessels  and  usually  an  affection  of  the 
membranes  of  the  brain.  The  usual  situation  of  the  meningitis 
is  at  the  base  of  the  brain,  extending  into  the  cord,  so  that  we 
have  a  diffuse  cerebro-spinal  meningitis,  which  usually  in- 
volves some  of  the  cranial  nerves,  especially  the  third  nerve. 
The  meningitis  may  affect  the  convex  portion  of  the  brain, 
especially  the  frontal  lobes.  Again  there  may  be  gummata, 
single  or  multiple,  which,  by  their  special  situation,  may  cause 
epileptic  seizures. 

The  disease  presents  many  symptoms  resembling  those  found 
in  general  paresis.  Again  the  acute  psychoses,  as  melancholia 
and  mania,  may  arise.  The  general  tendency  of  the  disease  is 
toward  dementia,  usually  progressive  in  its  character.  Not 
rarely,  however,  dementia,  acute  in  character,  may  arise,  in 
which  the  individual  may  become  unable  to  recollect  his  own 
personality,  or  recognize  his  surroundings.  This  is  probably 
due  to  anaemia  of  the  brain  dependent  upon  the  circulation,  and 
is  more  apt  to  precede  any  localizing  symptom  such  as  paralysis 
or  convulsions.  This  was  well  illustrated  in  the  following 
history : 

C.,  set.  42,  a  traveller  for  a  New  York  house,  while  in  Chicago 
became  suddenly  demented  and  was  arrested  in  the  street,  being  unable 
to  give  his  name  or  address.  He  was  taken  to  his  home  by  friends  and 
remained  in  a  stupid,  half -maniacal  state  for  some  weeks.  Under 
special  treatment  for  syphilis  his  mental  state  entirely  cleared  up. 
Spinal  symptoms  developed  later,  which  were  without  doubt  due  to 
syphilis,  from  which  he  died. 

The  special  symptoms  of  cerebral  syphilis  are  headache, 
usually  nocturnal,  paralysis,  usually  hemiplegic  in  type  and 
accompanied  by  aphasia,  and  not  infrequently  epileptic  seizures 
either  unilateral  or  general.  The  paralysis  may  be  entirely 
recovered  from,  according  as  the  artery  has  been  the  seat  of  a 
complete  thrombosis  or  a  partial  one.  The  paralytic  attack  is 
not  infrequently  followed  by  a  second  one,  or  a  third,  and  may 
be  on  the  same  side  as  the  previous  one,  or  on  the  other  side  of 
the  brain.  Associated  with  this  we  may  have  a  paralysis  of  the 
III.— 23 


328  INSANITY — FISHEE. 

third  nerve,  causing  a  paralysis  of  the  upper  eyelid  or  ptosis, 
and  inequality  of  the  pupils,  which  are  usually  very  slow  in  re- 
action to  light,  and  often  irregular  in  outline. 

There  may  be  marked  tremor,  especially  of  the  tongue  and 
hands  or  even  of  the  face.  The  speech  is  often  affected,  but 
differs  from  the  clumsy,  slurring  speech  of  general  paralysis, 
being  that  resulting  from  paralysis,  and  usually  accompanied 
by  some  loss  of  the  names  of  articles.  The  reflexes  of  the 
paralyzed  limbs  are  always  exaggerated.  The  mental  state  is 
one  usually  of  dementia,  the  memory  is  impaired,  and  at  times 
there  may  be  attacks  of  coma  lasting  for  hours  or  even  days.  The 
prognosis  is  not  altogether  unfavorable.  The  mental  disturb- 
ance may  entirely  disappear,  and  even  the  paralysis  if  the  lesion 
has  not  been  too  severe.  There  is  often  considerable  difficulty 
in  making  a  differential  diagnosis  in  some  of  these  cases  from 
general  paresis.  However,  delusions  are  rare,  and  it  is  unusual 
to  find  ideas  of  grandeur  and  wealth.  The  apoplectic  seizures 
with  paralysis  are  more  quickly  recovered  from  in  general  par- 
esis, and  the  localized  symptoms  are  rarely  as  well  defined  in  the 
latter.  Such  cases,  however,  in  general  paresis,  in  which  the 
physical  signs  of  the  disease  are  alone  present  or  only  accom- 
panied by  a  slight  dementia,  may  make  it  almost  impossible  for 
the  time  being  to  make  a  diagnosis  positively.  The  general 
course  of  general  paresis  is,  however,  as  we  have  seen,  compara- 
tively rapid  and  always  ends  fatally. 

In  a  legal  sense  these  cases  are  often  of  great  importance, 
especially  in  regard  to  testamentary  capacity.  Improvement, 
which  would  only  imply  a  remission  in  general  paresis,  and  no 
actual  abatement  of  the  delusions  or  of  the  dementia,  would 
mean  in  cerebral  syphilis  a  return  or  restoration  to  complete 
mental  power,  and,  therefore,  the  right  to  resume  control  of  the 
person's  own  affairs  or  property. 

ALCOHOLIC  INSANITY. — As  an  etiological  factor  alcohol 
enters  largely  into  the  production  of  various  forms  of  insanity. 
We  find  it  frequently  associated  with  other  causes  in  producing 
general  paresis,  mania,  etc. 

We  have  two  conditions,  however,  to  consider  in  alcoholism 
which  by  their  course  or  class  of  symptoms  mark  themselves 
out  as  peculiar  to  alcohol,  viz.,  acute  and  chronic  alcoholism. 
In  the  first  condition  we  have  symptoms  which  are  especially 


ALCOHOLIC   INSANITY.  329 

characteristic  of  mania.  It  is  usually  due  either  to  the  exces- 
sive ingestion  of  alcohol  or  may  occur  after  its  withdrawal. 
This  may  be  involuntary  on  the  part  of  the  individual,  as  the 
stomach  may  no  longer  be  able  to  retain  it.  There  is  also  much 
exhaustion  associated  with  the  withdrawal  of  the  alcohol,  as 
usually  during  these  alcoholic  excesses  very  little  food  is  taken. 

A  neuropathic  disposition  inclines  especially  to  the  produc- 
tion of  this  excitable  state,  or  a  previous  injury  of  the  head. 
In  the  latter  cases  a  small  amount  of  alcohol  may  bo  sufficient 
to  induce  mania.  The  course  is,  however,  brief  in  these 
cases,  and  is  not  associated  with  many  of  the  physical  signs  of 
the  disease,  as  tremor,  etc.  We  make  a  distinction  here  be- 
tween delirium  tremensand  acute  alcoholism  in  our  description, 
which  may  indeed  be  partly  artificial,  but  at  the  same  time 
seems  important. 

The  patient  is  excitable  and  often  violent,  desirous  of  shout- 
ing and  singing.  In  the  majority  of  the  cases  we  find  a  con- 
dition of  great  mental  excitement  continuing  for  days  or  weeks 
after  the  withdrawal  of  the  alcohol,  in  which  the  patient  is  very 
loquacious,  and  subject  to  hallucinations,  illusions,  and  delu- 
sions. He  wanders  from  one  subject  to  another,  speaking 
rapidly  but  incoherently.  The  hallucinations  affect  both  sight 
and  hearing;  he  converses  with  friends  as  if  they  were  present 
and  he  saw  and  heard  them. 

There  is  considerable  confusional  dementia  present,  all  idea 
of  time  and  place  being  lost  at  times;  any  recollection  of  how  he 
was  brought  into  his  present  place  being  absent.  There  are 
many  subjective  sensory  disturbances  leading  to  illusions,  as  of 
creeping  insects  or  animals  being  present.  This  may  have  its 
cause  in  a  neuritis,  commonly  present  in  these  cases.  In  ex- 
treme instances  there  may  be  an  absolute  paralysis  involving 
the  lower  and  secondarily  the  upper  extremities,  dependent  upon 
disease  of  the  peripheral  nerves.  This  latter  condition  is  often 
present  in  alcoholics  without  the  presence  of  mental  symptoms, 
but  the  association  of  the  two  conditions  is  not  rare. 

There  is  associated  with  these  acute  conditions  a  marked 
tremor  affecting  the  extremities,  especially  the  hands,  and 
also  the  muscles  of  the  face  and  tongue.  This  may  resemble 
very  closely  the  tremor  of  general  paralysis,  and  if  the  ex- 
citement is  associated  with  delusions  of  a  boastful  character, 


330  INSANITY — FISHER. 

which  is  not  rare,  may  make  the  diagnosis  for  a  time  difficult. 
The  physical  condition,  however,  shows  much  more  vasomotor 
disturbance,  and  there  is  usually  a  tendency  to  marked  perspi- 
ration. There  may  be  also  epileptic  seizures,  which  makes 
the  diagnosis  still  more  confusing.  The  comparatively  rapid 
improvement,  however,  after  the  withdrawal  of  the  alcohol  soon 
removes  all  doubt  in  these  cases. 

In  an  article  entitled  "  Mental  Symptoms  in  Alcoholic  Mul- 
tiple Neuritis  "  I  called  attention  especially  to  the  mental  symp- 
toms of  these  cases.  The  symptoms  differ  somewhat  from  those 
found  in  so-called  chronic  alcoholism  or  alcoholic  dementia. 
The  following  case  illustrates  it,  and  also  shows  the  possibility 
of  complete  recovery : 

A.  B.,  female,  aet.  30.  '  Subject  to  periodical  alcoholic  excesses,  not, 
however,  of  the  form  of  dipsomania.  Was  brought  to  the  hospital 
with  complete  paralysis  of  the  upper  and  lower  extremities  and  suffer- 
ing from  exquisite  pain  on  pressure  over  the  nerves  and  muscles  of  the 
extremities.  Patient  was  unable  to  state  how  she  had  been  brought  to  the 
hospital  or  by  whom,  although,  not  at  the  time  under  the  influence  of 
alcohol  in  any  degree.  Was  unable  to  state  the  day  of  the  week,  nor 
did  she  have  any  idea  of  time.  Patient  answered  ordinary  questions 
rationally,  but  would  forget  the  next  hour  or  day  that  she  had  spoken 
of  the  subject.  There  was  no  other  delusion  or  hallucination  of  any 
kind.  This  condition  continued  for  a  year,  a  complete  recovery  of  the 
paralysis  occurring  and  a  gradual  but  absolute  mental  restoration. 
The  intervening  year,  however,  always  remained  a  complete  blank. 

This  latter  class  of  cases  is  much  rarer  than  the  former,  with 
mania  and  delusion. 

The  pathological  changes  are  often  distinct  and  well  defined. 
We  find  a  multiple  neuritis  involving  the  peripheral  nerves,  and 
the  brain  shows  evidence  of  degeneration  of  the  cortex  cells  and 
the  associative  fibres.  There  is  usually  also  a  considerable  in- 
crease of  the  cerebro-spinal  fluid. 

These  conditions  may  be  completely  recovered  from  or  may 
pass  on  to  the  chronic  changes  which  come  under  the  head  of 
alcoholic  dementia. 

CHRONIC  ALCOHOLISM  OR  ALCOHOLIC  DEMENTIA  is  a  con- 
dition characterized  by  a  progressive  dementia  associated  with 
special  delusions,  especially  those  of  suspicion. 

The  etiology  of  these  cases  is  usually  the  constant  and  exces- 


ALCOHOLIC  INSANITY.  331 

sive  use  of  alcohol,  with  periods  of  more  or  less  prolonged  de- 
bauches. We  have,  therefore,  some  of  the  symptoms  of  acute 
alcoholism  just  described  associated  at  times.  The  chronic 
alcoholic  becomes  incapable  of  carrying  on  business,  in  fact 
loses  all  desire  to  do  so;  his  memory  is  defective,  and  he  loses 
all  the  higher  qualities  of  his  ethical  nature.  He  is  subject  to 
delusions  of  persecution  and  believes  that  people  are  conspiring 
against  him.  Delusions  of  hearing  are  common;  he  hears  the 
voices  of  his  enemies  talking  against  him,  threatening  to  kill 
him,  etc.  Visual  hallucinations  are  also  present.  Circumstantial 
accounts  of  assaults  and  often  robbery,  with  details  founded  on 
delusions,  may  be  given  which  have  absolutely  no  foundation 
in  fact.  On  the  other  hand  the  individual  may  accuse  himself 
of  acts  homicidal  or  otherwise,  which  were  clearly  not  committed. 

One  of  the  commonest  delusions  of  suspicion  is  that  of  the 
infidelity  of  the  wife  or  husband,  as  the  case  may  be. 

These  delusions  may  lead  to  acts  of  violence,  homicidal  in 
character.  As  the  dementia  progresses  there  is  often  a  fixed 
delusion  in  regard  to  these  acts.  It  is  not  rare  to  find  a  patient 
assert,  with  full  belief  in  his  statement,  that  he  has  been  at  a 
certain  place  and  met  certain  persons  and  transacted  business, 
when  it  is  known  that  he  has  not  left  the  house  for  weeks. 

He  may  be  unable  to  recognize  his  surroundings,  not  know- 
ing that  he  is  in  his  own  house,  or  may  be  unable  to  state  the 
time  of  the  year  or  week.  There  are,  however,  marked  changes 
in  the  course  of  the  symptoms,  depending  on  the  amount  of 
alcohol  consumed.  The  physical  signs  show  tremor  and  much 
muscular  weakness,  and  at  times  epileptic  seizures,  which  may 
be  followed  by  mania  or  melancholia. 

The  course  followed  by  the  law  is  that  alcohol  is  no  excuse 
for  crime  except  where  a  distinct  mental  disease  is  induced 
as  the  result  of  the  alcohol.  In  commitments  care  must  be 
observed,  as  recovery  from  the  delusions  is  often  rapid  when 
the  alcohol  is  removed,  and  litigation  for  damages  may  result. 
There  are  laws  at  present  regulating  the  confinement  of  women 
in  certain  institutions  for  a  year,  which  relieves  the  physician 
and  friends  of  the  responsibility. 

The  dementia  in  chronic  cases  has  a  tendency  to  remain  per- 
manent, even  after  the  removal  of  all  opportunities  of  obtaining 
alcohol.  The  pathological  changes  in  these  cases  are  definite 


332  INSANITY — FISHER. 

and  well  defined.  We  find  a  chronic  pachymeningitis,  often 
associated  with  meningeal  hemorrhage  and  a  degeneration  of  the 
cortex  cells  and  association  fibres.  There  is  also  cerebral  atrophy 
with  increase  of  the  cerebro-spinal  fluid. 

The  following  cases  will  illustrate  the  condition  described : 

A.  B.,  male,  set.  43.  Family  history  negative.  Always  of  a  neu- 
rotic disposition.  For  the  past  ten  years  has  been  an  excessive  drinker, 
especially  at  night,  when  he  would  take  large  quantities  of  gin.  B. 
has  had  several  attacks  of  delirium  tremens,  and  also  gives  history  of 
several  epileptic  seizures.  On  examination  found  patient  fairly  well 
nourished,  but  there  was  marked  tremor  of  the  muscles  of  the  face, 
tongue,  and  hands,  so  that  his  writing  was  scarcely  intelligible.  B. 
had  an  epileptic  attack  at  the  time,  remaining  more  or  less  confused 
mentally  for  two  hours.  Memory  was  very  defective — could  not  play  a 
game  of  whist  intelligently,  although  thoroughly  well  acquainted  with 
the  game.  The  question  which  arose  in  this  case  was  his  ability  to  trans- 
act business  and  his  responsibility  for  his  contracts.  The  partnership 
was  annulled  on  these  grounds.  There  were  at  no  time  any  delusions, 
simply  a  dementia  being  present.  Under  care  and  the  withdrawal  of 
the  alcohol,  marked  improvement  followed. 

A  second  case,  in  which  the  question  of  the  ability  to  manage  her 
own  property  arose,  is  as  follows  :  Mrs.  B.,  set.  65,  has  been  addicted 
to  excessive  drinking  for  years,  for  which  cause  she  is  separated  from 
her  husband. 

The  patient  is  naturally  a  very  shrewd  person  and  capable  of  trans- 
acting business  of  extensive  proportions,  when  not  under  the  influence 
of  alcohol. 

After  excesses  she  becomes  maniacal  and  has  delusions  of  being 
assaulted  and  robbed.  She  constantly  hears  voices  speaking  against 
her,  calling  her  indecent  names,  and  threatening  to  kill  her.  Has  illu- 
sions of  persons  around  her  saying  they  assaulted  her.  After  an  un- 
usually prolonged  debauch,  in  which  she  had  fallen  and  injured  her- 
self, she  ascribed  her  injuries  to  an  attack  by  these  persons. 

Her  story  was  that  they  had  entered  her  house,  seized  her  by  the 
hair,  and  robbed  her  of  a  large  sum  of  money,  which  they  knew  she 
carried  about  her.  This  delusion,  which  she  held  after  she  was  no 
longer  under  the  influence  of  alcohol,  was  described  with  full  details  of 
the  assault.  Even  during  her  relation  of  it,  however,  she  would  call 
attention  to  the  voices  in  the  room  above,  talking  against  her.  Any 
sound  was  interpreted  as  evidence  of  a  conspiracy.  Under  care,  how- 
ever, all  these  delusions  disappeared. 

Many  cases  similar  in  character  can  be  recorded,  in  which 
the  delusion  of  suspicion  and  conspiracy  is  associated  with  that 


ALCOHOLIC   INSANITY.  333 

of  the  fear  of  being  poisoned  or  of  losing  their  property.  This 
may  lead  to  certain  acts  to  avoid  the  impending  ruin  as  seen 
in  the  case  reported  by  Simon : 

A  well-to-do  business  man,  addicted  to  excessive  alcoholism,  im- 
agined that  he  was  becoming  poorer  every  day,  anil  that  his  neighbors 
reproached  him  for  the  most  necessary  living  expenses.  He  set  fire  to 
his  house,  to  avoid  the  complete  financial  ruin.  This  patient  ulti- 
mately recovered. 

This  writer  states  that  an  irresistible  impulse  may  often  ex- 
ist in  these  cases  and  that  homicides  most  often  committed  by 
chronic  cases,  are  the  result  of  these  impulses.  In  my  opinion 
these  acts  are  usually  the  result  of  the  hallucinations  or  delu- 
sions. 

The  question  of  responsibility  is  often  a  difficult  one.  Roan, 
Ortolan,  Helie  are  in  favor  of  allowing  extenuating  circum- 
stances in  all  cases  of  intoxication.  As  Cullere  says,  "  a  distinc- 
tion must  be  made  between  the  individual  who  resorts  to  alcohol 
for  the  courage  to  carry  out  an  act  or  crime,  and  he  who  in  un- 
foreseen intoxication  or  in  alcoholic  delirium  commits  an  illegal 
act.  In  case  of  drunkenness  the  expert  must  study  exactly  the 
habitual  mental  state  of  the  individual,  his  hereditary  tenden- 
cies, the  moral  or  emotional  shocks  which  may  have  shaken  the 
stability  of  bis  nervous  system." 

"  Although  drunkenness  in  itself  is  no  palliation  or  excuse 
for  crime,1  yet  mental  unsoundness,  superinduced  by  excessive 
intoxication,  and  continuing  after  the  intoxication  has  sub- 
sided, may  excuse;  or  when  the  mind  is  destroyed  by  long- 
continued  habit  of  drunkenness,  or  where  the  habit  of  intoxi- 
cation caused  an  habitual  madness ;  and  whore  a  person  is  in- 
sane at  the  time  he  commits  the  crime,  he  is  not  punishable, 
although  such  insanity  be  remotely  occasioned  by  undue  indul- 
gence in  spirituous  liquors,  or  from  what,  in  a  moral  sense,  is  a 
criminal  neglect  of  duty.  For  if  the  reason  be  perverted  or  de- 
stroyed by  a  fixed  disease,  though  brought  on  by  his  own  vices, 
the  law  holds  him  not  accountable.  But  temporary  insanity, 
resulting  immediately  from  voluntary  intoxication,  does  not 
destroy  legal  responsibility,  or  constitute  a  defence  for  crime; 
but  when  the  question  is,  whether  a  murder  is  of  the  first  or  of 
1  u  American  and  English  Encyclopedia  of  Law." 


33  i  INSANITY— FISHER. 

the  second  degree,  the  fact  of  drunkenness  may  be  proved  to 
show  the  mental  status  of  the  accused  at  the  time  of  the  act, 
and  thereby  enable  the  jury  to  determine  whether  or  not  the 
killing  resulted  from  a  deliberate  and  premeditated  purpose." 

SENILE  DEMENTIA. — This  condition  is  one  associated  with 
old  age,  and  is  perhaps  more  frequently  simply  a  sign  of  the 
gradual  decay  of  the  body  as  well  as  the  brain ;  in  fact,  as  a 
rule,  it  depends  upon  arterial  changes  of  a  degenerative  type. 
It  manifests  itself  by  loss  of  memory,  inability  to  fix  the  atten- 
tion on  the  subject  of  the  moment,  and  a  tendency  to  recur  to 
scenes  and  acts  of  a  period  long  past.  As  has  been  said,  "man 
is  as  old  as  his  arteries,"  and  consequently  as  a  result  of  any 
cause,  such  as  worry,  emotional  excitement  or  overwork,  or 
disease  due  to  alcoholism  and  syphilis,  we  often  find  true  senil- 
ity present  at  a  comparatively  early  age.  It  follows,  therefore, 
that  the  peculiar  symptoms  of  this  condition  may  occur  at  the 
age  of  forty -five  as  well  as  at  fifty  or  seventy-five  years  of  age. 

The  most  common  symptoms  associated  with  it  are  suspi- 
cion of  those  nearest  and  most  dear,  hallucinations  of  hearing 
and  of  sight,  and  delusions  which  are  often  of  a  persecutory 
character.  There  is  frequently  a  great  fear  of  impending 
poverty  or  ruin.  The  habits  change  to  those  of  extreme  miserly- 
ness,  so  that  even  the  ordinary  expenses  of  living  may  be 
grudged,  and  even  starvation  may  take  place,  although  the 
money  may  be  in  their  actual  possession.  We  have  alluded  to 
a  similar  set  of  delusions  occurring  in  alcoholic  dementia. 
While  this  condition  is  more  common,  we  may  find  just  the 
reverse  take  place.  There  may  be  special  antipathies  toward  cer- 
tain members  of  the  family  arising  from  a  delusion  of  suspicion, 
leading  to  great  injustice  in  making  a  wiU,  or  for  such  reason 
all  the  property  may  be  left  to  institutions.  This  necessarily 
leads  to  litigation  either  on  that  ground  or  that  of  undue  in- 
fluences. Old  age  alone,  even  with  decay  of  the  natural 
powers,  is  not  sufficient  to  render  such  a  will  invalid. 

Loss  of  memory  of  recent  events  leads  to  the  development  of 
a  more  or  less  marked  confusion  of  thought,  so  that  these 
patients  even  forget  where  they  are,  though  they  may  be  in 
their  own  homes  which  they  have  coccupied  for  years.  They 
may  even  assert  they  are  being  confined  by  force  in  some  dis- 
agreeable place,  whereas  as  a  matter  of  fact  they  are  perhaps 


SENILE    DEMENTIA.  335 

sitting  in  their  own  chair  or  room.  On  being  convinced  of  their 
mistake,  they  will  acknowledge  it,  but  will  almost  immediately 
relapse  again  into  the  same  or  a  similar  error.  Apoplectiform 
attacks  are  not  infrequent,  and  probably  explicable  by  some 
temporary  occlusion  of  the  cerebral  vessels  which  has  not  been 
complete  enough  to  cause  a  permanent  lesion.  This  condition, 
therefore,  represents  the  whole  state  of  the  circulation  of  the 
brain,  and  it  is  evident  that  not  enough  blood  is  carried  to  the 
various  parts  of  the  brain.  The  bodily  condition  often  corre- 
sponds to  the  mental  condition.  Where  the  mental  processes  are 
more  or  less  active,  though  impaired,  there  is  usually  loss  of 
flesh  and  interference  with  the  vegetative  functions;  where, 
however,  the  dementia  is  more  advanced,  so  that  hallucinations 
and  illusions  have  a  less  permanent  character,  the  physical  con- 
dition will  improve,  or  at  least  bodily  weight  will  increase,  and 
the  general  appearance  of  the  patient  will  improve.  This  is, 
however,  only  the  beginning  of  the  end,  and  does  not  indicate 
recover}'.  There  is  also  very  commonly  a  condition  of  athe- 
roma  affecting  the  vessels  of  the  heart,  leading  to  fatty  degen- 
eration. 

This  condition  may  be  expected  usually  between  the  ages  of 
sixty  and  eighty.  The  symptoms  are  generally  mild,  but  they 
vary  within  rather  wide  limits.  There  may  be  a  revival  of  the 
sexual  desires  which  have  long  remained  dormant,  or  there  may 
be  a  tendency  to  alcoholism  which  may  not  have  existed  pre- 
viously, so  that  a  person  hitherto  sober  and  orderly  may  become 
dissipated,  and  be  given  to  sexual  excesses  and  extravagance. 
These  individuals  naturally  fall  an  easy  prey  to  designing 
persons,  and  it  is  important  to  recognize  the  true  nature  of  this 
condition  in  the  early  stage,  for  otherwise  fortunes  may  be  dis- 
sipated. Certainly  it  would  seem  that  after  years  of  correct 
living  and  business  probity,  acts  contrary  to  the  generally 
accepted  character  of  the  person  should  be  considered  as  evidence 
of  mental  derangement  rather  than  as  evidence  of  previous  hy- 
pocrisy on  the  part  of  the  individual. 

The  final  stages  of  the  disease  are  not  dissimilar  from  those 
of  general  paresis.  There  may  be  considerable  excitement,  and 
even  maniacal  attacks  sufficiently  severe  to  require  restraint, 
or  the  removal  of  the  person  to  an  asylum.  Depression  is  not 
so  common  as  excitement ;  still  in  many  of  these  cases  there  is 


336  INSANITY — FISHER. 

a  tendency  to  suicide  as  a  result  of  such  a  profound  depression 
as  to  almost  simulate  acute  melancholia. 

This  disease  resembles  at  times  the  condition  observed  in 
women  at  the  menopause,  where  it  is  not  uncommon  to  see 
marked  depression  with  more  or  less  failure  of  the  mental 
powers,  loss  of  memory,  and  a  series  of  illusions  and  delusions. 
However,  this  latter  condition  is  often  followed  by  recovery. 

The  post-mortem  changes  observed  would  indicate  rather  a 
condition  of  atrophy  and  degeneration  than  any  active  process. 
The  walls  of  the  vessels  are  thickened  and  their  lumen  narrowed. 
The  membranes  are  frequently  thickened,  with  here  and  there 
evidence  of  a  pachymeningitis.  The  fluid  in  the  subarachnoid 
cavity  and  ventricles  is  increased.  The  volume  of  the  brain  is 
decreased.  The  convolutions  are  pale,  anemic,  and  flattened. 
The  sulci  are  not  so  deep  as  in  the  normal  brain.  There  is  also 
an  apparent  increase  in  the  Pacchionian  bodies,  and  they  are 
attached  to  the  dura  and  pia  along  the  longitudinal  sinus.  They 
may  increase  to  such  an  extent  as  to  lead  to  the  formation 
of  areas  of  softening  in  the  cortex  of  the  brain,  not  dissimilar 
to  that  found  in  general  paresis.  Microscopically,  the  cells  of 
the  cortex  show  signs  of  degeneration  and  loss  of  the  processes. 
The  walls  of  the  vessels  are  seen  to  be  considerably  degenerated, 
and  there  may  be  evidences  of  aneurismal  dilatations  of  the 
miliary  type. 

These  changes  are  all  of  a  general  rather  than  of  a  local 
character,  pointing,  as  we  have  said,  to  a  condition  of  atrophy 
and  degeneration  rather  than  to  any  active  process.  We  would 
note  that  the  association  fibres  connecting  one  area  of  the  brain 
with  another  are  also  involved,  explaining  perhaps  the  loss  of 
association  of  ideas  and  the  impairment  of  memory,  thus  lead- 
ing to  impaired  judgment.  This  is  perhaps  not  peculiar  to  the 
disease  under  consideration,  but  is  explanatory  of  similar  mental 
states  found  in  various  other  mental  disorders.  In  conclusion 
I  shall  describe  under  this  heading  apoplexy. 

CEREBRAL  APOPLEXY — by  which  we  mean  a  destructive 
lesion  of  the  brain  caused  by  hemorrhage  into  the  brain,  or 
softening  from  the  plugging  of  the  vessels  by  an  embolism  or 
thrombosis — may  involve  legal  questions  of  much  importance. 
We  do  not,  as  a  rule,  have  what  can  be  defined  as  insanity, 
but  often  there  is  dementia,  with  or  without  various  delusions 


CEREBRAL  APOPLEXY.  337 

and  hallucinations,  and  conditions  of  impaired  speech  or  aphasia, 
which  makes  it  difficult  for  the  individual  to  clearly  express  his 
wishes.  This  may  render  the  testamentary  capacity  doubtful. 

The  usual  condition  found  in  apoplexy  is  a  paralysis  of  one- 
half  of  the  body  and  aphasia,  which  may  be  permanent. 
Aphasia  may  be  simply  motor,  in  which  there  is  difficulty  to  ex- 
press the  ideas  desired,  by  reason  of  impaired  articulation,  or 
there  may  also  be  a  loss  of  the  names  of  things,  i.e.,  amnesic 
aphasia,  so  that  communication  has  to  be  carried  on  by 
gesture.  This  condition  does  not,  as  a  rule,  or  at  least  does  not 
necessarily,  imply  that  there  is  any  lack  of  understanding  of 
what  is  spoken  or  what  is  read,  so  that  full  intelligence  may  be 
maintained.  In  sensory  aphasia,  which  may  be  of  two 
varieties,  there  is  what  is  understood  as  word  blindness,  that  is, 
the  patient  is  no  longer  able  to  understand  written  language,  or 
again  there  may  be  word  deafness,  i.e.,  loss  of  understanding 
of  spoken  language.  Mind  blindness  may  be  present,  but  this 
always  implies  an  extreme  degree  of  dementia,  for  the  individual 
no  longer  comprehends  the  use  of  things,  or  their  object;  this 
has  been  called  apraxia.  The  whole  character  of  the  individual 
may  be  changed — he  may  become  filthy  and  obscene  in  his 
habits,  or  lewd  and  addicted  to  alcohol.  The  essential  point  is 
really  a  matter  of  fact  as  to  what  the  mental  condition  is  at  the 
time  of  examination.  The  mere  fact  of  having  had  an  apoplectic 
seizure  does  not  necessarily  imply  such  mental  impairment  as 
to  incapacitate  one  from  responsibility  for  his  acts.  The  ques- 
tion arises  most  frequently  in  regard  to  the  testamentary 
capacity  of  the  individual  and  whether  undue  influence  has 
been  used  at  the  time  of  the  making  of  the  will. 

The  rulings  as  brought  out  in  the  celebrated  Parish  will  case 
have  not  materially  changed  to  the  present  time.  In  this  case 
the  will  made  while  the  testator  was  in  the  full  ]x)ssession  of  all 
his  faculties  was  sustained,  but  the  codicils  made  after  his 
apoplectic  seizure  were  not.  The  surrogate  of  New  York  found 
and  decided  as  a  matter  of  fact  that  the  testator  had  not  testa- 
mentary capacity  on  the  15th  of  September,  1853,  or  on  the 
15th  of  June,  1854,  to  make  the  two  codicils,  and  that  they  were 
not  his  will  or  any  part  thereof,  and  he  refused  to  admit  the 
same  to  probate. 

The  weight  of  the  testimony  in  the  trial  brought  out  that  his 


338  INSANITY — FISHER. 

whole  moral  nature  was  changed,  and  that  he  was  not  morally 
responsible  for  the  unbecoming  and  ungentlemanly  conduct  he 
so  frequently  exhibited.  It  was  also  shown  that  after  his  attack 
he  never  was  able  to  utter  an  intelligible  word,  and  the  gestures 
made  by  him  with  the  left  hand  were  unmeaning  and  contra- 
dictory. "  If  Mr.  Parish  had  no  power  to  express  a  wish  to 
destroy  a  will,  it  follows  he  had  none  to  create  one,  and  the 
manifestation  of  his  wishes  depended  entirely  upon  the  inter- 
preter, and  the  integrity  of  the  interpretation."  ' 

However,  the  will  of  a  paralytic  will  be  sustained,  when, 
though  unable  to  talk  at  the  time  of  its  execution,  the  mind  is 
unimpaired  and  he  is  able  to  signify  his  assent  to  each  item  by 
an  affirmative  nod  of  the  head  as  it  is  read  to  him.8 

I  would  also  refer  to  a  case  where  the  question  of  senile 
dementia  following  an  apoplectic  seizure  arose  in  regard  to  pro- 
bating the  will  of  the  testator,8  and  a  similar  case  in  which  the 
probate  of  the  will  was  objected  to,  as  the  maker  had  had  two 
apoplectic  seizures,  after  which  his  observation  became  im- 
paired and  he  also  failed  to  recognize  acquaintances.4 


ARRESTED     CEREBRAL    DEVELOPMENT,    OR    DISEASE    OF 
THE  UNDEVELOPED   BRAIN. 

IDIOCY  is  a  mental  condition  due  to  maldevelopment  of  the 
brain,  which  may  be  congenital,  due  to  absence  of  parts  of  the 
brain  structure,  or  to  disease  consequent  upon  inflammatory 
changes,  or  to  defects  in  the  blood  supply  to  certain  brain  areas. 
The  degree  of  actual  brain  defect  will  represent  the  degree  of 
mental  impairment.  There  can,  therefore,  be  no  actual  sub- 
divisions of  idiocy,  although  for  the  sake  of  convenience  we 
may  speak  of  several  grades. 

In  a  medico-legal  sense  there  is  some  importance  in  these 
cases  both  in  civil  and  criminal  relations. 

1  Delafield  v.  Parish,  "Report  of  gate's  Court,  December,  1879;  Su- 

Cases  Argued  and  Determined  in  the  preme  Court,  second  department; 

Court  of  Appeals  of  the  State  of  General  Term,  September,  1880; 

New  York,"  vol.  xi.  (by  E.  Pe-  Court  of  Appeals,  1381 ;  Austin  Ab- 

schine  Smith).  bott's  New  Cases). 

'Rothrockv.  Rothrock  (Ore.),  30  4  The  New  York  State  Reporter, 

Pac.,  453.  by  R.  M.  Stover  of  New  York  (Le- 

3  Swenarton  v.  Hancock  (Abbott,  roy  Randall  v.  George  H  Down- 

vol.  ix.,  Rockland  County  Surro-  ing). 


IDIOCY.  339 

Etiology  of  Idiocy. — There  may  be  absence  of  almost  the 
whole  of  the  cerebral  hemisphere,  only  the  basal  ganglia  remain- 
ing. The  brain  may  be  the  seat  of  meningeal  inflammation, 
with  hemorrhage  either  meningeal  or,  more  rarely,  in  the  brain 
substance.  We  find  paralysis  and  usually  epilepsy  associated 
in  these  cases.  They  may  be  congenital  or  follow  the  diseases 
of  childhood,  as  the  exanthemata. 

Porencephalus,  usually  a  congenital  condition  in  which 
we  have  a  loss  of  certain  portions  of  the  brain  substance,  usually 
resulting  in  a  cyst  or  cavity  connecting  the  cortex  of  the  brain 
with  one  of  the  lateral  ventricles,  is  associated  with  idiocy  or 
imbecility.  We  also  have  in  these  cases  paralysis  and  epilepsy. 
In  this  relation  we  must  also  consider  traumatism,  which  may, 
of  course,  be  productive  of  extensive  destruction  of  the  brain. 
Among  other  causes,  not  associated  with  brain  defect,  we  must 
before  all  consider  hereditary  influences,  as  insanity,  the  various 
neuroses,  syphilis,  alcoholism,  and  consanguinity,  etc. ;  also 
microcephalus,  hydrocephalus,  hypertrophy,  and  cretinism. 

The  changes  observed  in  the  brain  depend  largely  on  the 
cause.  The  absence  of  the  hemispheres  explains  the  mental 
condition  in  such  cases.  In  the  second  class  referred  to,  in 
which  we  find  idiocy  or  imbecility  associated  with  hemiplegia 
and  epilepsy,  there  is  usually  considerable  atrophy  of  one  of 
the  hemispheres  of  the  brain ;  the  nerve  cells  and  fibres  also 
show  degeneration,  and  there  may  be  descending  degeneration 
of  the  nerve  tract  into  the  spinal  cord.  In  the  cases  dependent 
on  hereditary  syphilis  and  alcoholism,  there  is  evidence  of  im- 
pairment of  the  cells  of  the  cortex  and  a  tendency  to  the  for- 
mation of  connective  tissue,  resulting  in  sclerosis  of  the  cerebral 
substance. 

In  microcephalic  cases  we  find  a  decrease  in  the  cranial 
measurements,  which  may  be  symmetrical.  Most  cases  show 
evidence  of  dolichocephaly,  and  there  is  shortening  of  the  an- 
tero-posterior  diameter.  There  may  be  variations  in  the  de- 
formity, as  scaphocephaly,  plagiocephaly,  etc. 

In  so-called  cretinoid  idiocy,  which  is  dependent  on  some 
defect  in  the  functional  activity  of  the  thyroid  gland,  or  due  to 
its  absence,  the  conformation  of  the  skull  is  flatter  and  gives  the 
appearance  of  being  square,  the  condition  being  brachycephalic. 
The  bones  of  the  face,  especially  the  malar  processes,  are  also 


340  INSANITY — FISHER. 

prominent;  this  with  the  infiltration  and  thickening  of  the 
skin  gives  the  face  a  peculiar  expression.  The  mental  state 
corresponds,  however,  to  idiocy,  and  should  be  properly  in- 
cluded in  this  place. 

In  hydrocephalus,  which  is  a  chronic  condition  resulting  in 
dilatation  of  the  ventricles,  we  may  find  the  skull  very  much 
thinned,  and  the  cranial  measurements  largely  increased.  The 
brain  is,  however,  the  seat  of  atrophy,  the  cortex  being  much 
reduced  in  thickness  and  the  cell  element  showing  impairment 
or  destruction.  The  face  appears  much  smaller  than  normal  by 
the  contrast  with  the  increased  size  of  the  skull.  In  hypertrophy 
of  the  brain  we  find  an  increase  especially  of  the  white  substance 
of  the  brain,  and  probably  an  increase  of  the  neuroglia  tissue. 
There  is  considerable  increase  in  the  weight  of  the  brain. 
The  skull  measurements  are  not  increased  to  the  extent  found 
in  hydrocephalus. '  "  Bourneville  distinguishes,  from  an  anato- 
mico-pathological point  of  view,  the  following  forms  in  idiocy : 

(1)  Idiocy  symptomatic  of  hydrocephalus  (hydrocephalic  idiocy) ; 

(2)  idiocy  symptomatic  of  microcephaly  (microcephalic  idiocy) ; 

(3)  idiocy  symptomatic  of  the  arrest  of  development  of  the  con- 
volutions; (4)  idiocy  symptomatic  of  a  congenital  malformation 
of  the  brain  (porencephaly,  absence  of  corpus  callosum,  etc.); 

(5)  idiocy  symptomatic  of  hypertrophic  or  tuberculous  sclerosis; 

(6)  idiocy  symptomatic  of  atrophic  sclerosis — (a)  sclerosis  of 
one  or  both  hemispheres ;  (b)  sclerosis  of  one  lobe  of  the  brain ; 
(c)  sclerosis  of  isolated  convolutions ;    (d)  sclerosis  chagrinee 
(like  shagreen)   of  the  brain   (?) ;  (7)    idiocy  symptomatic  of 
chronic      meningitis     or      meningo-encephalitis     (meningitic 
idiocy) ;  (8)  idiocy   with  pachydermic  cachexia,  or  myxcede- 
matous  idiocy  connected  with  absence  of  the  thyroid  gland. 
This  latter  form  is  called  cretinoid  idiocy."  2 

The  idiot  manifests,  according  to  the  degree  of  his  mental 
impairment,  a  more  or  less  complete  loss  of  mental  activity. 
There  is  usually  great  restlessness,  and  inability  to  fix  the 
attention  on  any  one  thing ;  there  is  often  understanding  suffi- 
cient to  comprehend  what  is  said  to  them,  but  no  idea  of  the 
necessity  of  doing  what  is  requested — in  fact,  all  sense  of  re- 
sponsibility is  absent.  Speech  is  usually  involved.  The  vo- 

1  Tuke's  "Dictionary  of  Psycho-          *  Regis,     "Practical    Manual    of 
logical  Medicine. "  Mental  Medicine. " 


IDIOCY. 


341 


cabulary  may  bo  limited  to  but  few  words,  or  language  may 
never  be  acquired,  certain  sounds  intelligible  only  to  those  in 
charge  being  used  to  indicate  their  wishes,  a  language  of  their 
own  being  thus  formed.  The  higher  ethical  nature  is  absent, 
so  that  the  passions  and  desires  are  carried  out  unrestrainedly. 
The  sexual  propensities  may  be  increased,  masturbation  being 
openly  carried  on,  or  assaults  may  be  made  on  women  and 
children.  Such  patients  may  be  violent  and  homicidal,  oppo- 
sition usually  exciting  them  to  anger.  There  are,  however, 


Fio.  27.— Typical  Face  of  Idiot. 

cases  where  affection  seems  to  be  exceedingly  strong.  We 
find  in  almost  all  instances  a  tendency  to  destroy  articles,  to 
appropriate  anything  within  reach.  When  the  intelligence  is 
partially  preserved,  acts  of  assault  and  thieving  may  be  car- 
ried out  with  some  degree  of  cunning,  and  attempts  at  conceal- 
ment may  be  made. 

There  is  not  infrequently  a  marked  appreciation  of  music, 
and  in  some  few  instances  a  decided  aptitude  for  certain  things, 
as  drawing,  figures,  or  music. 

The  general  appearance  of  the  idiot  is  indicative  of  his 
mental  state.  Physically  ho  is  usually  small ;  the  head  is,  in 


342  INSANITY — FISHER. 

the  majority  of  the  cases,  as  we  have  said,  microcephalic.  The 
face  lacks  any  fixity  of  expression,  but  is  continually  chang- 
ing; the  mouth  is  open,  the  saliva  passing  unconsciously  away ; 
the  teeth  are  irregular,  and  the  palate  often  narrow  and  highly 
arched.  The  hands  and,  in  fact,  the  whole  body  are  subject  to 
choreiform  movements,  and  there  are  frequently  present  epi- 
leptic seizures.  Various  other  asymmetries  of  the  face  are  often 
present,  as  deformity  of  the  ears  and  eyes. 

IMBECILITY  is  a  congenital  or  acquired  state  of  mental  weak- 
ness, differing  in  degree  rather  than  kind  from  idiocy.  The 
same  causes  exist  here  as  in  idiocy.  It  not  infrequently  follows 
in  the  course  of  the  neuroses,  especially  epilepsy  and  chorea.  It 
may  manifest  itself  especially  in  the  moral  or  intellectual  fields. 
We  find  the  same  inability  to  apply  the  attention  to  the  acqui- 
sition of  learning. 

Imbeciles  frequently  give  evidence  of  moral  perversion,  in  the 
absence  of  ordinary  affection,  and  by  acts  of  cruelty.  They  are 
frequently  impulsive,  and  we  ijot  rarely  find  them  committing 
acts  such  as  we  have  described  under  the  head  of  pyromania, 
kleptomania,  etc.  The  motive  often  is  very  slight,  perhaps  a 
desire  of  revenge  for  some  fancied  wrong.  There  is  rarely  any 
feeling  of  remorse  for  what  is  done.  Many  such  cases  fill  our 
reformatories,  and  are  often  among  the  most  incorrigible  and 
mischievous  of  the  inmates.  In  the  milder  forms  the  condition 
may  not  have  been  observed  in  very  early  life,  or  until  the  re- 
straints of  school  show  an  almost  complete  inability  to  progress 
with  others  in  the  course  of  study.  Again  the  exhibition  of  a 
sort  of  moral  perversion  may  not  manifest  itself  until  later;  the 
higher  ethical  nature  seems  to  be  absent.  They  may  also  be 
inclined  to  venereal  and  alcoholic  excesses.  Perhaps  in  these 
cases  there  is  a  greater  tendency  to f  some  special  talents,  such 
as  we  have  referred  to,  in  music  or  mathematics,  etc. ,  than  in  the 
class  defined  as  idiots.  There  is,  however,  observed  through 
all  their  acts  a  seeming  absence  of  the  proper  appreciation  of 
the  relations  of  ordinary  life  and  its  responsibilities. 


MODIFIED    CLASSIFICATION.  343 

MODIFIED    CLASSIFICATION. 

The  modifications  in  the  classification  of  mental  diseases  have 
not  l>een  of  great  significance  in  the  last  ten  years. 

The  old  basis  of  division  has  remained  the  same.  No  abso- 
lute adherence,  either  to  the  etiological,  symptomatologies),  or 
pathological  has  been  followed,  but  rather  a  combination  of  these 
factors  has  been  employed.  There  is,  in  my  opinion,  no  neon* 
sity  for  an  exact  system  of  classification  either  for  legal  or  medi- 
cal practice. 

The  real  advance  in  psychiatry  in  the  nomenclature  of  men- 
tal diseases  is  a  more  exact  definition  of  the  various  diseases,  a 
further  separation  of  the  symptoms — which  have  been  classed 
together  as  the  symptom  complex  of  a  single  disease  or  its  dif- 
ferent stages. 

The  more  careful  clinical  observation  of  these  symptoms  in 
the  last  ten  years  has  led  to  a  considerable  advance  in  our  un- 
derstanding of  special  forms  of  insanity.  No  new  form  has  been 
discovered,  but  out  of  the  confused  aggregation  of  symptoms  it 
has  been  possible  to  group  a  certain  class,  which  appears  almost 
constantly  and  with  comparatively  little  variation  with  a  fixed 
form  sufficiently  strong  in  each  to  enable  us  to  apply  a  name  to 
the  entity. 

This  has  simplified  two  important  conditions  at  least,  and 
made  the  older  forms  more  clearly  defined,  by  thus  withdrawing 
into  a  class  by  themselves  cases  which  have  always  been  difficult 
satisfactorily  to  place  under  the  old  headings. 

Prof.  Emil  Kraepeliu  has  done  this  service  for  psychiatry. 
While  Kraepelin  is  not  optimistic  in  his  statements,  he  has  es- 
tablished a  better  working  schedule  of  mental  diseases  than  we 
have  previously  had. 

The  general  profession  finds  some  difficulty  in  accepting  in 
full  this  classification,  but  the  last  three  years  have  proved  its 
practicability,  so  that  it  has  been  almost  universally  adopted  in 
our  various  large  public  asylums  and  among  psychiatrists  in 
private  practice  and  in  the  courts.  The  two  forms  of  insanity 
referred  to  in  this  introduction  are  manic-depressive  insanity 
and  dementia  pnecox. 

Manic-depressive  insanity  is  a  term  which  has  been  intro- 
duced within  the  past  five  years  to  cover  a  class  of  symptoms 


344  INSANITY — FISHER. 

which  have  previously  been  classified  under  the  head  of  melan- 
cholia and  mania.  We  have  in  the  description  by  Kraepeliii 
no  new  symptoms  given,  in  fact  no  new  disease  described,  but 
rather  a  new  grouping  of  well-known  symptoms. 

Kraepelin  would  place  all  cases  of  mania  or  melancholia  in 
the  young  under  the  title  of  manic-depressive  insanity.  Melan- 
cholia in  its  typical  form,  characterized  by  depression,  slowness 
of  thought,  impassivity,  well-defined,  fixed,  but  not  systematized 
delusions,  and  self -condemnatory  conceptions  is  a  disease  only 
of  the  involutional  period  of  life,  i.e.,  the  climacteric. 

The  degeneration  of  the  individual  is  already  greater  than 
the  repair ;  in  other  words,  the  age  is  reached  when  no  further 
growth  takes  place  in  the  central  nervous  system,  but  rather  a 
decline  due  to  advancing  age  has  commenced.  He  uses  very 
aptly  for  this  condition  the  term  involution  and  thus  distin- 
guishes true  melancholia  from  all  forms  of  depression,  no  mat- 
ter how  similar  they  may  be  in  many  respects,  which  may  occur 
in  the  young,  where  the  process  of  evolution  or  growth  is  still 
going  on. 

With  the  definition  of  melancholia  limited  to  this  class  of 
patients,  he  very  properly  says,  the  outcome  of  the  disease  is 
very  different  from  that  of  so-called  melancholia  in  the  young. 

The  former  tends  progressively  toward  degeneration,  while 
in  the  latter  the  percentage  of  recovery  is  very  much  greater.  It  is 
also  claimed  by  this  author  and  his  supporters  that  melancholia 
in  the  young  is  rarely  depressive  alone,  but  either  at  the  time  is 
complicated  by  mania  or  in  case  of  recurrence  after  recovery 
is  as  likely  to  begin  with  maniacal  excitement  as  with  depres- 
sion. He  further  claims  that  there  is  no  assurance  of  a  permanent 
recovery,  but  that  as  a  rule  it  is  a  recurrent  disease,  alternating 
with  depression  and  excitement,  ultimately  to  end  in  dementia. 
We  have  then,  in  his  opinion,  in  the  young  adult  a  disease  char- 
acterized by  melancholia  or  depression,  resembling  in  its  general 
symptoms  the  melancholia  of  the  climacteric  or  involutional 
period  of  life,  but  differing  from  it  in  that  it  alternates  with 
mania  and  is  recurrent  in  its  nature.  This  classification  is  not 
wholly  acceptable  to  many  experienced  psychiatrists.  I  ac- 
knowledge with  them  that  Kraepelin  has  separated  out  for  us  a 
special  form  of  mental  disease,  for  which  the  term  manic-depres- 
sive is  ample  and  satisfactory,  cases  with  which  we  are  all  famil- 


MODIFIED    CLASSIFICATION.  1 '. 

iar,  but  which  we  have  not  been  able  satisfactorily  to  class  JIH 
mania  or  melancholia,  as  both  conditions  existed,  either  simul- 
taneously or  following  one  the  other  every  year  or  at  intervals 
of  five  or  even  ten  years. 

I  hold,  however,  that  we  have  a  true  melancholia  or  mania 
in  the  young,  with  little  or  no  variation  either  in  etiology  or 
course  from  that  occurring  in  the  old,  differing  only  in  the  prob- 
ability of  recovery,  which  is  easily  explained  by  the  greater  re- 
sistance presented  by  the  age  of  the  patient.  Kracj>elin  reports 
similar  cases,  but  holds  that  the  recovery  is  only  an  apparent 
one,  as  in  his  opinion,  if  these  patients  live  long  enough  and 
have  sufficient  cause  or  provocation,  a  second  attack  will  occur, 
either  depressive  or  manic.  This  seems  to  me  only  lagging  the 
question,  as  we  all  see  cases  which  after  twenty  years  or  more 
have  no  recurrence  and  in  which  no  evidence  of  disease  remains. 
From  a  medical  and  legal  aspect  we  must  regard  such  persons  as 
sane  and  responsible  for  all  their  acts.  This  point  of  view  is  of 
especial  significance  in  a  legal  sense. 

Dementia  Preecox. — Here  again  we  owe  to  modern  psy- 
chiatry in  the  hist  ten  years  a  simplification  in  the  classification 
of  a  most  difficult  set  of  symptoms  in  mental  disease.  It  is  a 
disease  of  adolescence.  It  belongs  to  the  evolutional  i>eriod  of 
life,  the  greater  number  of  cases  occurring  before  the  twenty- 
fifth  year. 

It  is  usually  congenital,  rather  than  acquired.  Stress,  illness, 
privation,  excesses  in  one  previously  inclined,  developing  symp- 
toms which  under  favorable  conditions  might  have  remained 
quiescent.  There  are  three  principal  forms:  the  hebephrenic, 
kat  at  nnir.  and  paranoid. 

The  first  form  occurs  in  the  very  young,  from  the  ages  of 
twelve  to  twenty-one.  There  is  great  loss  of  mental  power,  in- 
ability to  understand  the  ordinary  relations  of  life  or  to  carry 
on  either  work  or  study.  The  power  of  concentration  or  atten- 
tion is  lost  together  with  responsibility.  The  emotions  are  in 
the  ascendancy,  depressive  or  excitable,  varying  with  the  hour, 
from  mutism  to  volubility  with  verbigeration.  The  aesthetic  side 
of  life  is  much  a  fleeted,  leading  to  indecency  in  words  and 
actions.  This  passes  on  rapidly  to  dementia,  which  may  be  per- 
manent or  be  recovered  from  in  part,  leaving,  however,  some 
degree  of  mental  weakness.  We  see  many  such  among  the 


346  INSANITY — FISHER. 

young  who  are  unable  to  apply  themselves  to  any  definite  work, 
are  mischievous,  cruel,  and  without  a  true  appreciation  of  the 
character  of  their  actions. 

The  katatonic  form  presents  a  condition  in  which  katatonia, 
a  disease  described  by  Kahlbaum,  is  a  principal  factor. 

Katatonia  is  a  symptom  rather  than  a  disease,  and  is  found 
in  other  forms  of  insanity,  as  melancholia,  hysteria,  and  mania. 
In  dementia  prsecox  it  may  take  on  an  active  character  in  which 
the  various  positions  assumed  by  the  patient,  although  fixed,  for 
the  time  may  change  according  to  the  hallucination  or  delusion 
which  may  arise.  This  state  may  end  in  dementia  early  in  its 
course  as  in  the  hebephreuic  form.  It  occurs  most  commonly 
between  the  ages  of  eighteen  and  twenty-five,  and  is  frequently 
accompanied  with  delusions  of  grandeur  and  changed  personal- 
ity, as  the  delusion  of  being  God,  king,  etc. 

The  paranoid  type  is  more  difficult  of  diagnosis,  at  least  in 
the  acute  onset  of  the  disease.  It  occurs  at  a  still  later  period 
of  adolescence.  The  patient  in  early  life  may  have  been  con- 
sidered somewhat  erratic  or  even  brilliant,  but  usually  some- 
what unstable.  The  early  condition  is  often  ushered  in  by 
depression  or  hypochondria,  to  be  soon  followed  by  excitement 
with  egotistic  ideas  and  delusions  of  persecution,  with  at  times 
hallucinations  of  sight  and  hearing.  The  power  of  concentration 
is  soon  lost,  a  condition  which  is  recognized  by  the  patient  him- 
self. There  are  oftentimes  attacks,  maniacal  in  character,  or  a 
tendency  to  alcoholic  excesses.  These  cases  resemble  paranoia 
of  a  somewhat  atypical  form,  and  by  many  psychiatrists  are  still 
classed  as  that  disease,  but  more  properly  fall  under  the  head 
of  adolescent  insanity  or  dementia  prsecox.  Eecovery  is  rarely 
complete,  and,  as  in  the  other  forms,  an  early  and  permanent  de- 
mentia wholly  or  in  part  results. 


MENTAL    UNSOUNDNESS 

IN  ITS 

LEGAL    RELATIONS. 

BY 
TRACY  C.  BECKER,  A.B.,  LL.B., 

CouweUor-at-Law ;  Professor  of  Criminal  Law  and  Medical  Jurisprudence  in  the  Law 
Department  of  the  University  of  Buffalo,  etc. 

AND 

CHARLES   ANDERSON   BOSTON,    LL.B., 

Of  the  A'etr  I'orfc  City  Bar. 


THE  LEGAL  ASPECTS  OF  INSANITY  AND 
MENTAL  IMPAIRMENT. 

INTRODUCTION. 

THE   LEGAL   VIEW    OF   MENTAL    IMPAIRMENT  CON- 
TRASTED WITH  THE  VIEW  OF  THE  ALIENIST. 

A  person  may  be  insane  according  to  medical  science,  and 
yet  responsible  for  his  acts  in  law.1 

To  the  alienist  or  the  expert  medical  witness  it  must  often 
appear  that  the  law  ignores  psychopathic  science ;  and  to  the 
intelligent  layman  who  examines  the  decisions  of  the  courts,  they 
must  seem  to  be  chaotic  and  glaringly  inconsistent. 

It  is  true  that  this  branch  of  the  law  cannot  be  praised  as  an 
all-wise  and  harmonious  system.  Yet  many  apparent  contra- 
dictions arise  from  the  mere  technicalities  of  legal  practice ;  and 
the  seemingly  obstinate  and  perverse  refusal  of  the  courts  to 
take  notice  of  some  of  the  scientific  aspects  of  insanity  is,  on  the 
contrary,  to  be  justified  by  well-grounded  reasons  of  public 
policy.2 

For  example,  public  policy  is  thought,  by  the  courts  of  nearly 
all  the  States,  to  require  a  much  more  stringent  definition  of 
mental  irresponsibility  (in  the  criminal  law  at  least)  than  any 
man  of  science  would  be  likely  to  adopt  for  purposes  of  classifi- 
cation. 

A  striking  illustration  of  the  difference  above  mentioned  is 
afforded  by  the  trial  for  murder,  in  the  Criminal  Branch  of  the 
Supreme  Court  of  New  York,  of  William  Hooper  Young  (Feb- 
ruary, 1903).  The  Court,  in  the  course  of  the  trial,  accepted  a 

1  State  v.  Kalb,  7  Ohio  N.  P.,  547;  mental  state,  when  there  is  a  con- 
5  Ohio  S.  &  C.  P.  Dec.,  738;  State  v.  filet  of  evidence,  to  the  jury,  whose 
Tyler,    7  Ohio   N.  P.,  443;    5  Ohio  finding  will  not  often  Ix?  disturbed, 
S.  &  C.  P.  Dec.,  688.  though  an  alienist  might  have  reached 

2  Another  source  of  apparent  con-  an   opposite   conclusion.     People    r. 
fusion    lies    in    the    practice    of    the  Taylor,  138  X.  Y.,  398;  infra,  p.  400. 
courts  of  submitting  the  question  of 

849 


350  MENTAL   UNSOrJNDNSSS — BECKER  AND   BOSTON. 

plea  of  guilty  of  murder  in  the  second  degree,  for  reasons  which 
were  thus  explained  by  the  judge  to  the  jury: 

"  It  is  only  right  to  tell  you,  gentlemen,  that  the  court  ad- 
vised the  defendant's  counsel  to  tender  this  plea,  and  that  the 
court  also  advised  the  District  Attorney  to  accept  it.  The  man's 
mental  condition  was  the  cause  for  the  action  taken.  You  are 
aware  that  this  man  has  been  under  medical  observation.  The 
experts  reported  this  man  legally  sane,  but  insane  from  a  med- 
ical point  of  view.  He  therefore  is  supposed  to  know  the  differ- 
ence between  right  and  wrong,  and  should  be  held  responsible. 
But  as  his  insanity  has  been  reported  to  me  as  being  of  the  pro- 
gressive order,  it  is  difficult  to  tell  where  one  line  merges  into  the 
other.  It  seemed  to  me  that  under  the  circumstances  the  law 
was  not  justified  in  inflicting  the  death  penalty,  and  should  be 
satisfied  with  a  plea  that  should  confine  this  man  to  prison  for 
life  rather  than  run  the  risk  of  putting  to  death  a  possibly  irre- 
sponsible man. "  ' 

"By  medically  insane  they  say  they  mean  that  a  man  may  be 
well  able  to  determine  between  what  is  right  and  what  is  wrong, 
yet  not  be  physically  able  to  restrain  himself  from  doing  wrong. 
While  it  is  true  that  Young  has  delusions,  still  he  knows  what 
is  wrong  and  what  is  right.  Now,  there  is  a  very  narrow  line  of 
demarcation  between  these  two  kinds  of  insanity,  and  it  is  hard 
to  tell  where  one  merges  and  is  lost  in  the  other.  .  .  .  Under 
these  circumstances  I  think  the  cause  of  justice  can  better  be 
served  by  sending  this  man  to  prison  for  life,  rather  than  that 
there  should  be  any  question  as  to  whether  we  put  to  death  a 
man  that  was  irresponsible  in  any  way  for  his  deed. " " 

GENERAL   DEFINITIONS;    LEGAL    CLASSIFICATIONS. 

English  common  law  anciently  recognized  two  categories  of 
mental  diseases: 

(1)  DEMENTIA  NATURALIS,  or  idiocy;  and  (2)  DEMENTIA 
ADVENTITIA,  under  which  general  insanity  is  included.  To  this 
last  the  term  "lunacy"  is  usually  applied. 

The  following  definitions  are  from  "  The  American  and  Eng- 
lish Encyclopaedia  of  Law  " : 

1  N.  Y.  Times,  February  10,  1903.          2  N.  Y.  Evening  Sun,  February  11, 

1903. 


DEFINITIONS  AND   CLASSIFICATIONS.  351 

An  insane  person  is  one  whose  mind  is  affected  by  general  im- 
becility, or  is  subject  to  one  or  more  specific  delusions. 

A  Lunatic. — At  common  law,  a  lunatic  was  one  who  hath  had 
understanding,  but  by  disease,  grief,  or  other  accident  hath  lost 
the  use  of  his  reason. 

An  Idiot. — An  idiot  was  one  who  hath  had  no  understanding 
from  his  nativity. 

Non  Compos  Mentis. — The  words  non  compos  m>  nti*  seem  to 
have  been  used  as  a  generic  term,  including  both  idiocy  and 
lunacy.  They  had,  in  the  earlier  cases,  both  in  England  and  in 
the  United  States,  a  more  restricted  meaning  than  they  bear  at 
present,  and  were  held  to  import  a  total  deprivation  of  sense, 
and  not  to  include  mere  imbecility  or  weakness  of  mind.  In 
the  more  modern  cases  they  are  held  to  include  not  only  cases  of 
idiocy  and  lunacy,  as  strictly  defined  at  common  law,  but  also 
cases  of  imbecility  where  the  subject  is  incapable  of  conducting 
the  ordinary  affairs  of  life,  and  liable  to  become  the  victim  of 
his  own  weakness.1 

Dr.  Beck  uses  the  term  "mental  alienation"  to  cover  all 
cases  of  unsoundness  of  mind,  and  divides  these  into:  First. 
Those  states  of  mental  infirmity  depending  upon  congenital  de- 
fects of  the  brain,  or  on  the  imperfect  development  of  its  facul- 
ties during  infancy,  viz.,  idiocy  and  imbecility.  Second.  All 
those  forms  of  mental  derangement  which  arise  from  disease  of 
the  brain  subsequent  to  its  full  development,  and  which  may  be 
said  to  constitute  insanity  proper.  This  class  comprises  those 
conditions  of  perverted  mind  commonly  recognized  by  the  terms 
mania,  melancholia,  monomania,  and  dementia.  Tin-  legal  defi- 
nition of  a  state  of  mental  alienation,  and  the  adjudications 
under  it,  are  briefly  treated  at  Vol.  I.,  page  765  et  *<•</.  of  Dr. 
Beck's  treatise.1 

Says  Dr.  Ray:  "In  the  Roman  lair,  the  insane  or  demented 
are  divided  into  two  classes:  those  whose  understanding  is  weak 
or  null,  menti  capti,  and  those  who  are  restless  and  furious,  fttrioci. 
The  French  and  Prussian  codes  make  use  of  the  terms  dimenri. 
fureur,  imberilliti,  without  pretending  to  define  them. 

"The  English  common  law  originally  recognized  but  two  'and* 
of  insanity,  idiocy  and  lunacy,  the  subjects  of  which  were  desig- 

1  "Am.  and  Ene.  Encyclopedia  of          *  Beck's  "Med.  Jur.,"  12th  ed. 
Law,"  1st  ed.,  vol.  ii.,  title  insanity. 


352  MENTAL  TJNSOUNDNESS — BECKER   AND   BOSTON. 

nated  by  the  term  non  compos  mentis,  which  was  used  in  a  generic 
sense,  and  meant  to  embrace  all  who,  from  defect  of  understand- 
ing, require  the  protection  of  the  law.  An  occasional  attempt  has 
been  made  by  jurists  to  attach  some  definite  ideas  to  these  terms, 
and  to  point  out  the  various  descriptions  of  persons  to  whom 
they  may  be  applied.  Lord  Coke  says  there  are  four  kinds  of 
men  who  may  be  said  to  be  non  compos  mentis :  1.  An  idiot  who, 
from  his  nativity,  by  perpetual  infirmity  is  non  compos ;  2.  He 
that  by  sickness,  grief,  or  other  accident  wholly  loseth  his  mem- 
ory and  understanding ;  3.  A  lunatic  that  hath  sometimes  his 
understanding  and  sometimes  not,  aliquando  gaudet  lucidis  inter- 
vallis  ;  4.  He  that  by  his  own  vicious  act  for  a  time  depriveth  him- 
self of  his  memory  and  understanding,  as  he  that  is  drunken. 

"Nothing  can  show  more  plainly  how  imperfect  were  the 
notions  of  the  early  law  writers  concerning  insanity  than  this 
classification  of  insane  persons,  and  their  attempts  to  define  the 
several  classes.  An  idiot  is  defined  to  be  a  person  who  cannot 
count  or  number  twenty  pence  or  tell  who  was  his  father  or 
mother,  or  how  old  he  is,  so  as  it  may  appear  that  he  hath  no 
understanding  of  reason,  what  shall  be  for  his  profit  and  what 
shall  be  for  his  loss ;  but  if  he  have  sufficient  understanding  to 
know  and  understand  his  letters  and  to  read  by  teaching  or  in- 
formation, he  is  not  an  idiot." 1 

Bucknill  on  Criminal  Lunacy 2  describes  insanity  as  "  a  condition 
of  the  mind  in  which  a  false  action  or  conception,  or  judgment, 
a  defective  power  of  the  will  or  an  uncontrollable  violence  of  the 
emotions  and  instincts  have  separately  or  conjointly  been  pro- 
duced by  disease. " 3 

INTOXICATION,  as  a  transitory  phase  of  mental  impairment, 
will  be  defined  and  considered  below,  under  specific  heads.4  If 
it  results  in  permanent  mental  impairment,  the  law  regards  the 
effect,  insanity,  rather  than  the  cause. 

The  committee  of  one  judicially  declared  incompetent  is  a  per- 
son appointed  by  a  court  having  due  jurisdiction  to  have  charge 
of  the  person  or  property,  or  both,  of  the  incompetent. 

1  Ray,  "Medical  Jurisprudence  of  and  Stille,  "Med.   Jur.,"  vol.  iii.,  p. 

Insanity,"  4th  ed.,  p.  4,  citing  Coke's  118. 

Littleton,  247  c.,  and  1  Fitzherbert,  <  See  infra,  p.  354,  "Contracts;"  p. 

"  Natura  Brevium,"  583,  ed.  1652.  384,  "Wills;"  p.  425,  "Torts;"  p.  421, 

s  pp.  27,  28.  "Witnesses;"  p.  429,  "Criminal  re- 

3  See  also  Taylor,  "Med.  Jur.,"  sponsibility;"  p.  481,  "Habitually in- 

6th     Am.    ed.,    p.    631;      Wharton  temperate  person." 


STATUTORY    DEFINITIONS.  353 

STATUTORY  DEFINITIONS    AND   STATUTORY  WORDS 
OR  PHRASES  DENOTING  MENTAL  UNSOUNDNESS. 

Occasionally  a  statute  has  defined  the  term  used  by  it  to  de- 
note mental  unsound  ness;  for  instance,  in  New  York  the  term 
lunacy  in  the  statutes  includes  every  (continuing)  unsoundness 
of  mind  except  idiocy.1 

But  more  frequently  a  word  or  phrase  denoting  mental  im- 
pairment or  mental  soundness  is  introduced  into  a  statute  with- 
out any  definition,  and  in  such  cases  the  courts  have  IHMMI  called 
upon  to  define  it;  for  instance:  in  Ohio,  Revised  Statutes, 
§7,240,  authorizes  a  trial  of  the  issue  whether  a  person  isw/w^;  a 
person  is  not  "sane"  within  the  meaning  of  the  statute  when  he 
has  not  sufficient  reason  and  mental  capacity  to  understand  that 
his  act  was  wrong,  or,  having  such  sufficient  reason  to  distin- 
guish right  from  wrong,  has  not  sufficient  will  to  refrain  from 
the  wrong.* 

An  Ohio  statute  *  permits  the  making  of  a  will  by  a  person 
of  sound  mind  and  memory.  A  person  suffering  with  pneumonia 
rind  approaching  death,  whose  condition  is  such  that  there  is  im- 
mediate action  on  the  brain  cells  which  prevents  consecutive 
thought,  is  not  "of  sound  mind."  4 

In  Kentucky,  one  who  is  by  reason  of  great  age  and  mere 
physical  infirmity  unable  to  control,  manage,  and  care  for  his 
estate  is  not  one  "who  is  so  imbecile  or  unsound  as  to  be  in- 
competent." 

Additional  cases  discussing  particular  phrases  used  in  statutes 
are  cited  in  the  note.* 

1  Statutory  Construction  Law,  Laws  *  R.  S.  55  5914. 

of    1892,    chap.    677,    sec.    7.     See  4  In  re  Burrows  Est.,  1 1  Ohio  S.  & 

Matter  of   Preston,    113    App.    Djv.  C.  P.  Dec.,  229;  8  Ohio  N.  P.,  368. 

(N.  Y.),  732;  Code  Civ.  Pro.  £  2335:  *  Taylor  r.  Moore.  23  Ky.  Law  Rep., 

" incompetently  to  manage  affairs  in  1572;  65  S.  W.  Rep.,  612. 

consequence  of  imbecility  and  loss  of  *  Incompetent  and  incafwiMe, — In  re 

memory  and   understanding"  is  lu-  Leonard's  Est.  (Mic-h.),  54  N.  W.  R., 

nacy  within    this    definition.     In  re  1082.     Imbecile,     In  re  Kinswiler,  8 

Schrodt,  32  Misc.  Rep..  540;  67  N.  Y.  Ohio  N.  P..  132;  1 1  Ohio  S.  &  C.  P. 

Supp.,  244;  "incompetent  person  and  Dec.,  10.     Insanity.— State  r.  Helm, 

unfit  to  manage  his  affairs,"    In   re  69  Ark.,  167;  61  S.  \V.  Rep.,  915. 

Clark,  57  App.  Div.,5;  67  X.Y.  Supp.,  Unsound   mind   a»d   incapable   0} 

631     Matter    of     I^ewis,     57     Misc.  managing    his    estate, — Hamrick     r. 

(N.  Y.),  670.  State,  34  X.  K.  Ren..  3;  134  Ind..324. 

1  State  v.  Kalb,  7  Ohio  N.  P.,  547;  Unsound  mind,  -Mnas  r.  Territory, 

5  Ohio  S.  &  C.  P.  D.,  738.  10  Ok).,  714;  63  Pac.  R.,  960. 
III.— 28 


354  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

LEGAL  EFFECT  OF  MENTAL  UNSOUNDNESS  IN  GENERAL. 

It  will  be  seen  in  the  specific  treatment  of  particular  subjects 
below  that  various  mental  impairments  have  diverse  legal  effects, 
and  that  legal  considerations  give  rise  to  different  measures  of 
legal  competency  with  respect  to  different  classes  of  transactions. 
Accordingly  it  is  necessary,  in  studying  the  legal  relations  of  men- 
tal impairment,  to  consider  separately  these  different  classes. 

THE  EFFECT  OF  MENTAL  UNSOUNDNESS  ON  RESIDENCE. 

Change  of  residence  ordinarily  requires  an  intelligent  intent ;' 
but  residence  of  an  insane  person  can  be  changed  by  the  act  of 
his  committee, 2  or  by  one  having  charge  of  him,  as  his  parent  or 
guardian.3  Temporary  residence  of  an  incompetent,  as  in  an 
asylum,  does  not  change  his  legal  residence. 4 

THE  EFFECT  OF   MENTAL  UNSOUNDNESS  ON  CONTRACTS, 
INCLUDING   DEEDS. 

At  common  law  a  party  could  not  avoid  his  contract  on  the 
plea  of  lunacy,  in  accordance  with  an  ancient  maxim  that  no 
man  of  full  age  shall  be  allowed  to  disable  or  stultify  himself ; 
though,  at  the  same  time,  it  allowed  his  heirs  or  other  persons 
interested  to  avail  themselves  of  this  privilege.5  "Within  a  few 
years,  however  (1838),  English  courts  have  almost  entirely  dis- 
regarded the  ancient  maxim, 6  and  in  this  country  it  has  long 
since  lost  its  authority  altogether." 7 

The  effect  of  insanity  on  contracts  is  fully  treated  below.8 

lOn  the  subject    of    domicile    of  R.,  405.  Cf.  In  re  Fidelity  Trust  Co., 

persons  of  unsound  mind  see  Woern-  27  Misc.  (N.  Y.),  118;  57  N*  Y.  Supp., 

er's  "Law  of  Guardianship,"  §  206;  361. 

Woerner's    "Am.    Law.    of    Adm.,"  6  2  Blackstone,  295. 

§  206;   Wharton,  "Conflict  of  Laws,"  6  Baxter    v.    Earl    Portsmouth,    7 

2d  ed.,  $  52.     On  question  of  con-  D.  &  R.,  614;  9  Alh.  L.  J.,  30;  Chitty 

flict  of  laws  as  to  person  of  unsound  on  Contracts,  256;  Gates  v.  Bain,  2 

mind    see    Wharton,     "Conflict     of  Strick.,  1104. 

Laws,"    2d   ed.,    g§    574,    575.     On  7  Webster  v.    Woodward,    3   Day, 

jurisdiction   based   upon   citizenship  90;    Rice    v.    Peel,    15    Johns.,  503; 

see  infra  p.  598;  see    "Foreign    Cu-  Mitchells.  Kingman,  5  Pickering, 431. 

rators   of   Lunatics  and   the  English  But    see    O'Connell    v.    Beecher,  21 

Courts,"  36  Law  J.,  480.  App.  Div.  (N.    Y.),  298;    47  N.  Y. 

2  In  re  Sullivan,  24  Misc.  R.  (N.Y.),  Supp.,  334,  where  a  person  was  not 
357;  53  N.  Y.  Supp.,  717.  permitted  as  a  witness  to  express  an 

3  In  re  Holcomb  (Iowa),  82  N.  W.  opinion  on  his  own  mental  condition, 
Rep.,  1000.  to  avoid  his  contract. 

4  In  re  Porter,  34  App.   Div.,  147;  8  Infra,  p.  364. 
54  N.  Y.  Supp.,  654;    28  Civ.    Pro. 


COMPETENCY  TO  CONTRACT.  355 

At  present  it  will  be  sufficient  to  state  that  the  better  rule  now 
is  that  the  agreement  of  an  insane  person  is  not  void,  but  voida- 
ble, at  his  option  or  that  of  his  representatives.1  Hut  subsequent 
insanity  of  a  party  does  not  enable  him  to  avoid  his  contract, 
made  previous  to  his  becoming  insane,  nor  does  it  affect  his 
obligation  in  any  way,  unless  perhaps  it  be  a  contract  for  per- 
sonal services.1 

COMPETENCY   TO   CONTRACT— MEASURE   OF   COMPE- 
TENCY IN  GENERAL. 

When  a  contract  is  impeached  on  the  ground  of  mental  in- 
capacity of  a  party,  not  previously  adjudged  incvmprtent,  the  true 
inquiry  is,  whether  he  had  the  ability  to  comprehend  in  a  rea- 
sonable manner  the  nature  of  the  affair  in  which  he  partici- 
pated." If  fraud  or  undue  influence  has  been  practised  on  a 
person  of  weak  or  impaired  intellect,  other  principles  apply;4 
but  where  mental  incapacity  is  alleged,  there  must  be  inability 
to  know  what  the  act  is  to  which  the  contract  relates.  So  long 
as  one  possesses  mental  faculties  requisite  to  transact  rationally 
the  ordinary  affairs  of  life,6  his  contracts  and  deeds  will  be  valid. 
He  must  have  sufficient  intellectual  capacity  to  know  what  he  is 
doing,*  but  sufficient  discernment  or  education  to  transact  busi- 
ness with  prudence  and  discretion  is  not  required.7 

1  Blinn    v.    Schwarz,    177   N.    Y.,  4  Difference    in    mental    capacity 

252;  Hanley  v.  Nat.  Loan,  etc.,  Co.,  between  the  two  parties  to  a  con- 

29  S.  E.  R.,   1002;    44  W.  Va.,  450.  tract   is   not    ground   for  rescission, 

When  a  gift  is  made  by  a  lunatic,  the  unless  the  stronger  minded  defrauds 

donee    holds   the    property    charged  the  other.     Moore  v.  Cross,  87  Tex., 

with  a  constructive  trust  in  favor  of  557;  29  S.  VV.  R.,  1051. 

the  donor.     Teegarden  v.  Lewis,  35  5  Raymond  v.  Wat  lien,   142    Incl., 

N.  E.  R.  (Ind.),  24.  367;    41    N.    E.    R.,    815;    Davis   ». 

*  Sands  v.  Potter,  59  111.  App.,  206;  Calvert,  18 Ky.  L.  R.,  975;  38  S.  W.  R., 

Pollock  v.   Horn,  13  Wash.,  626;  43  884. 

Pac.    R.,  885;    Haincs  v.    Scott,  35  6  Ring  r.  Lawless.  190  111..  520;  61 

App.  Div..  515;  54  N.  Y.  Supp.,  844;  N.  E.  R.,  881;  Ramsdell  r.  Ramsdell, 

Van  Meter  v.  Darragh,  115  Mo.,  153;  8  Dct.   Ix?g.   News  (Mich.).  541;  87 

22S.W.  R., 30;  Lindbergc.  Davidson,  N.    W.    R..    81;    Kelly    r.    Perrault 

72  Minn.,  49:  74  N.  W.   Rep.,  1018;  (Idaho),  48  Pac.  R.,  45. 

W  ureter  v.  Amifield,  67  App.   Div.,  '  Bishop  on  Contracts,  §§  972, 973, 

158;  73  N.  Y.  Supp.,  (509.  974. 

3  He  must  have  a  reasonable  per-  Improvidence     and     unthriftincss 

ception  of  the  nature  and  terms  of  and     luck    of    business    success    do 

the  contract.     Elwood  r.  O'Brien,  74  not  constitute  mental  incompeten  e. 

N.    W.    Rep.,    740;     105  Iowa.  239;  Dominick  r.  Randolph.  124  Ala.,  557; 

Swartwood    r.     Chance,    131     Iowa,  27  So.  Rep..  4S I.     Nor  illiteracy  ami 

714;  109  N.  W.  R.,  297;   Sherl>ero  v.  ignorance  of  business.     Solx-ranes  r. 

Miller,  65  Atl.,  472  (N.  J.  E<j.).  Soberanes,  KM'.Cal.,  I ;  39  Pac.  R.,  39. 


356 


MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON. 


If  the  transaction  be  of  unusual  complexity,  it  has  been  held 
that  a  higher  degree  of  mental  capacity  is  requisite  than  to  at- 
tend to  the  ordinary  affairs  of  life  or  to  make  a  will ;  for  exam- 
ple, if  the  contract  be  one  for  the  exchange  of  lauds.1 

In  any  case  the  question  to  be  considered  is  not  whether  the 
alleged  incompetent  understood  the  details  of  the  transaction,  but 
whether  he,  in  fact,  had  the  capacity  to  understand  its  nature "  and 
decide  intelligently  about  it ; 3  not  whether  the  mind  was  insane 
or  impaired 4  or  had  not  capacity  to  transact  business  generally, 
but  whether  the  mind  had  capacity  to  deal  with  the  particular 
business  in  question. 5 

It  is  not  sufficient  to  show  merely  a  diseased  mental  state,  to 
avoid  a  contract.  Herein  is  the  essential  difference  between  the 
medical  and  the  legal  point  of  view ;  one  deals  with  the  objective 
physical  state,  the  other  with  the  capacity  of  the  mind  for  reason. 
It  must  be  shown  that  mental  disease  had  affected  the  under- 
standing to  the  degree  above  stated ;'  although,  of  course,  if  the 
disease  falls  within  the  extreme  category  of  idiocy,  lack  of  capac- 
ity may  be  presumed. 7 


burner  v.  Houpt,  53  N.  J.  Eq., 
526;  33  Atl.  R.,  28.  Cf.  contrary 
rule  as  to  wills,  infra,  p.  386. 

2  Merritt     v.     Merritt,     32     Misc. 
(N.  Y.),  21;  66   N.  Y.   Supp.,  123; 
aff'd    62  App.  Div.,  617;  71  N.  Y. 
Supp.,  1142. 

3  Mann  v.    Keene  Guaranty    Sav. 
Bk.,  86  Fed.,  51. 

4  O'Neill  v.  Nolan,  66  Hun  (N.  Y.), 
631;   21  N.  Y.  Supp., 222. 

5  Coffey  v.  Coffey,  74  111.  App.,  241. 
Thus,  where  delivery  of  a  deed  of 
trust  was  delayed,  the  test  was  not 
capacity  to  understand  the   details 
of  the  contract  at  the  time  of  de- 
livery, but  at  the  time  of  signing;  ca- 
pacity to  complete  the  original  trans- 
action at  the  time  of  delivery  was 
sufficient.     S.  c.,  Coffey  v.  Coffey,  179 
111.,  283;  53  N.  E.  R.,  590.     See  also 
Falk  v.  Wettram,  120  Cal.,  479;  52 
Pac.   Rep.,     707;     Lynch  v.   Doran, 
95  Mich.,  395;  54  N.  W.,  882;    Kroe- 
nung   v.  Goehri,  112  Mo.,  641;   20  S. 
W.,  661;     White    v.  Davis   (N.  Y.), 
62    Hun,    622;    17  N.   Y.   S.,     548; 
Wright  v.  Wright,  139  Mass.,  177;  29 
N.    E.,  380;     Brothers  v.   Bank   of 
Kaukauna,  84  Wis.,  381;  54  N.  W. 


Rep.,  786;  Carnagie  v.  Diven,  49  Pac. 
R.,  891;  31  Ore.,  366;  Farnsworth  v. 
Noff singer,  33  S.  E.  Rep.,  246;  46  W. 
Va.,  410.  In  Overall  v.  Avant,  46  S. 
W.  Rep.,  1031  (Tenn.Ct.  App.),  a  bill 
of  heirs  to  set  aside  deed  of  ancestor 
alleged  mental  incapacity  to  transact 
business,  paralysis  a  few  weeks  after 
execution  of  deed,  old  age,  grantor 
easily  influenced,  and  sale  for  small 
percentage  of  actual  value,  held  a 
sufficient  statement  of  facts  to  show 
want  of  mental  capacity,  on  de- 
murrer. See  also  illustrations  of 
lack  of  mental  capacity,  Beasley  v. 
Beasley,  180  111.,  163;  54  N.  E.  Rep., 
187;  Gait  v.  Provan,  79  N.  W.  Rep., 
357;  108  Iowa,  561. 

6  It  is  not  enough  to  show  merely 
that  a  person  was  in  the  first  stage 
of  paresis.  Haines  v.  Scott,  35  App. 
Div.  (N.  Y.).  515;  54  N.  Y.  Supp., 
844;  Critchfield  v.  Easterday,  26 
App.  D.  C.,  89. 

"'  An  action  will  not  lie  on  the 
alleged  contract  of  an  admitted 
"congenital  idiot."  Bicknellv.  Spear, 
38  Misc.  R.  (N.  Y.),  389;  77  N.  Y. 
Supp.,  920. 


DELUSIONAL   INSANITY.  357 

DELUSIONAL  INSANITY   AND  STATES  OP  MIND  BOR- 
DERING ON  INSANITY. 

The  greatest  difficulties  in  connection  with  the  application  of 
the  above  tests  to  given  cases  have  arisen  where  delusional  in- 
sanity, and  specifically  paranoia,  have  existed.  The  courts  have 
frequently  been  called  upon  to  determine  whether  the  presence 
in  the  mind  of  a  maker  of  a  will  of  systematic  insane  delusions 
incapacitated  him  for  the  testamentary  act,  but  not  so  frequently 
in  the  case  of  contracts.  The  cases  on  wills  are  considered  sepa- 
rately (infra,  page  394),  but  may  be  consulted  as  generally  ap- 
plicable to  contracts  also.  As  to  both  contracts  and  wills  the 
general  rule  may  be  laid  down  that  delusions  alone,  or  even  in- 
sane delusions,  do  not  affect  them,  unless  they  operated  di- 
rectly to  induce  the  execution  of  the  instrument.1  For  example, 
a  mere  belief  in  witches  does  not  incapacitate  to  make  a  deed.1 

In  a  suit  by  an  insane  person  to  recover  the  proceeds  of  a 
note  assigned  by  her  at  a  time  when  she  was  alleged  to  be  insane, 
it  was  for  the  jury  to  determine  whether  plaintiff  was  compe- 
tent to  make  the  contract,  audit  was  proper  for  the  judge  to  re- 
fuse to  instruct  that  delusion  is  the  true  test  of  insanity  in  the 
absence  of  frenzy  or  raving  madness.8 

Delusions  do  not  incapacitate  where  the  subject-matter  of 
the  deed  is  not  affected,4  or  where  the  insane  delusion  did  not 
move  the  grantor  to  make  the  deed.4 

-  Where  the  evidence  showed  that  the  maker  of  a  trust  deed 
was  capable  of  comprehending  and  acting  intelligently  upon  the 
business  out  of  which  the  deed  grew,  and  understood  the  nature 
and  consequences  of  his  act,  evidence  of  monomaniacal  delusions 
was  held  insufficient  to  invalidate  the  deed.* 

In  a  certain  class  of  cases,  however,  the  question  whether  de- 
lusions are  insane  delusions  or  not  is  important.  Where  the  ex- 

1  See  Hughes  r.  Jones,  116  N.  Y,  Turner  r.  Union  National  Bank,  10 

67;  Hay  v.  Miller,  48  Nel>.,  156;  66  Utah,  77:   37  Pac..  9.5. 

N    W.   R.,    1115;   Dewey  v.   Allgire,  4  See  Bowman  r.  N.  W.  Mut.  Re- 

37  Neb.,  6;  55  N.  W.  R.,  276.  lief  Ass'n..  IK)  Wi«.,  144;  62  N.   W. 

8  Schuettler  v.   Carman,   98   Iowa,  Rep.,  924;  infra  p.  396. 

276;    67  N.  W.  R.,  249.  *  Meigs  r.   Dexter.   172  Mass.,  217, 

'Turner  v.    Utah  Title   Insurance  52  N.  K.  R..  75. 

and  Trust  Co.,  10  Utah.  61:  37  Par.,  •  Seawel  r.  Dirst,  70  Ark.,  166;  66 

91   (1893);     Turner  ?•.   Wells.   Kargo  S.  W.  R.,  1058. 
&   Co.,    10   Utah,    75;   37   Pac.,   94; 


358  MENTAL    UNSOUNDNESS — BECKER   AND   BOSTON. 

edition  of  a  contract  was  induced  by  erroneous  opinions  and  be- 
liefs,  this  does  not  invalidate  it  unless  those  particular  errors 
amounted  to  insane  delusions.  If  they  were  founded  on  facts  it 
can  rarely  be  held  that  they  evidenced  lack  of  capacity.1 

In  Jones  v.  Hughes,  15  Abbott's  New  Cases,  141  (N.  Y. 
Supreme  Court,  8th  district,  Special  Term,  1883),  Daniels,  Judge, 
said :  "  This  action  has  been  prosecuted  to  set  aside  and  annul  a 
deed  executed  by  Richard  Hughes,  under  the  name  of  David 
Jones,  to  the  defendant,  Joseph  Jones,  because  of  mental  in- 
capacity of  the  grantor.  The  deed  was  executed  on  the  7th  of 
October,  1870,  and  recorded  on  the  second  day  of  the  succeeding 
month.  It  in  terms  conveyed  the  property  called  Buckhoru  Isl- 
and, situated  near  the  foot  of  Grand  Island  in  the  Niagara 
River.  It  has  been  owned  and  occupied  by  the  grantor  from  the 
year  1853.  The  grantee  in  the  deed  is  the  son  of  the  grantor  by 
a  second  marriage,  alleged  to  have  been,  as  it  probably  was,  un- 
lawfully contracted.  The  plaintiff  is  a  son  by  a  preceding  mar- 
riage, and  entitled  to  inherit  the  property  in  case  the  deed  should 
be  set  aside.  The  grantee  had  nothing  whatsoever  to  do  with 
the  transaction  and  in  no  measure  influenced  the  conduct  of  the 
grantor  in  making  it.  The  grantor  was  desirous  of  having  the 
grantee  and  his  wife  occupy  the  property  and  be  taken  care  of 
and  supported  by  them  during  his  natural  life.  His  additional 
object  was  to  secure  a  like  support  for  his  second  wife. 

"Before  the  deed  was  made  the  grantor  consulted  an  ac- 
quaintance, with  whom  he  had  dealt  many  years,  concerning 
the  execution  of  the  deed,  and  weut  with  him  to  a  reputable  at- 
torney to  have  the  business  done.  These  and  other  witnesses 
agree  that  in  what  he  said  and  did  on  these  occasions  he  appeared 
to  act  rationally  and  intelligently,  and  the  evidence  of  all  these 
persons  tends  very  directly  to  establish  the  fact  that  he  fully 
understood  the  business  which  was  transacted  and  the  object 
designed  to  be  accomplished  by  it,  as  well  as  the  property  to 
be  conveyed ;  and  that  it  was  his  deliberate  purpose  to  make  the 
disposition  of  it  which  he  in  form  made  by  the  execution  of 
this  deed.  In  the  preceding  month  of  March  he  made  a  twelve 
years'  lease  of  the  same  property  upon  the  same  consideration 
to  the  plaintiff,  who  went  into  possession  but  surrendered  it 

1  See  Cutler  v.  Zollinger,  22  S.  W.      Wills, infra, p. 394,  "Mistaken belief;" 
Rep.,    895;   117    Mo.,  92.     See  also      p.  395,  "  Insane  delusions." 


DELUSIONAL   INSANITY.  35'J 

afterward  lxt-aii.se  of  disagreement  between  himself  and  his 
father.  Testimony  was  given  in  behalf  of  the  plaintiff,  as  well 
as  by  himself  as  a  witness  in  the  ea.se,  showing  that  his  father, 
who  was  a  man  of  very  advanced  age,  was  irritable  in  his  dispo- 
sition, boisterous  in  his  speech,  suspicions  of  those  who  dealt 
with  him  or  were  employed  by  him  in  the  management  of  his 
property,  and  indulged  in  the  relation  of  marvellous  and  exag- 
gerated stories.  This  appeal's  to  have  been  his  character  and 
his  habits  for  many  years  preceding  the  time  when  the  deed  was 
made,  and  while  no  one  suspected  his  sanity  or  his  ability  prop- 
erly to  manage  his  own  afl'airs,  the  suspicions  entertained  by 
him  appeared  to  have  arisen  from  observations  he  had  made, 
leading  him  to  believe  that  the  persons  employed  by  him,  or 
managing  his  property,  dealt  dishonestly  with  him;  and  the 
relations  he  repeated  of  marvellous  occurrences,  in  which  he 
had  been  a  party,  referred  to  transact  ions  which  had  taken  place 
in  his  early  life.  The  statements  he  made  and  the  suspicions 
he  entertained  appeared  to  have  been  exaggerated  and  in  many 
cases  extremely  absurd  in  their  character;  but  as  long  as  they 
were  founded  upon  the  facts  from  which  he  was  satisfied  to  de- 
duce them,  they  were  not  indications  of  insanity  or  unsoundness 
of  mind,  although  extended  very  much  beyond  what  was  justi- 
fied by  the  circumstances.  They  were,  therefore,  distinguisha- 
ble from  mere  delusions,  and  do  not  establish  that  unsoundness 
of  mind  which  would  legally  disable  him  from  making  a  binding 
disposition  of  his  property.  While  lie  indulged  in  these  state- 
ments and  suspicions,  he  still  continued  to  manage  and  conduct 
his  affairs,  and  the  persons  having  dealings  with  him  apparently 
found  no  reason  for  suspecting  his  inability  to  do  that  business 
with  accuracy  and  judgment.  Toward  the  latter  portion  of 
his  life,  and  before  or  about  the  time  when  the  deed  was  made, 
he  was  impressed  with  the  delusion  that  British  ships  lay  in 
the  vicinity  of  the  island,  manned  by  early  acquaintances,  for 
the  purpose  of  protecting  it;  but  thin  delusion  mix  in  no  form  or 
wanner  connected  with  the  execution  and  delirenj  of  thin  deed.  His 
mind  still  in  other  respects  and  on  other  subjects,  although  im- 
paired by  age,  in  its  strength  was  active  and  intelligent.  Be- 
tween the  delusion  and  the  transaction  of  his  business  there 
seems  to  have  been  no  connection  whatever.  Upon  other  occa- 
sions he  became  violent  and  vindictive  in  his  conduct,  but  there 


360  MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

was  always  a  ground  of  offence  calculated  to  produce  resentment 
as  well  as  irritation  on  his  part.  His  conduct,  though  extreme, 
was  not  unnatural  for  a  person  of  his  disposition,  education,  and 
temperament.  He  believed  in  witchcraft  and  feats  which  may 
be  accomplished  by  the  power  of  persons  affecting  it,  but  this 
was  rather  a  matter  of  superstition  than  evidence  of  mental  in- 
capacity or  delusion.  While  he  was  boisterous,  vindictive,  re- 
vengeful, easily  provoked  and  aroused,  he  still  appears  to  have 
understood  the  business  transactions  to  which  he  was  a  party, 
and  to  manage  them  with  intelligence  and  judgment.  Upon  all 
the  evidence  elicited  from  the  witnesses  in  the  case  upon  these 
subjects,  it  cannot  be  concluded  that  he  was,  by  reason  of  men- 
tal infirmity,  incapable  of  making  and  executing  this  deed.  On 
the  contrary,  this  evidence  sustains  the  conclusion  that  it  re- 
sulted from  intelligent  consideration  and  reflection  upon  his 
part,  and  that  it  was  understandiugly  made  to  carry  into  effect 
a  fixed  design  which  he  himself  alone  had  previously  formed. 
Evidence  was  given  showing  that  proceedings  were  taken  under 
the  statute  in  September,  1871,  on  the  application  of  the  grantee 
in  this  deed,  to  procure  an  adjudication  determining  his  father, 
the  grantor,  to  be  a  lunatic  cr  person  of  unsound  mind.  Previ- 
ous to  that  time  he  had  been  imprisoned  in  the  county  jail  at 
the  suit  of  the  plaintiff,  and  evidence  has  been  given  tending  to 
indicate  that  such  an  imprisonment  would  aggregate  the  ten- 
dency of  his  health  in  the  direction  of  a  state  of  insanity.  This 
theory  is  entirely  natural,  for  the  imprisonment  of  an  old  man 
at  the  instance  of  his  son  would  ordinarily  be  attended  by  some 
effect  on  his  character  and  mental  condition.  The  fact  that  his 
conduct  and  speech  impressed  the  jurors  as  well  as  the  jailer 
with  the  conviction  that  he  was  a  person  of  unsound  mind  at 
the  time  can,  for  this  reason,  have  no  very  decided  influence 
upon  the  inquiry  whether  that  was  or  not  his  condition  at  the 
time  of  the  execution  of  the  deed.  To  determine  that,  the  im- 
portant evidence  was  that  which  related  to  the  contemporaneous 
occurrences  and  the  previous  conditions  in  which  this  man  ap- 
peared to  have  been.  The  application  upon  which  the  proceed- 
ings were  instituted  and  carried  on  was  based  on  the  petition  of 
Joseph  H.  Jones,  the  grantee  of  the  deed.  In  this  petition  it 
was  alleged,  '  Davis  Jones,  the  grantor,  eighty-five  years  of  age, 
had  been  a  lunatic  for  the  space  of  five  years  preceding  that 


DELUSIONAL    INSANITY.  361 

time  and  so  far  deprived  of  his  re;ison  as  to  be  wholly  unfit  and 
unable  to  govern  himself  or  to  manage  his  own  affairs ';  and 
upon  the  hearing  under  the  authority  of  the  writ  which  was  is- 
sued, the  jury  iu  form  found  that  to  l>e  his  condition.  But 
neither  these  allegations  nor  the  conclusions  of  the  jury  pre- 
sented the  inquiry — whether  as  a  matter  of  fact  he  was  compe- 
tent to  execute  this  deed  at  the  time  when  it  was  made.  That 
was  not  a  subject  presented  for  trial  by  the  petition,  or  the  in- 
vestigation made  by  the  jury;  it  was  not  a  matter  alleged  in  the 
petition  or  in  any  manner  drawn  in  question.  No  evidence 
could  properly  have  been  given  upon  it,  and  it  was  not  the 
province  of  the  jury  to  make  a  determination  which  would  or 
would  not  sustain  this  particular  transaction.  The  purpose  of 
the  proceeding  was  to  determine  whether  from  his  age  and  im- 
becility he  required  a  guardianship  of  a  more  competent  person 
for  the  protection  of  himself  and  his  affairs.  The  legal  prose- 
cution of  such  an  inquiry  did  not  include  the  question  now  pre- 
sented in  this  case — whether  or  not  the  grantor  of  this  deed  was 
competent  to  execute  it.  Therefore,  the  finding  of  that  jury  is 
not  in  any  way  prejudicial  to  the  present  question  (Am.  Sea- 
men's Soc.  v.  Hopper,  33  N.  Y.,  619).  It  has  IXMMI  held  accord- 
ingly that  an  inquisition  of  this  nature,  finding  the  party  to  have 
been  of  unsound  mind  for  a  preceding  period  of  time,  is  not  con- 
clusive as  to  his  incapacity  to  make  a  will  during  that  time 
(Campbell  v.  Consalus,  25  N.  Y.,  613),  and  a  similar  view  of 
such  a  proceeding  was  taken  in  Banker  r.  Banker  (63  X.  Y., 
409).  Judgment  will,  therefore,  be  ordered  in  favor  of  the  de- 
fendant." 

This  decision  was  affirmed  by  the  X.  Y.  Court  of  Apj>eals, 
Hughes  v.  Jones,  116  N.  Y.,  67. 

OLD  AGE  AND  MENTAL  WEAKNESS.     UNDUE  INFLUENCE. 

Though  the  grantor  in  a  deed  be  extremely  old  or  feeble  men- 
tally, his  understanding,  memory,  and  mind  enfeebled  by  age, 
and  his  actions  occasionally  strange  and  eccentric,  and  though  he 
be  unable  to  transact  many  affairs  of  life,  yet  if  age  has  not  ren- 
dered him  imbecile  so  that  he  docs  not  know  the  nature  and 
effect  of  the  contract,  it  is  not  invalid.1 

•Ball  r.  Smith,  83  Hun  (N.  Y.X       Wilkinson.    117    III..   370;   35  N.    E. 
438;  23  N.  Y.  Supp.,  54;   Francis  ?-.       Rep.,    loU;    Huckey    r.   Buckcy,    38 


362 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


Old  age  is  not  of  itself  evidence  of  incapacity  to  make  a 
contract, 1  nor  will  age,  weakness  of  mind,  and  eccentricity  render 
a  deed  void  if  the  grantor  understands  the  nature  and  effect  of 
his  act.2  But  where  old  age  has  rendered  the  grantor  imbecile,3 
or  where  he  is  unduly  influenced 4  or  imposed  upon 5  by  persons 
standing  in  a  confidential  relation  to  him,4  or  where  the  deed  is 
voluntary  and  there  is  doubt  whether  the  grantor  understood  or 
assented, "  or  where  a  person  of  great  age  is  imposed  upon  in  a 
season  of  excitement  and  distress,7  his  deed  is  voidable.  In  such 
a  case  his  mental  weakness  is  merely  an  element  in  a  cause  of 
action  based  on  undue  influence.8  When  the  elements  of  age, 
infirmity,  and  mental  weakness  are  blended  with  a  contractual 
act  of  a  suspiciously  disadvantageous  character,  a  presumption 
of  fraud  may  arise. 

Contracts  claimed  to  have  been  made  with  aged  or  infirm 
persons  to  be  enforced  after  death,  of  an  unreasonable  nature, 
for  example,  disinheriting  their  lawful  heirs,  are  properly  sub- 
ject to  suspicion,  and  must  be  established  by  the  strongest 
evidence.9 

While  a  court  can  grant  no  relief  against  the  consequences  of 
mistaken  judgment  or  mere  imprudence  on  the  part  of  the  one 
making  a  contract,  yet  where  the  'nature  of  the  act  by  a  person 


W.  Va.,  168;  18  S.  E.  Rep.,  383; 
Davis  v.  Latta,  94  Iowa,  727;  62 
N.  W.  Rep.,  17. 

1  Carnagie  v.  Diven,  49  Pac.  Rep., 
891;    31    Oregon,    366;    Peabody    v. 
Kendall   (111.  Sup.),  32  N.  E.  Rep., 
674;  Argo  v.  Coffin,  32  N.  E.  Rep., 
679;  142  111.,   368;   Lynch  v.  Dor  an 
(Mich.),  54  N.  W.  Rep.,  882;  Buckey 
v.  Buckey,  38  W.  Va.,  168;   18  S.  E. 
Rep.,  383;  see  also  infra  p.  410.  Dun- 
can v.  Mason  (Ky.),  20  S.  W.,  252. 

2  Delaplain  v.  Grubb,  44  W.  Va., 
612;    30   S.    E.    Rep.,   201;   see  also 
McKissock  v.  Groom,  148  Mo.,  459; 
50  S.  W.   Rep.,   115;  Richardson  v. 
Adams,    110  Ga.,  425;  35  S.  E.  R., 
648;    Sibley  v.  Somers    (N.  J.  Ch.), 
50  Atl.  R.,  321. 

3  Brothers  v.  Bank  of  Kaukauna, 
84  Wis.,  381;  54  N.  W.,  785;  see  also 
Henrizi  v.    Kehr,    90   Wis.,   344;   63 
N.  W.  Rep.,  285;  Boggess  v.  Boggess, 
29  S.  W.  Rep.,  1018;  127  Mo.,  305. 

4  Ross    v.    Payson,    160    111.,   349; 
43   N.    E.    Rep.,   399;   Tomlinson  v. 


Tomlinson,  103  Iowa,  740;  72  N.  W. 
R.,  664;  Wille  v.  Wille,  57  S.  C.,  413; 
35  S.  E.  Rep.,  804. 

5  Landfair  v.  Thompson,  112  Ga., 
487;  37  S.   E.   Rep.,  717;    Vanosdel 
v.  Hyce  (La.),  46  La.  Ann.,  387;  15 
So.,  19.     Deweyt>.Allgire,37Neb.,6; 
55  N.  W.,  276. 

6  Hayes    v.    Kerr,    19    App.    Div. 
(N.  Y.),  91;  45  N.  Y.  Supp.,  1050; 
Thomas  v.  Crawford,  118  Mich.,  253; 
76  N.  W.  Rep.,  394. 

1  Bruguier  v.  Pepin,  76  N.  W.  Rep., 
808;  106  Iowa,  432;  Thomas  v. 
Crawford  (supra). 

8  Mays  v.  Prewett,  98  Tenn.,  474; 
40  S.  W.  R.,  483;  Jennings  v.  Hen- 
nessy,  26    Misc.    (N.    Y.),    265;    55 
Supp.,  833. 

9  Shakespeare  v.  Markham,  72  N. 
Y.,    400.     But    see    Looby   v.    Red- 
mond, 66  Conn.,  444;  34  Atl.  Rep., 
102.     Deed   of   aged,   infirm,   fretful 
grantor,  upheld.     Francis  v.    Wikin- 
son  (111.    Sup.),    147    111.,    370;     35 
N.  E.,  150. 


OLD    AGE   AND    MENTAL   WEAKNESS.  363 

mentally  enfeebled  is  such  sus  to  justify  the  conclusion  that  he 
has  l>een  imposed  upon  by  artifice  or  undue  influence,  a  court  of 
equity  will  intervene. 

Though  the  mind  of  one  party  to  a  written  contract  had  be- 
come impaired  by  age,  the  contract  is  none  the  less  operative 
against  the  other  party,  if  the  latter  was  in  full  possession  of  his 
faculties.1 

Mere  Physical  and  Mental  Weakness  Does  Not 
Incapacitate. — In  an  action  against  the  maker  of  a  promis- 
sory note,  given  to  settle  a  debt  he  had  incurred,  the  defence 
was  that  he  was  non  compos  mentis.  He  had  IHH.MI  of  great 
physical  and  mental  strength,  but  at  the  time  of  signing  the 
note  was  physically  very  weak,  and  had  lost  much  of  his  intel- 
lectual vigor,  but  was  competent  to  attend  to  his  ordinary  busi- 
ness affairs.  His  letters  concerning  the  transaction  were  clear, 
and  showed  a  good  memory,  and  his  conduct  and  language  after- 
ward showed  that  he  fully  understood  what  he  had  done.  Held, 
that  he  was  competent  to  make  the  contract.' 

The  principle  is  identical  with  that  applying  to  old  age  which 
causes  mental  weakness,  but  not  actual  iml)ecility.' 

And  the  same  rules  apply  to  all  kinds  of  mental  weakness, 
whether  induced  by  pain,  the  use  of  anaesthetics/  or  the  ap- 
proach of  death,*  or  congenital.  The  e fleet  of  such  weakness 
upon  the  capacity  to  contract  is  merely  a  question  of  its  degree.* 

1  Elder  v.   Schumacher,    18  Colo.,  ness:   Dewey   ?'.  Algire,   37   \eb.,  6; 

433;  33  Pac.,  175.  55  N.  W.  Rep.,  27(5;  Hay  r.  Miller, 

*  Des  Moines,  etc.,  v.  Chisholm,  71  48  Neb.,  156;  66  X.  \V.  Hep.,  1115; 
Iowa,  675.     Mere  weakness  of  mind  Z^ltner  r.    Hodman  Home,    1   Ohio, 
will  not  invalidate  a  contract;  if  the  S.  &  C.  P.  Dec.,  306  (here  the  deed 
maker  of    a  promissory  note  knew  was  made  without  the  knowledge  of 
what  he  was  doing,  to  whom  given  relatives,  to  a  home    for   the    aged, 
and  for  whose  benefit  the  contract  in    consideration    of    maintenance), 
was  made,  that  it  was  for  the  pay-  Turner    r.    I 'tali   Title,  etc.,  Co.,   10 
ment  of  money,  and  the  amount,  he  Utah,  61;  37  Pae.   Rep..  1)1,  94,  95; 
had  sufficient  capacity.     Ducker   v.  Kroenung  r.   (Jtx'hri.    112  Mo.,  641; 
Whitson,    16  S.    E.    Rep.,  854;    112  20  S.  \V.  Rep.,  661;  Peters  t.  Peters, 
N.  C.,  44.  59  N.  W.  Rep..  609:  101  Mich.,  291; 

'Supra,  p.  361.  Hallnrd  '-.  Chicago,  etc.,  Ry.  Co.,  70 

4  Cutts  v.  Young.  147  Mo.,  587;  49  Mo.  App.,    10S;   Hoeh  r.   Hoeh,   197 

S.  W.   Rep.,  548;  Swank  v.  Swank,  Pa.    St.,    3X7:    47    Atl.    Rep.,    351; 

61    Pac.  R.,  846  (Ore.);    Krause    v.  Bennett  P.  Bennett  (Neb.),  91  N.  W. 

Stein,  173  Pa.  St.,  221;  33  Atl.  Rep.,  R.,   409;    Eldredge    r.    Palmer,    185 

1031.  III..  618,   57  N.  E.  Rep.,  770;   Saffer 

*  Loftus  v.  Maloney,  89  Va.,  576;  v.  Mast,  79  N.  E.  R.,  32;  223  III.,  108; 
16  S.  E.  R.,  749.  Odell  r.  Moss,  130  Cal.,  352;  62  Pac. 

*  See   generally   on   mental   weak-  R.,  555. 


364 


MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 


EFFECT  OF  IXCOMPETENCY  IN  GENERAL. 

With  the  exception  of  certain  cases  hereafter  mentioned,  an 
agreement  of  an  insane  person  immediately  connected  with  and 
growing  out  of  his  insanity  is  voidable,  at  his  option  or  that  of 
his  representatives,  and  not  void.  This  is  the  law,  by  the  great 
weight  of  authority,  and  it  applies  in  all  cases  of  contracts,  in- 
cluding deeds  of  lands,  where  the  incompetent  has  not  been  so 
adjudged  by  a  tribunal  having  due  jurisdiction.1 

A  person  incompetent  to  execute  a  deed  is  incompetent  to 
execute  a  power  of  attorney  to  make  a  deed,  and  the  deed  exe- 
cuted under  such  power  is  void,  if  his  deed  would  be  void.2 

1  Wharton's  Law  of  Contracts, 
sec.  107,  p.  138;  Bishop  on  Contracts, 
sees.  873-874;  Luhrs  v.  Hancock, 
181  U.  S.,  567;  Blinn  v.  Schwarz, 
177  N.  Y.,  252;  Smith  v.  Ryan,  191 
N.  Y.,  452;  Allis  v.  Billings,  6 
Mete.  (Mass.).  415;  Lancaster  Co. 
Nat.  Bk.  v.  Moore;  78  Pa.  St.,  407; 
Long  v.  Long,  9  Md.,  348;  Riley  ?;. 
Carter,  76  Md.,  581;  25  Atl.  R.,  667; 
19  L.  R.  A.,  489;  Matthiessen  & 
Weichers  Ref.  Co.  v.  McMahon,  38 
N.  J.  L..  536:  Wilder  v.  Weakley,  34 
Ind.,  181;  JEtna  Life  Ins.  Co.  v. 
Sellers,  154  Ind.,  370;  56  N.  E.  R., 
97;  Behrens  v.  McKenzie,  23  Iowa, 
333;  Morris  v.  Gt.  North.  Ry.  Co., 
67  Minn.,  74;  69  N.  W.  R.,  628; 
Hawley  v.  Nat'l  Loan,  etc.,  Co.,  44 
W.  Va.,  450;  29  S.  E.  R.,  1022; 
French  Lumbering  Co.  v.  Theriault, 
107  Wis.,  627;  83  N.  W.  R.,  927;  51 
L.  R.  A.,  910;  Moran  v.  Moran,  186 
Mich.,  8;  63  N.  W.  R.,  989;  Wol- 
cott  v.  Conn.  Gen.  L.  I.  Co.,  100  N.  W. 
R.,  569;  11  Det.  Leg.  N.,  346; 
Robinson  v.  Kidd,  59  Pac.  R.  (Kan.), 
863;  62  Pac.  R.,  705;  Arnett's 
Committee  v.  Owens,  23  Ky.  L.  R., 
1409;  65  S.  W.  R.,  151;  McAnan  v. 
Tiffin,  143  Mo.,  667;  45  S.  W.  R., 
656;  Jamison  v.  Culligan,  151  Mo., 
410;  52  S.  W.  R.,  224;  Gribben  v. 
Maxwell,  34  Kans.,  8.  Cf.  Release, 
Tex.  Pac.  Ry.  Co.  v.  Crow,  3  Tex. 
Civ.  App.,  266;  22  S.  W.  R.,  928; 
Alabama  &  V.  Ry.  Co.  v.  Jones; 
73  Miss.,  110;  19  So.  R.,  105, 
Ballard  v.  Chicago,  R.  I.  <fe  P.  R.  R. 
Co.,  70  Mo.  App.,  108.  Contrary 
decisions. — In  California  a  distinc- 


tion is  ingeniously  made  between  the 
contracts  of  persons  entirely  without 
understanding,  which  are  void,  and 
of  persons  not  entirely  without  un- 
derstanding, though  without  under- 
standing of  a  particular  transaction; 
in  the  latter  case  the  deed,  though 
voidable,  is  not  void.  Castro  v. 
Geil,  42  Pac.  R.,  804;  110  Cal.,  292. 
And  by  statute,  contracts  of  insane 
persons  are  sometimes  void.  Payne 
v.  Burdette,  84  Mo.  App.,  332. 
In  Georgia  held,  where  the  grantor 
was  insane  at  the  time  of  executing 
a  deed  and  remained  insane  till 
death,  the  doctrine  that  the  deed 
is  voidable  at  the  election  of  the 
grantor  has  no  application.  Boynton 
v.  Reese,  112  Ga.,  354;  37  S.  E.  R., 
437.  In  Nebraska,  the  deed  is  void 
though  not  induced  by  fraud  or 
wrongdoing.  Wager  v.  Wagoner, 
53  Neb.,  511;  73  N.  W.  R.,  937.  See 
also  cases  holding  contracts  void: 
Dewey  v.  Algire,  37  Neb.,  6;  55  N.  W. 
Rep.,  276;  Gingrich  v.  Rogers,  96 
N.  W.  R.,  156  (Neb.);  German  Savs. 
&  Loan  Soc.  v.  De  Lashmutt,  67  Fed. 
R.,  399;  Colorado.— Elder  v.  Schu- 
macher, 18  Col.,  433;  33  Pac.  R., 
175.  Alabama. — Wilkinson  v.  Wil- 
kinson, 129  Ala.,  279.  Massachu- 
setts.— Brigham  v.  Fayerweather, 
144  Mass.,  48. 

2  Plaster  v.  Rigney,  97  Fed.  Rep., 
12;  38  C.  C.  A.,  25;  Dexter  v.  Hall, 
15  Wall  (U.  S.),  9:  and  if  his  deed 
would  be  voidable,  the  deed  under 
the  power  is  also  voidable.  Williams 
v.  Sapieha,  94  Tex.,  430;  61  S.  W. 
Rep.,  115.  Cf.  Daily  Telegraph  v. 


EFFECT   OP   IXCOMPETEXCY    IX    (JEXEKAL.  365 

Iii  England,  and  in  a  few  States  of  the  United  States,  in  order 
to  invalidate  a  contract  because  of  the  insanity  of  the  maker 
before  he  is  interdicted,  in  addition  to  showing  his  incapacity, 
it  must  appear  that  he  tr«*  knoirn  by  those  who  saw  and  con- 
versed with  him  to  be  in  a  state  of  mental  derangement,  or  that 
the  person  who  contracted  with  him  kneic  his  incapacity.1 

In  Imperial  Loan  Co.  v.  Stone2  (1892)  it  was  held  that  a  party 
to  a  contract  cannot  avoid  it  on  the  ground  of  his  insanity  at  the 
time  he  entered  into  it,  unless  his  insanity  was  at  the  time  known 
to  the  other  con  tract  ing  party.  And  the  burden  of  proving  both 
the  insanity  and  the  knowledge  of  it  by  the  other  contracting 
party  lies  upon  the  party  seeking  to  avoid  the  contract.3  This 
view  is  not  at  all  universally  accepted  in  the  United  States;  for 
instance,  in  Georgia  the  ignorance  of  the  other  contracting  party 
does  not  make  the  contract  binding  on  the  lunatic  or  his  repre- 
sentatives.4 

It  has  been  held  in  Georgia  and  Alabama  that  neither  igno- 
rance of  the  insanity  on  the  part  of  the  other  contracting  party 
nor  the  fact  that  an  ordinarily  prudent  person  could  not  have 
discovered  it  makes  the  contract  binding  on  the  lunatic  or  his 
representatives,5  especially  if  it  be  an  executory  contract.9 

It  seems  to  be  established,  however,  as  a  general  rule  of 
equity  in  the  United  States,  that  where  a  person  in  good  faith 

McLaughlin.  [1904]  App.   Dec.   776;  Berger,  70  App.  Div.,  393;  78  N.  Y. 

73  Law  J.  P.  C.,  95;  91  Law  T.,  233;  Supp.,    709,    the    foreclosure    of    a 

20  Times  Law  R.,  674  (Eng.  H.  of  mortgage  was  permitted  on  showing 

L.).  of  good   faith  of  mortgagee  and   his 

1  Stockmeyer  v.  Tobin,   139  U.  S.,  ignorance  of  mortgagor's  insane  con- 

176.     In  Louisiana  this  is  the  statu-  dition. 

tory  rule,  Martinez  r.  Moll,  46   Fed.  4Orr   r.    Equitable    Mtg.    Co..    33 

Rep.,  724,   1.  S.  Cir.  Ct.   La.,  con-  S.  E.  Rep..  708;  107  Ca.,  499:  Field 

struing    Art.    1788,    Louisiana    Civil  V.  Shorb,  99  CaL.  661 ;   34  I'ac.,  504. 

Code}     Wolf   r.    Edwards,    106   La.,  •  Orr    ?•.    Enuitabh-    Mtg.    Co.,    33 

477;  31  So.  Rep.,.r>S;    Im|>erial  Loan  S.  E.    Rep.,  708;    107  (Ja..  499  (in 

Co.  v.  Stone,    1   Q.   H.,  599  (Eng.);  this  cast;  even  though  there  had  been 

Memphis   Nat.    Bank    r.    Sneed     97  no  previous  adjudication  of  incom- 

Tenn.,  120,  36  S.  W.  Rep.,  716  (case  potency).     In  Alabama  a  note  given 

of    renewal    note    given    by    insane  by  an  insane  |x>rson,  for  necessaries, 

maker  to  replace  prior  note  made  by  to  a  payee  ignorant  of  insanity,  was 

the  insane  person  while  competent).  held  not  to  bind  the  estate.    Milligan 

»  1  Q.  B.  (Eng.),  599.  r.  Pollard,  1 12  Ala.,  465;  20  So.  Rep., 

8  So  held  in  Flach  r.  C.ottschalk,  620.     C/.   Walker   r.   Winn,  39  So., 

41  Atl.  R.,  908.  88  Md..  368,  where  12  (Ala.). 

the  contract  was  fair  and  the  buyer  *  Cundell    r.    Haswell    (R.    I.),    51 

was  a  lunatic,  the  seller  was  ignorant  Atl.     R.,   426   (insane    purchaser   at 

of  the  fact  and  could  not  l>e  restored  execution  sale  not  liable  to  complete 

to  the  status  quo.     And  in  Hardy  v.  his  purchase). 


366 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


entered  into  a  fair  contract  with  another  apparently  sane,  and  the 
contract  has  been  executed  and  an  adequate  consideration  paid, 
the  contract  is  voidable  only  if  the  consideration  can  be  and  is 
restored  by  the  lunatic  or  those  who  represent  him,  so  as  to  put 
the  parties  in  statu  quo.1 

But  where  the  incompetent  has  suffered  financially  by  an  un- 
fair contract,  it  will  be  set  aside,  without  restoration  of  benefits 
received.2 

Who  May  Avoid  Contract. — The  insane  person,  or  the  commit- 
tee or  other  person  representing  him,  or  claiming  under  him,3 
and  after  his  death,  his  personal  representatives,  but  not  the  other 
party  to  the  contract,  may  elect  to  avoid  it.4  If  the  insane  per- 
son, or  those  above  mentioned  and  claiming  in  his  right,  do  not 
so  elect,  no  one  else  can  plead  his  insanity  to  avoid  the  effect  of 
his  contract.5 

Ratification. — An  insane  person  is  no  more  competent  to  ratify 
a  contract  than  to  make  one ;  therefore,  it  is  no  defence  to  an 


^ee  infra,  p.  368,  "Conditions  of 
Avoiding  Contracts."  Ins.  Co.  r. 
Hunt,  79  N.  Y.,  541 ;  Bicknell  v.  Spear, 
Misc.  (N.  Y.),  389;  77  N.  Y.  Supp.,  38, 
420:  Haines  v.  Scott,  35  App.  Div. 
(N.  Y.),  515;  Gribben  v.  Maxwell.  34 
Kans.,  8;  Young  v.  Stevens,  48  N.  H., 
133;  Brodrib  v.  Brodrib,  56  Cal.,  563; 
Copenroth  v.  Kienby,  83  Ind.,  18; 
Bokemper  v.  Hazen,  96  Iowa,  221; 
Schaps  v.  Lehner,  54  Minn.,  208; 
Hosier  v.  Beard,  54  Ohio  St.,  398; 
Myers  v.  Knabe,  51  Kan.,  720;  33 
Pac.  R.,  602;  D.  M.  Smith's  Com.  v. 
Forsythe,  90  S.  W.  R.,  1075,  28  Ky. 
L.  R.,  1034;  Rusk  v.  Fenton,  14 
Bush,  490;  29  Am.  Rep.,  413  (Ky.); 
Parker  v.  Marco,  76  Fed.  R.,  510; 
Harrison  v.  Otley,  101  Iowa,  652; 
70  N.  W.  R.,  724;  Rhodes  v.  Fuller, 
139  Mo.,  179;  40  S.  W.  R.,  760; 
Flach  v.  Gottschalk,  88  Md.,  368; 
41  Atl.  R.,  908. 

2  Reasons.  Jones,  119  Mich.,  672; 
78  N.  W.  R.,  899.  Wilkins  v.  Wil- 
kins,  35  Neb.,  212;  52  N.  W.  R.,  1109. 

*  Sander  v.  Savage,  75  App.  Div., 
333;  78  N.  Y.  Supp.,  189.  But  the 
wife  and  children  of  a  grantor  can- 
not during  his  life  question  his 
capacity  to  convey  land,  as  they 
have  no  interest  therein  presently 
enforceable.  Baldwin  v.  Golde,  88 
Hun,  115;  34  N.  Y.  Supp.,  587;  c/. 


Hunt  v.  Rabitony,  7  Detroit  Leg. 
News,  447;  84  N.  W.  R.,  59;  French 
Lumbering  Co.  v.  Theriault,  107  Wis., 
627;  83  N.  W.  R.,  927;  51  L.  R.  A., 
910.  The  grantee  by  a  deed  made 
after  restoration  to  sanity  of  the 
grantor  may  have  set  aside  a  former 
deed  by  the  grantor  made  when  he 
was  insane.  Clay  v.  Hammonds, 
199  111.,  370;  65  N.  E.  R.,  352.  The 
contract  of  an  insane  partner  does 
not  bind  his  firm,  if  the  other  con- 
tracting party  knew  of  his  insanity. 
Schmidt  v.  Ottman,  15  So.  Rep.,  310; 
46  La.  Ann.,  888. 

4  Bunn  v.  Postell,  33  S.  E.  Rep., 
707;  107  Ga.,  490. 

s  At  well  v.  Jenkins,  40  N.  E.  Rep., 
178;  163  Mass.,  362;  Mead  v.  Stegall, 
77  111.  App.,  679;  Warmsley  v. 
Darragh,  12  Misc.  (N.  Y.),  199. 
Where  the  mind  of  one  party  to 
a  contract  has  become  impaired  by 
age,  the  contract  is  no  less  opera- 
tive against  the  party  who  is  in 
full  possession  of  his  faculties. 
Hannon  v.  Hannon,  51  Fed.  Rep., 
113.  A  remainder-man  cannot  dur- 
ing lifetime  of  insane  life  tenant 
avoid  deed  of  such  life  tenant  with 
power  to  convey.  McMillin  v.  Wm. 
Deering  Co.,  38  N.  E.  Rep.,  398;  139 
Ind.,  70. 


CONTRACTS   FOR    NKCESSARIE8.  30? 

action  by  his  guardian  to  recover  money  paid  by  him,  to  say 
that  the  payment  was  made  by  him  in  settlement  of  his  contract 
obligation  entered  into  during  insanity.1 

CONTRACTS  WITH  INSANE  PERSONS  HKFOKE  FIND- 
ING OF  LUNACY,  BUT  DURING  PERIOD  COVERED 
BY  FINDING. 

A  contract  executed  by  one  who,  thereafter,  by  inquisition  in 
proceedings  de  lunatico,  is  found  to  be  a  lunatic,  although  made 
within  the  period  during  which  he  is  declared  by  the  finding  to 
have  been  a  lunatic,  is  not  absolutely  void,  the  proceedings  are 
presumptive,  not  conclusive,  evidence  of  want  of  capacity,  and 
may  be  overcome  by  satisfactory  evidence  of  sanity.2 

In  order  to  be  concluded  by  the  subsequent  adjudication,  or 
proceedings  thereunder,  the  other  contracting  party  must  be  a 
party  thereto.3 

CONTRACTS  FOR  NECESSARIES. 

A  supposed  exception  to  the  general  rule,  that  the  contracts 
of  insane  persons  are  either  void  or  voidable,  is  found  in  the  case 
of  contracts  for  necessaries  supplied  in  good  faith  to  an  insane 
person,  and  suitable  to  his  rank  in  life.  But  the  liability  is  for 
the  reasonable  value  and  not  for  the  agreed  price;  for  instance, 
a  not*1  given  by  an  insane  person  for  necessaries  to  an  ignorant 
payee  has  been  held  not  to  bind  his  estate.4 

1  YVeis  v.  Ahrenbeck,  5  Tex.  Civ.  N.  J.  !•"<).,  192,  citing  Rice  r.  IVot, 
App.,  542;  24  S.  W.  Rep.,  350.  In  15  Johns.  503:  Hicks  r.  Marshall.  3 
pleading,  an  allegation  of  disaffirm-  Hun,  327;  Matter  of  Beckwith,  3 
ance,  either  by  the  guardian  during  Hun,  443;  Mutual  Life  Ins.  Co.  v 
the  continuance  of  the  incompetency  Hunt,  79  X.  Y.,  541;  Matter  of  Mot- 
or by  the  incompetent  after  rcstora-  gan,  7  Paige,  230;  Westerfield  r. 
tion,  is  necessary.  Louisville,  etc.,  Jackson.  3  N.  Y.  State  Rep.,  353. 
Ry.  Co.  r.  Herr.  35  X.  K.  Rep.,  550;  See  Hardy  r.  Berger.  70  App.  Div.. 
135  Ind.,  591.  393;  7.S  X.  Y.  Supp.,  709. 

-  Hughes    r.    Jones,     110    X.     Y.,  a  Kakin  r.  Hawkins,  37  S.  K.  Rep.. 

07,  73,  citing  Van   DciiKen  r.  Sweet.  022    (\V.    Va.).     This    view    is    not 

51  X.  Y..  37X;  Hanker  r.  Hanker,  03  universally   held;  s»-e  infra,  p.    ."»25, 

X.  Y.,  40'.);  Hart  r.  Deamer,  0  Wend.,  Adjudication*  <>!  lunacy  <i.v  endrnct. 

497;     Osterhout     r.     Slux-maker,     3  4  Milligan  r.  Pollard'  (Ala.).  20  So. 

Hill,  513;    1   (Irecnleaf  on   Kvidence,  Rep.,  020;  so  also  of  a  note  given  to 

see.  550.      Hut  such  retroactive  find-  an    attorney    for    services,   McKee's 

ings  are  now  in  Xew  York  prohibited  Adinr.  r.  I'umell.  3S  S.  \V .  Rep..  705; 

by  Code  Civ.  Proc.,  sec.  2335,  and  are  IS   Ky.   Law   Rep..  S79.     One  who 

ineffective  for  any  purpose.     Matter  lends    money    on    n    lunatic's    note 

of   I'reston,  113   App.    Div.   (N.   Y.),  may  recover  so  much  as  the  lunatic 

732.     Ami  see  also  Mott  v.  Molt,  4'J  uses  for  necessities  or  for  the  protec- 


368  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

CONDITIONS  OF  AVOIDING   CONTEACTS. 

In  States  where  a  contract  made  by  an  insane  person  is  void- 
able, as  a  condition  of  rescinding  the  voidable  contract  or  deed 
the  consideration  must  generally  be,  if  possible,  restored.1  But, 
provided  the  contract  be  a  voidable  one,  and  not  valid  for  the 
reasons  above  pointed  out  (the  apparent  sanity  of  the  maker, 
his  inability  to  restore  the  consideration  received,  and  the  fairness 
of  the  executed  contract),  where  the  consideration  received  by 
the  insane  person  cannot  be  restored  in  kind  the  contract  may 
still  be  rescinded  without  restoration.2 

In  general,  a  bona-fide  purchaser,  without  notice,  from  the 
grantee  under  a  voidable  deed  from  a  lunatic,  acquires  good 
title.3  And  the  only  remedy  of  the  lunatic  or  his  guardian  is  to 
recover  the  purchase  price,  and  in  a  proper  case,  damages,  from 
the  grantee  of  the  lunatic.4 

RATIFICATION    AFTER    RESTORATION    OF    COM- 
PETENCY. 

After  restoration  to  sanity  the  former  incompetent  must  elect 
icithin  a  reasonable  time  whether  to  affirm  or  disaffirm  his  voidable 

tion  and  benefit  of  his  estate.  First  770.  In  Texas,  where  it  is  no 
Nat.  Bk.  v.  McGinty  (Tex.  Civ.  App.),  proved  that  the  lunatic  has  the  pro- 
69  S.  W.  R.,  495.  ceeds,  or  their  result,  in  possession,  or 
This  subject  will  be  dealt  with  they  have  not  been  spent  for  neces- 
below  (page  .381)  in  treating  of  the  saries,  restoration  will  not  be  re- 
extra-contractual  liability  of  insane  quired.  Williams  v.  Sapieha,  94 
persons  for  necessaries.  Tex.,  430;  61  S.  W.  R.,  115.  In  Mis- 

1  Morris  v.  Gt.  Northern  Ry.  Co.  sissippi,    where      an   insane    person 
(Minn.),  69  N.  W.  Rep.,  628;     JEtna  bought   chattels  and   gave  his  note 
Life    Ins.    Co.    v.    Sellers    (Ind.),    56  secured  by  a  deed  of  trust   of  the 
N.  E.  Rep.,  97;  154  Ind.,  370.  chattels,    the    vendor    was    allowed 

2  Rea  v.  Bishop  (Neb.),  59  N.  W.  only  to  sell   the  chattels  and  not  to 
Rep.,     555;     Creekmore    v.    Baxter  recover  on  the  note.     Bates  v.  Hy- 
(N.    C.),    27   S.    E.    Rep.,    994;    121  man,    28    So.    R.,    567.     For   cases 
N.  C.,  31;    Bates  v.  Hyman  (Miss.),  showing     when    the     consideration 
28   So.    Rep.,    567;     Feigenbaum   v.  need    not    be    restored    see    Brown 
Howe,  32  Misc.    R.,  514;   66  N.   Y.  v.  Cory  (Kans.    App.),  59    Pac.  R., 
Supp..  378.   Cf.  Ronan  v.  Bluhm,  173  1097;  Gilgallon  v.  Bishop,    46  App. 
111.,  277;  50  N.  E.  R.,  694;  McKenzie  Div.  (N.  Y.),  350;    61   N.  Y.  Supp., 
v.  Donnell,  151  Mo.,  461;  52  S.  W.  467;    Sander    v.    Savage,    36   Misc. 
R.,    222;    Jamison   v.    Culligan,    151  (N.  Y.),  385;  73  N.  Y.   Supp.,   695. 
Mo.,  410;  52  S.  W.   R.,  224;  as  to          3Arnett's  Com.  v.  Owens,  23  Ky. 
necessity    of    placing    third    parties  L.   R.,  1409;  65  S.  W.  R.,   151,    and 
who     have     acquired     rights     from  cases  cited. 

grantor    of   deed   in   statu   quo,    see          *  Lack  v.  Brecht,  166  Mo.,  242;  65 
cases    lasc    cited    ana    Eldredge    v.      S.  W.  R.,  976. 
Palmer,  185  111.,  618;  57  N.  E.  R,, 


CONTRACTS   WITH   INSANE   PERSONS.  369 

contract.1  Aiid  his  election  to  uflirm  may  be  manifested  by  his 
conduct,2  without  an  express  agreement  of  ratification;  for  ex- 
ample,  by  his  retaining  and  enjoying  the  consideration.9  But 
his  ratification  must  be  based  on  full  knowledge,  and  cannot  be 
predicated  of  mere  silent  acquiescence,  not  inconsistent  with 
ignorance  of  the  transaction.4  After  the  death  of  the  incom- 
petent, his  personal  representative  may  ratify  and  his  ratification 
may  be  implied.5 

In  some  States  the  power  of  ratification  of  the  incompetent's 
contracts  is  accorded  to  the  guardian  or  committee.9 

CONTRACTS  WITH  INSANE  PERSONS  SUBSEQUENT  TO 
FINDING  OP  INSANITY. 

The  effect  of  insanity  upon  contracts  may  be  entirely  differ- 
ent when  a  judgment  has  been  had  declaring  the  incompetent  to 
be  such.  In  States  where  it  is  provided  by  statute  that,  after 
a  finding  of  an  inquisition  of  insanity,  the  insane  person  shall 
be  incapable  of  making  a  contract  or  performing  any  civil 
act,  an  agreement  entered  into  by  such  a  person  is  absolutely 
void. 

In  Carter  v.  Beckwith,7  the  New  York  Court  of  Appeals,  per 
Andrews,  J.,  said:  "It  is  well  settled  that  a  lunatic  whose 
lunacy  has  been  judicially  determined,  and  for  whom  a  commit- 
tee has  been  appointed,  is  incapable  of  entering  into  any  con- 
tract, and  that  any  contract  which  he  may  assume  to  make  while 
in  that  situation  is  absolutely  void."  The  courts  will  not  in- 
quire whether  the  lunacy  in  fact  continued  and  existed  when  the 
contract  was  made.  The  presumption  of  its  continuance  is  con- 

1  O.  &  W.  Thum  Co.  v.  Tloczynski,  incompetency.     lilinn    r.     Sohwarz. 

114     Mich.,      149;     72  N.    W.    R.,  63  App.   Div.,  25:  71   X.  Y.  Supp.. 

140;  Morris  v.  Great    Northern    Ry.  343,  aff'd  177  N.  Y..  252. 

Co.,  67 Minn.,  74;  69  X.  W.  Rep.,  628;  "Whitcomb   r.    Hardy,   73   Minn., 

but  see  Kelly  r.  Burke.  31  So.  Rep.,  285;  76  N.  W.  Rep..  29. 

512  (Ala.),  where  sale  of  intoxicating  *  Heasley  r.  Beasley,  l&O  111.,  163; 

liquor  to  an  insane  j>erson  was  held  54  N.  K.  R.,  187. 

(under  a  state  statute)  incapable  of  *  Bunn  r.   Poetell,  33  S.   E.    Rep., 

ratification  in  a  lucid  interval  and,  707;  107  ('.a..  490. 

therefore,    not   ratified    by   acquics-  •  Infra,  i>.  597. 

cence in  such  period.  7  128    N.    Y.,    312.    316.    citing: 

'  Whereafter  restoration  the  former  Wadsworth  ?•.  Sharpntwn.  8  N.  V, 

incompetent    sued    his   attorney   for  388;  I,amoureaux  r.  Crosby.  2  Paige, 

proceeds  of  sale,  that  was  a  ratifica-  (N.  Y.),  422;  Hughe*  r.    Jones,   1HJ 

tion  of  sale  made  by  attorney  during  N.  Y..  67. 
Ill  —24 


370  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

elusive  as  to  all  dealings  after  the  inquisition  until  it  lias  been 
superseded.1  For  the  purpose  of  the  judicial  determination  usu- 
ally is  to  appoint  a  committee  to  care  for  the  lunatic's  business 
and  contractual  affairs. 

Where  a  finding  of  insanity  has  been  made  in  a  proceeding 
instituted  for  that  purpose,  its  validity  cannot  be  questioned 
collaterally  in  an  action  where  the  adjudged  insanity  is  relied 
on.  In  general,  until  superseded,  it  is  a  bar  to  all  the  world, 
as  a  judgment  in  rem.2 

CONTRACTS  MADE  DURING  LUCID  INTERVALS. 

In  the  absence  of  an  adjudication  of  incompetency  still  re- 
maining in  force,  a  contract  made  during  a  lucid  interval  is 
valid.  By  a  lucid  interval  "is  not  meant  a  perfect  restoration 
to  reason,  but  a  restoration  so  far  as  to  be  able  beyond  doubt  to 
comprehend  and  to  do  the  act  with  such  perception,  memory, 
and  judgment  as  to  make  it  a  legal  act."3 

1  People  ex  rel.   Smith  v.   Comrs.,  ship  had  been  practically  abandoned, 
etc.,  100  N.  Y.,  215;  In  re  Otis,  101  the  deed  was  held  valid,  though  the 
N.  Y.,  580;  Brown  v.  Miles,  61  Hun,  guardian     was     not     formally     dis- 
453;    New  England   Loan  &  Trust  charged.    Thorpe    v.    Hanscom,    66 
Co.  v.  Spitler,  54  Kan.,  i>60;  38  Pac.  N.  W.  R.,  1;  64  Minn.,  201;    and  in 
R.,    799.     But   see  Reese  v.    Reese,  Ohio,   where  the  guardian  was  ap- 
89    Ga.,    645,    15   S.    E.,    846;    Me-  pointed  to  obtain  a  pension,  but  the 
Cleary  v.  Barcalow,  6  Ohio  Cir.  Ct.  lunatic   remained   in   charge   of   his 
Rep.,  481;  see  infra,  title,  Restora-  property,  including  a  mill,  his  con- 
tion  to  Sanity,  p.  59.  tract   for   necessary   repairs   to   the 

2  In     Georgia,     the     Civil     Code  mill    at    a    fair    price  was  enforced. 
(§  3652)  provides  that  (an  adjudged  Kimball    v.  Baumgardner,    16   Ohio 
or  unadjudged)  lunatic  cannot  con-  C.  C.,  587;   see   also  Topeka  Water 
tract;     this   disability   was   held   to  Supply  Co.  v.  Root,  56  Kan.,  187;  42 
extend    to    drawing   a    check    on    a  Pac.  R.,  715;  Lower  v.  Schumacher 
bank,  and  the  bank  honoring  such  61  Kan.,  625;   60  Pac.  R.,  538. 
check  was  held  liable,  though  it  was          3  Wharton  and  Stille,  "Med.  Jur.," 
ignorant  of  the  lunacy  and  though  the  sec.    2.     When    the    court    charged 
adjudication  had  been  made  in  an-  that,  if  one  was  at  times  insane  but 
other     State.     American     Trust     &  had  lucid  intervals,  during  such  an 
Banking  Co.  v.  Boone,  29  E.  E.  S.,  interval   he   could   contract,    it   was 
182;   40  L.  R.  A.,  250;    102  Ga.,  202;  held,  not  error  to  fail  to  qualify  with 
see  also,  Kiehne  v.  Wessell,  53  Mo.  the  statement  that  insanity  is  pre- 
App.,  667;    New  England  Loan  and  sumably  continuous  and  that  even 
Trust  Co.  v.  Spitler,  54  Kan.,  560;  38  in  a  lucid  interval  a  person  may  not 
Pac.  Rep.,  799;  State  Bank  v.  Nor-  have     mind     enough     to     contract, 
duff,  2  Kan.  App.,  55;  43  Pac.  Rep.,  Norman  v.  Georgia  Lock  Co.  (Ga.), 
312.     Per  contra,  in  Minnesota,  where  18  S.  E.  R.,  27.     See  also  Van  Osdel 
one  under  guardianship  as  a  lunatic,  v.  Hyce,  46  La.  Ann.,  387;  15  So.  R  , 
contract  was  fair  and  the  guardian-  19. 


EFFECT   OF   INSANITY    UPON   PARTNERSHIP.  371 

CONTRACTS  IX   BEHALF  OF  INSANE  PERSONS. 

Ordinarily  no  one  can  contract  in  behalf  of  an  insane  person 
so  jus  to  bind  him1  except  his  duly  appointed  guardian,  and  he 
only  to  a  limited  extent,  for  necessaries.  This  subject  is  fully 
treated  below  (page  381,  The  Effect  of  Mental  Unsoumlness  on 
Liability  for  Necessaries).  By  statute  in  some  States  the 
powers  of  a  guardian  are  so  defined  as  to  permit  him  to  ratify 
his  ward's  advantageous  contracts.2 

EFFECT  OF  INSANITY  ON  AGENCY  AND  AN  AGENT'S 

CONTRACTS. 

Insanity  of  a  principal  revokes  his  agent's  authority.3  An 
insane  pe  1*8011  cannot  appoint  an  agent,4  and  if  he  attempts  to, 
the  agent's  contracts  iu  his  behalf  are  at  least  voidable.5  If. 
after  a  principal  has  become  insane,  the  agent  makes  an  agree- 
ment with  a  person  ignorant  of  the  principal's  authority,  the 
ignorance  ought  in  law  to  have  precisely  the  same  effect  as  igno- 
rance in  dealing  directly  with  an  insaue  person,  of  his  insanity.* 
This  we  have  already  treated  of.7 

EFFECT  OF  INSANITY  UPON  PARTNERSHIP. 

In  England  the  insanity  of  a  partner  will  not  work  a  dissolu- 
tion of  the  partnership.  It  is  a  ground  for  dissolution  only,  and 
if  the  continuing  partner  does  not  avail  himself  of  it,  it  will  be 
presumed  that  he  is  willing  to  wait  to  see  whether  the  incapacity 
of  his  partner  may  not  prove  merely  temporary.  In  some  of  the 
United  States  it  has  been  decided  that  the  insanity  of  the  partner 
works  a  dissolution  of  the  partnership.  Insanity  should  not  dis- 
solve a  partnership.  The  prevailing  opinion  is  that  it  only  gives 
a  good  and  sufficient  cause  for  a  court  of  equity  to  decree  a  dis- 

1  Bicknoll  v.  Spear,  38  Misc.  (N.  Y.).  4  Elias  v.  Enterprise  R.  &  L.  Asso., 

389:  77  N.  Y.  Supp..  920;  Mattson  r.  46  S.  C.,  188;   24  S.  K.  R.,  102. 

Mattson  (Wash.),  09  Pac.  R.,    1087;  »  Plaster   r.    Kidney.   97   Fed.    R., 

Brashears  v.  Frazier,  19  Ky.  L.  R.,  12;  3S  ('.  ('.  A..  25;  Clay  r.   Ham- 

1284;  43  S.  W.  R.,  427.  mond,  199  111..  370.  05  X.  K.  R..  352. 

*  Page  i».  L.  &   N.  R.  Co.  (Ala.),  'But    see    Men-it  t    r.    Men-it!,    43 

29  So.  R.,  676.     See  Lack  r.  Breoht,  App.  Div.  (X.  Y.).  08;  59  N.  Y.  Supp., 

166  Mo.,  242;  65  S.  W.  R.,  976.  357. 

8  Renfro  Iv.   City   of    Waco   (Tex.  '  Supra,  p.  365. 
Civ.  App.),  33  S.  W.  R.,  766. 


372  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

solution.  If  it  does  dissolve  the  partnership,  it  cannot  give  to 
the  partner  not  affected  with  it  the  right  to  dissolve  arbitrarily 
or  at  will.  Nor  will  it  dispense  with  the  necessity  of  a  partner 
joining  in  the  execution  of  an  instrument  which  must  be  executed 
by  all  the  partners. 

In  the  case  of  Friedburgher  v.  Jaberg,  N".  Y.  Sup.  Ct.,  First 
District,  Special  Term,  December,  1887  j1  Patterson,  Judge, 
said :  "  It  is  claimed  by  the  defendant  that  under  the  peculiar 
circumstances  of  this  case,  the  actual  participation  or  assent  of 
Stadelmann — one  of  the  partners — was  not  necessary ;  that  he  was 
insane  at  the  time  the  assignment  was  made,  and  could  neither 
join  in  its  execution  nor  sanction  it.  Assuming  that  the  evi- 
dence of  Dr.  Wildman  and  Dr.  Nichols,  medical  experts,  and 
that  of  the  witnesses  who  were  called  to  testify  to  peculiar  con- 
duct of  the  nou -assenting  partner  at  or  about  the  time  the  as- 
signment was  made,  established  the  fact  that  he  was  non  compos 
mentis  at  that  time,  did  that  of  itself  confer  the  power  upon,  and 
authorize  one  member  of  the  firm  alone  to  convey  the  partner- 
ship property  to  a  trustee?  I  ana  not  aware  of  any  case  in  which 
this  precise  question  has  been  presented ;  but  as  one  of  first  im- 
pression, it  seems  to  me  that  insanity  not  declared  by  inquisition 
can  no  more  be  urged  as  a  reason  for  dispensing  with  the  assent 
of  the  partner  than  can  his  incapacity  to  concur,  arising  from 
any  other  cause,  such  as  absence  or  serious  illness.  Insanity 
does  not  dissolve  partnership.  The  prevailing  opinion  is  that  it 
only  gives  a  good  and  sufficient  cause  for  the  court  of  equity  to 
decree  a  dissolution.  If  it  does  not  dissolve  the  partnership,  it 
cannot  give  the  right  to  the  partner  not  affected  with  it  to  dis- 
solve it  arbitrarily  at  will.  But  the  execution  of  a  general  as- 
signment operates  practically  as  a  dissolution  of  a  firm.  But  what- 
ever the  courts  might  decide  in  a  case  of  insanity  on  inquest  and 
office  found,  I  am  not  disposed  in  this  case  to  hold  that  the  in- 
sanity authorized  one  partner  to  execute  the  assignment.  The 
disability  here  seems  to  have  been  an  acute  mania  of  short  dura- 
tion, for  the  sufferer  was  discharged  from  the  asylum  within  four 
weeks  from  the  first  day  of  his  confinement,  and  shortly  after  his 
release  he  began  suit  to  set  aside  his  partner's  act.  It  can  scarcely 
be  held  under  an  active  state  of  affairs  that  during  this  period 
of  incapacity  all  the  power  and  authority  of  both  parties  inhered 
J20  Abb.  N.C.  (N.  Y.),  279. 


INSANITY   AND   CONTRACT  OP   INSURANCE.  373 

in  Jaberg,  and  that,  by  reason  of  the  tomjMmiry  disability. 
Jaberg  became  vested  by  law  with  the  authority  to  create  a  trust 
which  placed  beyond  reach  all  the  assets  of  the  concern  and  vir- 
tually extinguish  all  the  interest  of  the  disabled  partner  in  the 
business."1 

In  Kent  i->.  West2  it  was  held  that  neither  a  sane  partner  nor 
the  committee  of  a  lunatic  partner,  nor  both,  have  power,  with- 
out authority  of  court,  to  continue  the  partnership  business,  and 
that  the  committee  of  a  lunatic  partner  has  no  power  to  join 
with  the  same  partner  to  charge  the  lunatic's  estate  for  services 
rendered. 

EFFECT    OF    INSANITY    UPON     THE    CONTRACT    OF 

INSURANCE. 

Insanity  is  no  excuse  for  failure  to  pay  an  assessment  upon  a 
policy  or  contract  of  insurance.3  Where  an  insurance  policy 
contains  a  clause  that  it  shall  be  avoided  by  suicide  of  the  in- 
sured 4  or  by  death  by  his  own  hand 5  it  may  become  necessary 
to  determine  whether  the  suicide  was  insane,  for  unless  the  pol- 
icy expressly  excepts  death  by  suicide,  though  insane,  suicide 
when  insane  is  not  deemed  a  breach  of  its  terms.8  And  such  in- 
sanity is  said  to  exist  when  the  reasoning  faculties  of  the  insured 
are  so  far  impaired  that  he  is  not  able  to  understand  the  moral 
character,  the  general  nature,  consequences,  and  effect  of  the  act, 
or  is  impelled  thereto  by  an  insane  impulse  which  he  cannot 
resist.8 

A  State  statute  prohibiting  the  inclusion  in  a  policy  of  a 
clause  exempting  liability  where  the  insured  shall  have  "com- 
mitted suicide,"  has  been  construed  to  mean  as  well  when  insane 
as  when  sane.7 

Where  the  policy  contains  a  clause  against  "suicide,  sane  or 
insane,"  it  is  not  necessary  in  order  to  violate  its  terms  that  the 

1  And  see  Schmidt  v.  Ottman,  46  '  Central  Mutual  L.  I.  Assn.  r.  An- 

La.  Ann.,  888;    15  So.,  310;  supra,  derson,  195  111..  135;  62  X.  K.  R.,838. 

p.  364.  '  Grand  Ixxlge  r.  Wieting,  168  111., 

9  33  App.  Div.,  1 12;  53  N.  Y.  Supp.,  408;  48  N.  K.  Hep.,  59. 

244.  T  See  Knighta  Templars' A  Masons' 

3  Grand  Lodge  A.  O.  U.  VV.  r.  Jesse,  Life   Indemnity  Co.   r.  Jarnian,    104 
50  111.  App.,  101.  Fed.  R.,  (>:W;  44  C.  C.    A.,  93,  aflf'd 

4  See  infra,   p.  390,    for  suicide  as  Supr.  Ct.    U.  S.,  187  U.  S.,  197;  23 
evidence  of  insanity.  Supr.  Ct,  R.,  108;  see  also  B  rower  r. 

Supreme  Lodge,  74  Mo.  App.,  490. 


374  MENTAL   UNSOUNDNESS— BECKER   AND   BOSTON. 

suicide  be  conscious  of  the  moral  quality  of  his  act,  or  that  he 
have  the  will  power  to  resist  the  suicidal  impulse. l 

Still,  the  act  must  be  one  of  suicide  and  not  an  accident,  for 
it  has  been  held  where  the  policy  contained  such  a  provision  that 
the  insured  must  have  had  cause  to  know  that  the  means  em- 
ployed would  destroy  or  endanger  life. 2  The  presumption  is  that 
he  was  conscious  of  his  act.3  Such  a  policy  is  abrogated  by  sui- 
cide, though  it  be  the  result  of  an  uncontrollable  insane  impulse, 
and  though  the  insured  be  unable  to  understand  the  character 
and  effect  of  his  act.4  Self-destruction  other  than  accidental, 
regardless  of  mental  condition,  avoids  the  policy.5 

Though,  as  a  general  rule,  a  murderer  named  as  beneficiary  in 
a  policy  on  the  life  of  his  victim  forfeits  his  interest  therein,8  if 
such  a  beneficiary  be  insane  when  he  commits  a  homicide,  he 
does  not  lose  the  benefit  of  the  insurance.7 

EFFECT   OF   INTOXICATION   ON    CONTKACTS. 

A  habitual  drunkard  or  a  heavy  drinker8  is  not  incompetent 
to  contract  unless  at  the  time  of  the  execution  thereof  his  under- 
standing was  clouded  or  reason  dethroned  by  actual  intoxication 
or  insanity.9 

In  States  which  provide  for  adjudications  of  habitual  drunk- 
enness, after  the  appointment  of  a  guardian  or  committee,  the 
drunkard's  deed  is  void.10 

1 B rower    v.    Supreme    Lodge,    74  eign  Camp  Woodmen,  62  S.  C.,    145 

Mo.    App.,    490;    Huff  v.    Sovereign  40  S.  E.  Rep.,  155;  divided  court. 

Camp.  85  Mo.  App.,  96;  Manhattan  6  Clarke  v.  Eq.  Life  Ass.,  118  Fed. 

L.  Ins.  Co.  v.  Beard,  23  Ky.  L.  R.,  R.,  374  (U.  S.  C.  C.  A.,  Md.);  Union 

174;   66  S.  W.  R.,  35.  Mutual  Life  Ins.  Co.  v.   Payne,    105 

2  Nelson  v.   Equitable  Life    Ass'n  Fed.,  172;  45  C.  C.  A.,  193. 

Soc.,  73111.  App.,  133;  see  for  policy  6  Schmidt  v.  Northern  Life   Ass'n, 

avoided    by    suicide:      Dischner    v.  83  N.  W.  R.,  800  (Iowa);  51  L.  Ra., 

Piqua  Mut.  Aid  Ass'n,  14  S.  D.,  436;  141. 

85  N.  W.  R.,  998.  '  Holdom  v.  A.  O.  U.  W.,  159  111., 

3  Dickerson  v.  N.  W.  Mut.  L.  I.  Co.,  619;  31  L.  R.  A.,  67;  43  N.  E.  Rep., 
200  111.,  270;  65  N.  E.  R.,  694.  772. 

4  Supreme     Court     of     Honor     v.  &  Coombe's  Execr.  v.  Carthew,  43 
Peacock,   91   111.  App.,  632;  such  a  Atl.  R.,  1057  (N.  J.). 

provision    is    reasonable,    ibid.;    and  9  Van  Wyck  v.  Brasher,  81  N.  Y., 

a  fortiori   a    provision    limiting  the  260;    see    McGarvan   v.    Brooks,    16 

recovery  in  case  of  suicide  sane  or  So.  R.,  436  (Miss.). 

insane,  is  valid.     Scherar  v.  Pruden-  10  Cockrill  v.  Cockrill,  79  Fed.,  143; 

tial  Ins.    Co.   (Neb.),  88  N.  W.  R.,  92    Fed.,    811;    34    C.    C.    A.,    254; 

687;    Manhattan    Life    Ins.    Co.    v.  Delaplain  v.  Grubb,  44  W.  Va.,  612; 

Beard,    23    Ky.    Law    R.,    1747;    66  30  S.  E.  R.,  201. 

S.  W.   R.,  35;  see  Latimer  v.  Sover-  In  Pennsylvania  on  an  inquisition 


EFFECT   OF   INTOXICATION    ON    CONTRACTS.  375 

In  general,  a  contract  entered  into  when  the  obligor  is  in  such 
a  state  of  intoxication  as  deprives  him  of  the  exercise  of  his  un- 
derstanding, is  voidable,1  although  the  intoxication  was  volun- 
tary and  not  procured  by  the  other  party.  Occasionally  such  a 
contract  has  been  held  absolutely  void.2 

But  it  is  not  a  defence  to  a  contract,  a  note,  for  example, 
that  the  maker  was  merely  so  intoxicated  as  not  l<>  be  able  to 
give  proper  attention  to  it;  intoxication  is  not  a  defence  unless 
the  maker  did  not  know  what  he  was  doing.3 

The  contract  of  an  intoxicated  person  is  voidable  only  at  his 
election,  not  at  the  election  of  the  other  party.4 

One  who  makes  a  contract  while  drunk  can  ratify  it  when 
sober,  and  such  ratification  may  be  by  conduct  inconsistent  with 
an  intent  to  repudiate.5 

In  these  respects  the  rules  relating  to  contracts  by  insane  per- 
sons are  applicable  to  contracts  by  intoxicated  persons;  there  is 
no  difference  in  principle.6 

While  an  instrument  procured  by  fraud,  trick,  or  artifice,  or 
executed  by  11  party  in  such  a  mental  state  as  to  be  incapable  of 
consenting  or  contracting,  may  be  invalid  as  between  the  parties 
to  the  transaction,  these  facts  do  not  always  constitute  a  defence 
as  against  an  innocent  person  who  is  himself  free  from  any  fraud 
or  negligence,  and  who  has  advanced  money  or  property  to  an- 
other upon  the  faith  of  such  an  instrument.7 

Intoxication  of  Railway  Passenger. — The  intoxication 
of  a  passenger  raises  questions  as  to  the  duty  and  rights  of  the 
railway  company  toward  him,  for  the  general  discussion  of 
which  books  on  railways  and  carriers  may  be  consulted.  CJen- 

of  habitual   intcni|>erance,   the  jury  3  Wright   r.   Waller   (Ala.).   29  So. 

is  empowered  to  find  how  long  the  I^P--    57;   cf.    Parker   r.    Marco,   70 

person  has  been  a  habitual  drunkard,  Fed,  Rep.,  510. 

and     their     finding      is     ]>ri>na facie  *  Lacy  r.  Mann,  59  Kan..  777;  53 

evidence   of   incapacity   during   that  Pac.  Rep.,  754;  cf.  the  similar  princi- 

time;  a  vendee  who  received  a  con-  pie  with   resjiect   to  insanity;  gufira. 

veyance  from  him  during  such  time  p.  300. 

is  a  person  ayyriei'eil  who  may  under  *  See  Smith  r.  Williamson.  8  I'tah, 

the  law  traverse  the  fin- ling.'     Laws  219:  30  Pac.  Rep..  753. 

of  1874,  May  8;  In  re  Sampson,   19  •  See  »u;>ra,  pp.  366. 

Pa.  Co.  Ct.  R.,  I:  5  Pa.  Dist.  R.,  717.  '  The  subject   is  too  complex  for 

'See  Hale  r.  Sterp  (Colo.),  42  Pac.  treatment  here;    see  Page  r.  Kreky. 

Rep.,  598;  Longhead  r.  Coombs  Co.,  137  N.  Y.,  307;   /•/.  Yonn  r.  lament. 

2  Mo.  App.  Rep.,   1017.  50  Minn.,  210;    57  X.   W.    R.,  478: 

*Baira  r.  Howard.  30  X.  K.  Rep.,  Cutler  r.  Zollinger.   117  Mo..  92;  22 

732;    51    Ohio    St.,    57-    Hunter    r.  S.  W.  R.,  895 
Talbard,  34  S.  K.  Rep.  (W.  Va.),  737. 


376  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

erally  a  carrier  may  expel  a  passenger  who  is  drunk  and  who  de- 
means himself  so  as  to  interfere  with  the  comfort  of  other  pas- 
sengers. '  And  previous  intoxication  coupled  with  obscene  and 
indecent  behavior  has  been  deemed  admissible  in  evidence  in  an 
action  for  refusal  to  carry  the  same  person  at  a  subsequent 
time.2 

EFFECT   OF  INSANITY  UPON  MARRIAGE. 

In  the  "American  and  English  Encyclopaedia  of  Law,"  Vol. 
XI.,  1st  ed.,  p.  142,  the  rule  is  accurately  stated  that  "a  person 
who  is  so  insane  as  to  be  incapable  of  entering  into  a  valid  con- 
tract concerning  property  cannot  enter  into  a  valid  contract  of 
marriage.  Mere  weakness  of  understanding  will  not  invalidate 
a  marriage,  nor  will  insanity  which  does  not  affect  the  subject- 
matter  of  the  contract.  The  authorities  are  in  conflict  as  to 
whether  the  marriage  of  an  insane  person  is  void  ab  initio,  so  that 
it  may  be  impeached  collaterally. " 3  It  is  void  ab  initio  if  one  of 
the  parties  was  an  adjudged  lunatic.4  And  such  a  marriage  can- 
not be  rendered  valid  by  cohabitation  after  restoration.5  In 
New  York  the  marriage  of  an  insane  person  is  valid  until  di- 
rectly impeached.6  And  in  Missouri,  though  a  statute  declares 
the  contracts  of  insane  persons  void,  a  marriage  contract  is  not 
deemed  within  the  operation  of  the  law.7 

INSANITY   AS    GEOUND  FOE    AVOIDING  MAEEIAGE 

AB  INITIO.8 

In  order  to  annul  a  marriage  for  insanity  it  must  be  made  to 
appear  that  the  insanity  existed  at  the  time  of  the  marriage.9 
When  it  did  so  exist  it  is  cause  for  annulment.10  In  Pennsyl- 

1  Chesapeake    &    O.    Ry.    Co.    v.  other  contracts,  where  actual  restora- 
Saulsberry  (Ky.),  66  S.  W.  R.,  1051;  tion  avoided  the  effect  of  a  previous 
Edgerly  v.  Union  St.  R.  Co.,  36  Atl.  adjudication  of  incompetency. 
Rep.,  558;  67  N.  H.,  312;  or  if  he  5  Sims  v.  Sims;  supra. 

falls  into  a  stupor,  Hudson  v.  Lynn  6  Stuckey  v.  Mathes,  24  Hun,  461. 

&  B.  R.  Co.  (Mass.),  59  N.  E.  Rep.,  '  Payne  v.  Burdette,  84  Mo.  App., 

67.     As  to  duty  of  railroad  toward  332. 

intoxicated  passenger,  see  Roseman  8  See   Kern  v.  Kern  (N.    J.    Ch.), 

v.  Carolina  Central  R.  Co.,  112  N.  C.,  26  Atl.,  837. 

709;  16  S.  E.  Rep.,  766.  9  Forman  v.  Forman  (Super.  Ct.  of 

2  Stevenson  v.  West  Seattle  L.  &  I.  N.  Y.),  24  N.  Y.  Supp.,  917;  Nonne- 
Co.  (Wash.),  60  Pac.  R.,  51.  macher  v.  Nonnemacher,  159  Pa.  St., 

3  See  infra,  p.  598,    as  to  suits  by  634;  28  Atl.  Rep.,  439;  see  infra,  p. 
insane  persons  for  divorce.  511,  title,  Evidence. 

4  Sims  v.  Sims,  121  N.  C.,  297;  28  10  Pyott  v.  Pyott,  90111.  App.,  210; 
S.  E.  Rep.,  407;   40  L.  R.  A.,   737;  aff'd  191  111.,  280;  61  N.  E.  Rep.,  88. 
but  see  supra,  p.  370,  for  cases  on 


INSANITY   AS  A   DEFENCE   IN   DIVORCE  ACTIONS.          37? 

vania  it  has  been  held  that  the  courts  have  no  power  to  deter- 
mine the  validity  of  a  marriage  alleged  to  be  void  for  lunacy.1 
In  Georgia  it  has  been  held  that  the  next  of  kin  or  heirs-at-law 
of  one  of  the  contracting  parties  can  attack  the  marriage  on  the 
ground  of  mental  incapacity.1 

INSANITY   AS  CAUSE  FOR  DIVORCE. 

The  policy  of  different  States  toward  divorces  differs  very 
materially,  and  the  causes  for  divorce  are  different  in  different 
States;  they  are  usually  enumerated  in  statutes,  and  those  causes 
have  from  time  to  time  varied  in  the  same  State.  Insanity  has, 
from  time  to  time,  been  a  statutory  cause  for  divorce.3  It  is  now 
a  statutory  ground  of  absolute  divorce  in  District  of  Columbia, 
Georgia,  Idaho,  Maine  (with  limitations),  Minnesota  (if  insan- 
ity existed  at  marriage),  Pennsylvania,  Utah,  Virginia  (if  in- 
sanity existed  at  marriage),  and  Washington.4 

INSANITY  AS  A  DEFENCE  IN  DIVORCE  ACTIONS. 

Though  not  directly  a  cause  for  divorce,  insanity  may  be  the 
underlying  cause  of  some  other  delinquency  which  is  ground  for 
divorce;  in  such  case  it  becomes  necessary  to  determine  whether 
the  insanity  excuses  the  delinquency. 

In  England  insanity  is  not  a  good  defence  unless  lasting  and 
abiding  without  hope  of  recovery  or  amelioration,  and  mere  re- 
current or  intermittent  insanity  is  no  defence.5 

And  though  a  person  sued  for  divorce  on  the  ground  of  adul- 
tery be  subject  to  delusions,  yet  if  capable  nevertheless  of  un- 
derstanding the  nature  of  the  act  committed  and  its  probable 
consequences,  the  insanity  would  be  no  defence  to  the  petition 
for  divorce.8 

In  New  York  it  was  said:  "A  violation  of  the  marriage  con- 
tract by  an  insane  hnsbaud  or  wife  does  not  furnish  ground  for 

1  Pitcairn  v.  Pitcairn,  201   Pa.  St.,  absence  of  a  statute.     Pile  r.   Pile, 

368;  50  All.  R.,  963.  94  Ky.,  308:  22  S.  W.,  215  (1893). 

"  Mtdlock  r.  Merritt,  102  C.a.,  212;          4  See  table  in   "World  Almanac," 

29  S.  E.  Rep.,  185.  1908,  pp.  498-199. 

8  In    Kentucky   it    was   held    that          •  Hanbury    r.    Hanbury,    Probate 

lunacy  is  not  a  ground  for  a  divorce,  Div.  (1892),  222. 
though    it    prevents    the    wife   from          *  Yarrow  r.  Yarrow,  Probate  Div. 

discharging     her     conjugal     duties.  (Eng.),  92. 
This   seems   to   be   the    rule   in   the 


378  MENTAL  UNSOUNDNESS — BECKER   AND    BOSTON. 

a  dissolution  of  the  marriage.  Thus  extreme  cruelty,  if  caused 
by  insanity,  is  not  a  cause  for  divorce,1  and  the  same  rule  ap- 
plies to  acts  of  sexual  intercourse  between  an  insane  husband  or 
wife  and  a  stranger.  Insane  delusions  on  the  part  of  a  wife  who 
has  committed  adultery  are  no  defence  to  a  suit  for  divorce, 
where,  when  committing  adultery,  she  was  capable  of  appreciat- 
ing the  nature  of  the  act  and  its  probable  consequences. " 2 

Is  the  insanity  of  a  defendant  a  bar  to  an  action  for  divorce, . 
in  the  absence  of  a  statute  ? 

The  Supreme  Court  of  Vermont,  in  Nichols  v.  Nichols,3  held 
that  a  decree  of  divorce  on  the  ground  of  adultery  cannot  be 
granted  against  an  insane  person.  In  Ohio,  when  the  defendant 
was  adjudged  a  lunatic,  the  divorce  suit  abated.4 

To  this  it  may  be  replied  that  divorce  statutes  are  meant  to 
relieve  parties  from  intolerable  wrong,  and  the  wrong  of  adul- 
tery is  none  the  less  intolerable  because  the  party  committing  it 
is  insane.  This  view  was  intimated  in  England  in  the  Mordaunt 
case,5  although  that  case  was  decided  upon  the  peculiar  construc- 
tion of  the  statute.  Insanity  of  either  party  is  now  held  no  bar 
to  a  divorce  in  England,  and  in  this  country  some  States  have 
followed  the  English  rule.6 

INSANITY   AS   A   GEOUND   OF    SEPAEATION. 

The  distinction  between  divorce  a  vinculo  matrimonii  or  abso- 
lute divorce,  and  divorce  a  mensa  et  thoro,  or  from  bed  and  board, 
commonly  called  limited  divorce  or  judicial  separation,  is  still 

1  So  also  in  Pennsylvania,  Hansell  serter   became   insane,    his   insanity 
v.  Hansell,    13  Pa.  Co.  Ct.  R.,  514;  was  no  defence.  Harrigan  v.  Harrigan, 
3  Pa.  Dist.  R.,  734.  135  Cal.,  397;  67  Pac.  R.,  506.     Ef- 

2  Stuckey  v.  Mathes,  24  Hun,  461.  feet  of  adjudication  of  insanity. — 

3  31  Vt.,  328;  and  see  also  Wray  v.  In  Kansas  a  wife  sued  a  husband  for 
Wray,  19  Ala.,  522,  and  Broadstreet  divorce  on  the  ground  of  desertion; 
v.  Broadstreet,  7  Mass.,  474;   Mohler  an  adjudication  of  his  insanity  made 
v.  Shank's  Est.,  61  N.  W.  R.  (Iowa),  prior  to  the  desertion  was  interposed 
981.  as    a    defence.     The    plaintiff    was 

4  Rhode   v.    Rhode,   8   Ohio   S.  &  allowed  to  show  that  during  his  ab- 
C.  P.  Dec.,  684.  sence  in  his  new  residence  he  was 

;L.  R.,  2  P.  &  M.,  103,  109.  considered  sane  and  had  there  pro- 

6  Matchen    v.    Matchen,     6    Barr  cured   a   divorce   from   his   wife   on 

(Pa.),  332.     Divorce  granted  against  service  by  publication,   and  it  was 

an  insane  person  for  acts  committed  held  that  he  could  not  maintain  his 

before    he    became    insane;    lago   v.  defence  on  the  ground  of  the  adjudica- 

lago,  168  111.,  339:  48  N.  E.  Rep.,  30.  tion  alone.     Rodgers  v.  Rodgers,  56 

Where   desertion   was   a   ground   of  Kan.,  483;  43  Pac.,  779;  c/.  Sims  v. 

divorce,  and  desertion  continued  for  Sims,   121  N.  C.,  297;  28  S.  E.  R., 

the  requisite  period  before  the  de-  407,  40  L.  R.  A.,  737. 


INTOXICATION   IN   ITS    RELATION   TO    MARRIAGE.  379 

commonly  recognized  in  the  legislation  of  the  several  States,1 
and  tht>  grounds  differ  in  different  States.  A  separation  will 
usually  be  decreed  on  account  of  insanity. 

INSANITY  AS  A  DEFENCE  IN  SEPARATION  ACTIONS. 

Separation  is  granted  not  necessarily  for  the  fault  of  a 
defendant,  but  often  because  cohabitation  is  inf\i>edicnt.  If, 
therefore,  acts  endangering  the  safety  of  the  plaintiff  result  from 
the  insanity  of  the  defendant,  such  insanity  is  no  defence,  in 
jurisdictions  where  the  action  can  be  maintained  against  an 
insane  person.2 

INTOXICATION   IN  ITS  RELATION   TO   MARRIAGE. 

Intoxication,  like  insanity,  may  have  an  effect  upon  the  mar- 
riage relation  in  inquiries  respecting  the  capacity  to  consent  to 
enter  the  relation ;  as  a  cause  for  divorce,  in  those  States  where 
habitual  intemperance  constitutes  such  cause;  as  a  ground  of 
separation ;  and  as  a  defence  where  it  is  the  cause  of  some  de- 
linquency which  is  ground  of  divorce  or  separation  in  the  ab- 
sence of  intoxication. 

Capacity  to  Consent.— In  Ohio,  where  a  person  had  been 
adjudicated  incapable  of  taking  care  of  himself  on  account  of 
intemperance,  it  was  held  only  prima  facie  evidence  of  want  of 
mental  capacity  to  marry.3 

Habitual  Intemperance  or  Use  of  Drugs  as  a  Cause 
of  Divorce  or  Separation.— Habitual  intemperance  is  not 
a  cause  for  absolute  divorce,  unless  so  provided  by  statute. 

In  Kentucky  a  divorce  on  the  ground  of  habitual  intoxication 
was  denied  where  the  wife  knew  at  the  time  of  the  marriage  that 
the  husband  was  a  slave  to  intoxicants;4  it  was  granted  to  the 
husband  where  the  wife  had  been  a  habitual  drunkard  for 
several  years  before  the  action.5 

The  principal  discussion,  where  the  law  permits  an  absolute 
divorce  for  habitual  intemperance,  has  arisen  over  what  const i- 

1  See     Bishop    on     Marriage    ami  s  McOeary    r.    Barcalow,   6    Ohio 

Divorce;  Stewart  on  Divorce.  Circuit  C't.,  4SI. 

»  Hanbury     v.     Hanbury     (F.ng.),  4  Tilton    r.    Tilton,    16    Ky.    Law 

Prob.  Div.  (1892),  222.    Cf.  Pyott  v.  Rep.,  538;  29  S.  \V.  Rep.,  290. 

Pyott,  90  111.  App.,  210;    affil    191  » Crowley  r.  Crowley,  19  Ky.  Law 

111.,  280:  61  N.  E.  R.,  88;  Kuster  v.  Rep.,  285;  40  S.  \V.  Rep.,  380. 
Kustcr,   37  Misc.   (N.   Y.),    136;   74 
N.  Y.  Supp.,  853. 


380 


MENTAL,   UNSOUNDNESS — BECKER   AND    BOSTON. 


tutes  habitual  intemperance, 
this  question.1 


Cases  cited  in  the  note  relate  to 


THE  VALIDITY   AND   EFFECT   OF  JUDGMENTS 
DERED   AGAINST  AN   INSANE   PEESON.2 


EEN- 


Generally  a  judgment  entered  against  a  person  of  unsound 
mind,  whether  entered  by  default,  on  consent,  on  after  a  trial,  is 
not  for  that  reason  void,  and  if  otherwise  valid  it  cannot  be  col- 
laterally questioned ; 3  but  it  is  irregular  if  the  insane  person  was 
unrepresented  by  a  guardian,4  and  upon  application  seasonably 
made  to  the  court  which  entered  it,  will  be  opened.5  This  may 


1  Intoxication  once  in  three  weeks; 
divorce  denied:  Dennis  v.  Dennis, 
68  Conn.,  186;  34  L.  R.  A.,  449; 
36Atl.  Rep.,  34;  once  to  three  times 
each  week  for  four  years;  divorce 
granted:  Marous  v.  Marous,  86  111. 
App.,  597. 

In  Louisiana  repeated  acts  of 
drunkenness  followed  by  occasional 
spells  of  sobriety  and  moderate 
drinking,  but  with  the  habit  of  drink- 
ing fixed  so  that  temptation  can- 
not be  resisted,  have  been  held  to 
constitute  habitual  drunkenness,  and 
if  it  be  of  such  nature  as  to  make  it 
unbearable  for  husband  and  wife  to 
live  together,  it  is  cause  for  sepa- 
ration from  bed  and  board.  De 
Lesdernier  v.  De  Lesdernier,  45  La. 
Ann.,  1364;  14  So.  Rep.,  191. 

In  New  York  a  separation  was 
granted  to  a  wife  where  the  husband 
was  intoxicated  a  large  part  of  the 
time,  ranging  from  partial  to  com- 
plete stupor,  and  had  inflicted  per- 
sonal violence  on  her.  Kissam  v. 
Kissam,  21  App.  Div.,  142;  47  N.  Y. 
Supp.,  270.  Intemperance  or  in- 
toxication in  divorce  statutes,  refers 
to  intoxication  from  the  use  of  in- 
toxicating liquors,  unless  the  use  of 
drugs  is  specifically  referred  to;  thus, 
in  Georgia,  it  was  held  not  to  in- 
clude a  condition  resulting  from  the 
use  of  morphine.  Ring  v.  Ring,  112 
Ga.,  854;  38  S.  E.  Rep.,  330. 

In  Massachusetts  gross  and  con- 
firmed drunkenness,  caused  by  the 
voluntary  and  excessive  use  of 
opium  or  other  drugs,  is  a  ground  for 
divorce,  but  the  ground  must  exist 
at  the  time  of  the  filing  of  the  libel. 
Act  1889,  c.  447;  see  supra,  p.  379. 


Burt  v.  Burt,  46  N.  E.  Rep.,  622; 
168  Mass.,  204;  see  also  note  to 
Edwards  v.  State  (Tex.  Cr.  App.), 
39  L.  R.  A.,  262. 

2  Classified  under  contracts  because 
judgments  are  regarded  by  law 
writers  as  obligations  strictly  analo- 
gous to  contracts,  and  called  "con- 
tracts of  record."  See  Thomas  v. 
Hunsicker,  108  N.  C.,  720;  Weaver  v. 
Brennan,  146  Pa.  St.,  299;  Redmond 
v.  Peterson,  102  Cal.,  595;  Bond  v. 
Neusch wander,  86  Wis.,  391.  As  to 
burden  of  proof  of  insanity  where 
effort  is  made  to  set  aside  judgment 
on  ground  of  insanity,  see  infra,  p. 
556 ;  see  infra,  p.  598,  for  actions 
against  insane  persons  ;  see  infra,  p. 
523,  for  judgments  against  intoxicated 
persons  ;  see  infra,  p.  598,  for  parties 
to  actions  against  insane  persons ; 
see  supra,  p.  379,  for  judgments 
against  insane  persons  in  matri- 
monial actions. 

3Withrow  v.  Smith,  37  W.  Va., 
757;  17  S.  E.  Rep.,  316;  White  v. 
Hinton,  3  Wyo.,  753;  30  Pac.  Rep., 
953;  Noel  v.  Modern  Woodmen,  61 
111.  App.,  597;  Dunn  v.  Dunn,  114 
Cal.,  210;  46  Pac.  Rep.,  5;  Chamblee 
v.  Broughton,  120  N.  C.,  170;  27 
S.  E.  Rep.,  111. 

4  Harris  v.  Schlinke,  65  S.  W.  Rep., 
172  (Tex.  Civ.  App.);  but  see  Wis- 
dom v.  Shanklin,  74  Mo.  App.,  428. 

5  For     instance,     in     Indiana,     a 
judgment  against  one  insane,  at  the 
time    of    its  entry,   though    not  so 
adjudicated,    will  be    set    aside    on 
application  within  two  years.    Judd 
v.  Gray,  156  Ind.,  278;  59  N.  E.  R., 
849.   In  Iowa  within  one  year  after 
removal  of  disability,  Code  1873,  §§ 


EFFECT   ON    LIABILITY    FOR   NECESSARIES.  381 

properly  be  done  on  application  of  his  guardian  wlwn  appointed;1 
and  the  heirs  of  an  insane  person  since  deceased  are  not  bound 
by  a  judgment  so  rendered  against  him.3 

The  measure  of  capacity  has  been  defined  by  the  courts. 
Where  defendant's  mind  was  impaired,  but  he  understood  the 
nature  of  the  legal  proceedings,  it  was  held  proper  to  refuse  to 
open  judgment  against  him,  at  the  suit  of  his  heirs.' 

Application  to  open  such  an  irregular  judgment  must  be 
made  without  unreasonable  delay.4 

If  a  guardian  is  duly  appointed  as  provided  by  law,  a  judg- 
ment against  an  insane  person  is  of  the  same  force  and  effect  as 
against  any  other,  and  the  right  to  resort  to  an  execution  upon 
a  judgment  is  not  generally  suspended  by  the  insanity  of  the 
judgment  debtor.5 

THE    EFFECT    OF    MENTAL  UNSOUNDNESS   ON  LIABILITY 
FOR  NECESSARIES. 

Insane  persons  are  liable  for  necessaries,  independent  of  ex- 
press contract." 

This  rule  has  been  so  applied  that  a  man,  notwithstanding 

3154-62;      Hawley    ».     Griffin,     92  L.  R.  A.,  910;  83  N.  W.  Rep.,  927; 

N.  W.  R.,  113  (judgment  opened  at  Bicknell   v.  Spear,  38  Misc.  R.,  389' 

instance  of  heirs  of  insane  defendant  77    N.    Y.    Supp.,    920;    Mattson    v- 

since    deceased);    cf.    Glasscock    v.  Mattson  (Wash.),  69  Pac.  R.,  1087. 

Tate,  107  Tenn.,  486;  64  S.  W.  Rep.,  Otherwise     by     statute:    Wilkinson 

715.  Gadilis  &  Co.  v.  Markert  (N.  J.),  47 

'Butlers  v.  Comyns,  81  111.  App.,  Atl.  R.,  488;  65  N.  J.  L.,  518. 

418;  Crawford  v.  Thompson,  161  111.,  3  Spinlock  v.  Xoe  (Ky.),  43  S.  W. 

161;   43  N.   E.    Rep.,   617;    Kent  r.  Rep.,     31;    see    also    Garretson    r. 

Kent,  22  Misc.  (N.  Y.),  403;  50  N.  Y.  Hubbard,  81   N.  W.   Rep.,   174;  sec 

Supp.,  339.  Hawley  r.  Griffin,  92  N.  \V.  R.,  113 

9  Townsend  v.  Price,  53  Pac.  Rep.,  (Iowa). 

668;  19  Wash.  St. ,415.    Cf.  also  the  *  In    Illinois,  the  court,  after  the 

following:     Judgment     void     if     no  end  of  the  term  at    which  a  judg- 

guardian  ad  litem  appointed,  though  ment     of    dismissal     was     rendered 

an    attorney    appeared    for    insane  against  an  insane  plaintiff,  who  was 

person.     Ex  partc  Rountrce,  51  S.  C.,  so    adjudged    after    the    commenee- 

405;    29    S.    E.    Rep.,    66;    but    see  ment  of  the  action,  refused  to  open 

Livingston   v.    Livingston,    56   App.  the  judgment  on  the  ground  of  lack 

Div.  (N.  Y.),  484;  67  N.  Y.  Supp.,  of  power.     Leonard   r.    The    Times, 

789;  and  also  where  a  guardian  nad  51  111.  App.,  427. 

been  appointed  if  he  was  not  made  a  s  Pollock  r.  Horn,   13  Wash.,  626; 

party:  Ex  parte  Kitfter,  31  S.  E.  Rep.,  43  Pac.  Rep..  885 

274;    53  S.   C.,    461.     To   the  same  "See    sufira,   p.    367,  for   liability 

effect:  Heff  v.  Cox,  5  Ohio  N.  P.,  413;  upon      contracts      for      necessaries. 

Taylor     v.     Lovering     (Mass.),     50  Dandurand  r.  Kankakee  Co.,  96  III. 

N.    E.    Rep.,   612;    l7l    Mass.,   303;  App.,  464;  63  X.  E.  Rep..  101;   afTM 

Gillespie  v.  Gouly.   120  CaL,  515;  52  196    111.,    537;    63    N.    E.    R.,    1011; 

Pac.  Rep..  816;  French  Lumlwring  Borum  r.  Bell,  31  So.  R,  (Ala.),  454. 
Co.  v.  Theriault,  107  Wis.,  627;  51 


382 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


he  has  been  found  to  be  an  idiot  from  birth,  is  liable  for  neces- 
saries for  himself,  his  wife,1  and  children,  unless  some  unfair 
advantage  has  been  taken  of  him.2 

Appointment  of  Committee. — After  the  appointment 
of  a  guardian,  the  liability  for  necessaries  is  conditioned  on  the 
guardian's  express  request,  or  his  refusal  to  provide  for  the  ward 
or  those  entitled  to  support  by  the  ward.3  That  services  were 
beneficial  to  the  ward  is  insufficient,  unless  they  were  requested 
by  the  guardian,  or  rendered  necessary  by  the  very  fact  of  his 
failure  to  provide  them.  Subject  to  the  supervision  of  the 
court  appointing  him,  the  guardian  has  full  power  and  discre- 
tion to  contract  in  behalf  of  the  ward  for  goods  and  services 
necessary  and  suitable  to  the  ward's  station  in  life,  and  the  ward 
is  bound  by  such  contracts  the  same  as  a  sane  person.4 


1  See  also  infra,  p.  383 ;  Effect  on 
Domestic  Relations. 

-  1  Story  Eq.  Jur.,  307;  Barnes  v. 
Hathaway,  66  Barb.,  452;  Stan- 
nart  v.  Barns,  63  Vt.,  244.  But 
where  the  marriage  is  disputed,  in- 
sanity at  the  time  of  marriage  would 
be  a  defence.  Pyott  v.  Pyott,  90  111. 
App.,  210;  aff'd  191  111.,  280;  61 
N.  E.  R.,  88. 

3  Creagh  v.  Tunstall  (Ala.),  12  So. 
Rep.,  713;    1    Story  Eq.    Jur.,    307; 
Barnes    v.     Hathaway,     66     Barb. 
(N.  Y.),  452;   Stannart  v.  Barns,  63 
Vt.,  244;  Kent  v.  West,  33  App.  Div. 
(N.  Y.),   112;  53  N.  Y.  Supp.,  244; 
Brashears  v.  Frazier,  19  Ky.  Law  R., 

•1284;  43  S.  W.  R.,  427. 

4  Lewis  v.    Mason,  42   App.    Div., 
423;  59  N.  Y.  Supp.,  123;  Boldman 
v.  Leng's  Est.  (Mich.),  8  Det.  Leg.  N., 
175;  86  N.  W.  R.,  148;  In  re  Averill's 
Est.,  133  Cal.,   414;  66  Pac.  R.,  14; 
see  also  Masters  v.  Jones   (Ind.),  64 
N.  E.  R.,  213;  Hart  v.  Miller  (Ind.), 
64  N.  E.  R.,  239. 

The  liability  of  the  public  for  the 
care  and  maintenance  of  insane  per- 
sons is  generally  regulated  by  local 
statutes,  which  have  given  rise  to 
numerous  disputes  on  the  subjects  of 
cost  of  maintenance  and  residence.  It 
is  not  within  the  scope  of  this  article 
to  discuss  them  ;  see  infra,  p.  607,  et 
seq.,  "  Indigent  insane"  ;  seealsom/ra 
as  to  what  is  regarded  as  necessaries  ; 
see  also  vol.  iii.,  p.  578,  "Care  and 
Custody  of  Incompetent  Persons ' ' ; 


cf.  State  Hospital  v.  Fountain,  129 
N.  C.,  90;  39  S.  E.  Rep.,  734:  Thed- 
ford  v.  Reade,  25  Misc.  (N.  Y.),  490; 
54  N.  Y.  Supp.,  1007;  Oneida  Co.  v. 
Bartholomew,  82  Hun  (N.  Y.),  80; 
31  N.  Y.  Supp.,  106. 

In  some  States  statutes  declare 
that  the  relatives  of  insane  persons 
shall  be  liable  for  their  care.  Super- 
intendents of  the  Poor  v.  Rabbitt, 
57  N.  W.  Rep.,  1084;  99  Mich.,  60; 
State  v.  Sweet,  21  R.  I.,  87;  41  Atl. 
Rep.,  1011;  see  Long  Island  State 
Hospital  v.  Stuart,  22  Misc.  R. 
(N.  Y.),  48;  49  N.  Y.  Supp.,  372; 
St.  Lawrence  Hospital  v.  Fowler,  15 
Misc.  (N.  Y.),  165;  37  N.  Y.  Supp., 
16;  Hemlock  Poor  Dist.  v.  Hufford, 
8  Kulp.  (Pa.),  202;  In  re  Kolb's 
Est.,  6  Pa.  Dist.  Rep.,  543;  for  right 
to-  interest  on  unpaid  board  at 
asylum  see  Western  State  Hospital 
v.  Conier,  99  Va.,  702;  40  S.  E.  R., 
52;  3  Va.  Sup.  Ct.  R.,  539. 

Statutes  making  the  insane  per- 
son's estate  liable  for  his  support  are 
constitutional.  In  re  Yturburru's 
Est.,  134  Cal.,  567;  66  Pac.  R.,  729; 
see  for  example  of  such  recovery 
Dandurand  v.  Kankakee  Co.,  96  111. 
App.,  464;  63  M  E.  R.,  1011;  see 
also  Directors  of  Infirmary  v.  Merkle, 
3  Ohio  N.  P.,  169;  Palmer  v.  Hudson 
River  St.  Hosp.  (Kan.),  61  Pac.  R., 
506;  State  Hospital  v.  Fountain, 
128  N.  C.,  23;  38  S.  E.  Rep.,  34;  see 
s.  p.,  129  N.  C.,  90;  39  S.  E.  R.,  734; 
Inhab.  of  Kittery  v.  Dixon,  96  Me., 


EFFECT   UPON   NON-CONTRACTUAL   MATTERS.  888 

By  analogy  to  liability  for  necessaries,  an  attorney  who  rep- 
resents an  insane  IKTSOII,  or  an  inquisition  into  his  sanity,  is  en- 
titled to  compensation  from  the  committee  of  his  property;1  and 
witness'  fees  and  attorney's  fees  on  a  hearing  to  determine  his 
restoration  are  properly  payable  ont  of  his  estate.7  As  are  the 
fees  of  an  attorney,  though  he  l>e  unsuccessful,  if  his  application 
is  in  good  faith.3 

THE   EFFECT   OF   INSANITY   ON   DOMESTIC   RELATIONS 

The  insanity  of  a  husband,  even  with  appointment  of  a  com- 
mittee, does  not  relieve  him  of  his  duty  to  support  his  wife,  nor 
does  it  deprive  her  of  her  power  to  bind  him  for  her  neces- 
saries, in  case  lie  fails  to  provide  them.4  This  so-called  "agency 
of  necessity  "  persists.  Accordingly  she  may  procure  necessaries 
and  her  husband's  estate  will  l>e  liable;  or  In'tter,  she  may 
apply  to  the  court  having  jurisdiction  over  his  guardian  to  com- 
pel him  to  make  suitable  provision.5 

THE  EFFECT  OF  MENTAL  UNSOUNDNESS  UPON  NON-CON- 
TRACTUAL MATTERS  INVOLVING  CONSENT  OF  THE 
INCOMPETENT. 

A  valid  consent  implies  a  mind  capable  of  appreciating  the 
nature  and  consequence  of  the  consent.  The  same  principle 
which  invalidates  contracts  in  the  interest  of  a  mentally  incom- 
petent party  is  applied  wherever  consent  is  required  to  make  an 
act  valid  in  the  law.  For  instance,  where  consent  makes  an  act 
otherwise  criminal  or  wrongful,  legal,  and  the  apparent  consent 
is  the  action  of  an  incompetent  mind,  the  act  remains  as  though 
no  consent  had  l>een  given.  Sexual  intercourse  with  an  insane 

368;  52  Atl.  Rep.,  799;  Central  Ky.  74  N.  Y.  Supp..  70;  170  N.  Y.,  7;  62 

Asylum  r.  Pcnick,  44  S.  W.  Hep.,  92;  N.  K.  Hen..  7«1. 
19  Ky.  Law  R.,   1583:  McXairy  Co.          4  ('/.    also   Schelling  r.    Kankakee 

v.  McCoin,  4')  S.  W.  Hep..  1070:  101  County,  96  III.  App.,  432,  and  Swift 

Tenn.,  74;  U.  S.  r.  I'rizzell,  19  App.  v.  Car|«-nter,   18  R.  I..  545:  28  Atl. 

(1).  C.X  48;  see  1   O.  L.  1)..   190,  for  R.,  963;  for  discussion  of  the  nature 

case  wiiere  the  contract  was  implied.  and  extent  of  a  husband's  liability  to 

1  In  re  Hardy,  26  App.   Div..   164;  care  for  his  insane  wife  sec  also  Cen- 

27  X   Y  Civ   Pro   Rep..  174;  49  N.  Y.  tral  Kentucky. etc.,  Asylum  r. Craven. 

Supp.,    953;    r/.    Kent    r.    West,    33  17  Ky.  L.  R.,  C>67:  :«  S.  \V.  R.,  291. 
APP    Div,    112;   53   N.   Y.    Supp.,          lThedford    r.     Reade,    25    Misc. 

244  (N.  Y.).  490.  54  Supp.,  1007;  Hallett 

*  Kelly  v.   Kelly,  74  N.  VV.   Rep.,  v.    Hallett.    S    Ind.    Aim..    305;    34 

899;  72  Minn.,  19.  N.  K.  R..  740;  Tiffany  r.  Worthington, 

3  In  re  Lanier,  68  App.  Div.,  320;  96  I  >wa,  560;  65  N.  \V.  R..  817. 


384  MENTAL   UNSOUNDNESS— BECKER   AND   BOSTON. 

woman,  though  she  apparently  consent,  is  none  the  less  rape, 
provided  her  insanity  be  known  to  the  defendant.1 

So  also,  though  an  insane  person  consent  to  the  possession  of 
his  funds  by  another,  the  other  may  be  guilty  of  embezzling 
them.2 

THE  EFFECT  OF  MENTAL  TJNSOTJNDNESS  UPON  WILLS  AND 
TESTAMENTS.3 

\ 

TESTAMENTARY  CAPACITY— GENERAL  PRINCIPLE. 

On  the  whole,  no  convincing  distinction  has  been  made  by 
the  courts  or  text  writers  between  the  capacity  needful  for  a 
valid  will  and  for  a  contract.4  "In  order  to  make  a  valid  will,  a 
testator  must  have  sufficient  capacity  to  comprehend  the  nature 
of  the  act  he  is  performing ;  he  must  understand  the  extent  of 
the  property  of  which  he  is  disposing ;  he  must  comprehend  the 
relation  which  he  holds  to  those  who  have  claims  upon  him,  and 
be  capable  of  making  a  rational  selection  among  them. " 5  But 
absolutely  sound  and  perfect  mental  faculties  are  not  requisite.6 

The  stereotyped  phrase,  which  often  constitutes  a  part  of  the 
preamble  of  a  will,  "  being  of  sound  and  disposing  mind,  mem- 
ory, and  understanding,"  expresses  with  considerable  accuracy 
the  degree  of  mental  competency  necessary  to  make  a  valid  will.7 

In  Illinois  it  has  been  said  that  one  whose  mind  is  sound,  is 
of  "sound  mind  and  memory  "  as  regards  testamentary  capacity, 
although  his  memory  is  somewhat  impaired.8 

1  State  v.  Williams,  149  Mo.,  496;  3  P.  &D.,  72,  note,  stating  the  oppo- 

51  S.  W.  Rep.,  88.  site  view. 

2Hobbs  v.   People,    183  111.,   336;  6  "The  Am.  and  Eng.  Encycl.  of 

55  N.  E.  Rep.,  692.  Law,"     1st    ed.,    vol.    xi.,    p.     151; 

a  The   method   of   making   an   in-  Bennett  v.  Bennett  (N.  J.  Pre.  Ct.), 

quiry  into  the  validity  of   wills  de-  26  Atl.  Rep.,  573;  50  N.  J.  Eq.,  439; 

pends  on  the  practice  in  the  particu-  Blough   v.    Parry    (Ind.),    43   N.    E. 

lar  State  in  which  the  controversy  is  Rep.,  560;  Dean  v.  rhillips,  22  Ky. 

pending,    which    it    is    not     within  Law  Rep.,  1621 ;  61  S.  W.  Rep.,  10;  In 

the  scope  of  this  article  to  explain.  re  Hoyt'sEst.,  10  Kulp  (Pa.),  166;  cf. 

Sometimes  the  question  is  raised  and  Murphy's    Exr.   v.    Murphy,  23  Ky. 

determined  in  an  inquiry  conducted  Law  R.,  1460;  65  S.  W.  R.,  165. 

before  a  probate  court  or  officer,  at  6  Ring  v.  Lawless,  190  111.,  520;  60 

other  times  before  a  jury  in  an  ac-  N.  E.  R.,  881. 

tion,  at  other  times  before  a  jury  on  *  See  Waugh  v.  Moan,  200  111.,  298; 

special  issues  framed  and  submitted  65   N.  E.   R.,  713,  where   sane  was 

to  the  jury  by  a  court.  regarded  in  an  instruction  as  synony- 

4  Gable   v.    Rauch,    50   S.    C.,    95;  mous  with  sound  mind  and  memory. 

27  S.  E.  R.,  555,  declaring  less   re-  8  Taylor  v.  Pegram,   151  III.,   106; 

quired;  Burdett  v.  Thompson,  L.  R..  37  N.  E.  Rep.,  837. 


TESTAMENTARY    CAPACITY.  B8JJ 


IDIOTS. 

An  idiot,  it  is  agreed  on  all  sides,  has  no  testamentary  capac- 
ity; though  as  to  what  constitutes  idiocy  there  is  a>  much  doubt 
in  testamentary  as  in  contractual  issues. 

STATUTORY  WILLB. 

In  many,  if  not  all,  of  the  States  testamentary  competency  is 
the  subject  of  statutory  definition,  but  the  statutes  never  in  any 
substantial  particular  change  the  general  principle  above  set 
forth. 

InNeic  York. — All  persons,  except  idiots,  persons  of  unsound 
mind,  married  women  and  infants,  may  devise  their  real  estate 
by  a  last  will  and  testament.1 

Every  male  person  of  the  age  of  eighteen  years  or  upward, 
and  every  female  not  being  a  married  woman  of  the  age  of  six- 
teen and  upward,  of  sound  mind  and  memory,  and  no  other,  may 
give  and  bequeath  his  or  her  personal  estate  by  will,  in  writing.2 
Similar  statutes  have  been  adopted  in  other  States,  the  age  qual- 
ification varying  in  different  States. 

DEGREE  OF   INTELLECT. 

In  the  State  of  New  York  it  was  formerly  held  under  the 
statute  in  force  that  a  person  of  weak  mind,  "if  not  an  idiot  or 
a  lunatic  or  of  unsound  mind,"3  is  competent  to  make  a  will. 
Mere  imbecility  does  not  incapacitate.  The  exception  in  the 
statute  designates  pel-sons  totally  wanting  in  reason  and 
understanding.  An  imbecile,  of  however  low  degree  of  mental 
capacity,  has  the  power  of  legal  assent  or  will ;  and  the  ques- 
tion in  each  such  case  is,  whether  that  power  was  duly  exer- 
cised.1 

But  the  rule  is  now  laid  down  by  the  Court  of  Appeals  as 

1  2  R.  S.,  p.  57,  sec.  1.  3   Den.,   37,   note:    1852,    Person   r. 

*2  R.  S.,  p.  60,  sec.  21.  Warren.  14  Bark,  488.    See  also  den. 

*  2  R.  S.,  p.  57,  sec.  1.  T.    1853,    Newhouse   r.    dodwin.    17 

4  Ct.  of  Err.,  1841,  Stewart  v.  Lis-  id.,  236;  Osterhout  r.  Shoemaker 
penard,  26  Wend.,  255  (see  dissent-  3  Hill,  513;  and  see  Petrie  r.  Shoe- 
ing opinion  of  Clerke,  J.,  in  Thomp-  maker,  24  Wend.,  85;  Burner  r. 
son  r.  Thompson,  21  Barb.,  107);  Hill.  1  Bradf..  360.  Compare  Clark 
Supr.  Ct.,  1846,  Blanchard  r.  Nestk-,  r.  Suwyer,  2  N.  \.  (2  Comst.).  4U8. 
III.— 25 


386  MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 

follows:  "In  law,  the  only  standard  as  to  mental  capacity,  in  all 
who  are  not  idiots  or  lunatics,  is  found  in  the  fact  whether  the 
testator  was  'compos  mentis '  or  'non  compos  mentis  '  as  these  terms 
are  used  in  their  fixed  legal  meaning.  Such  being  the  rule,  the 
question  in  every  case  of  probate  is,  had  the  testator,  as  compos 
mentis,  capacity  to  make  a  will?  not,  had  he  capacity  to  make 
the  will  produced  ?  If  compos  mentis  he  can  make  any  will,  how- 
ever complicated ;  if  non  compos  mentis  he  can  make  no  will — not 
the  simplest. " 1 

In  general  the  principle  is  that  a  testator  must  be  of  sound 
and  disposing  mind  and  memory  so  as  to  be  capable  of  making 
a  testamentary  disposition  of  his  property  with  sense  and  judg- 
ment, in  reference  to  the  situation  and  amount  of  such  property, 
and  to  the  relative  claims  of  the  different  persons  who  are  or 
might  be  the  objects  of  his  bounty.  It  is  essential  that  the  tes- 
tator should  have  sufficient  capacity  to  comprehend  perfectly 
the  condition  of  his  property,  his  relations  to  the  persons  who 
were  or  might  have  been  the  objects  of  his  bounty,  and  the  scope 
and  bearings  of  the  provisions  of  his  will,  and  sufficient  active 
memory  to  collect  in  his  mind,  without  prompting,  the  particu- 
lars or  elements  of  the  business  to  be  transacted,  and  to  hold 
them  in  his  mind  a  sufficient  length  of  time  to  perceive  at  least 
their  obvious  relation  to  each  other,  and  to  be  able  to  form  some 
rational  judgment  with  relation  to  them.2 

If  he  has  this  degree  of  capacity,  he  is,  within  the  meaning 
of  the  statute  of  wills,  a  person  of  sound  mind  and  memory,  and 
is  competent,3  even,  it  is  said,  though  his  mind  was  so  weakened 
that  he  could  not  take  care  of  his  estate,4  and  without  regard  to 

1  Ct.  of    App.,  1862,    Delafield    v.  plained  in  5  N.  Y.  Surr.  (1  Redf.), 

Parish,   25  N.   Y.,   997,   affirming  5  204,  note;  In  re  Townsend's  Will,  75 

N.    Y.    Surr.     (1    Redf.),     130;    42  Hun  (N.  Y.),  593;  27  N.  Y.  Supp., 

Barb.,  24;  and  see  Ean  v.  Snyder,  603;   Ledwith     v.    Claffy,    18    App. 

46   Barb.,    230;     Cayuga   Surr.    Ct.,  Div.,  115;  45  N.  Y.  Supp.,  612. 

1888,  Matter  of  Soule,  22  Abb.  N.  C.,  3  N.  Y.  Surr.  Ct.,  1879,  La  Bau  v. 

236;     19  State  Rep.,  532;    3   N.  Y.  Vanderbilt,  3  Redf.,  384,  436,  citing 

Supp.,  259;  Whiter.  Ross,  48  State  25  N.  Y.,  9,  35  id.,  70;  id.,  559;  60 

Rep.,    599;   20    N.    Y.    Supp.,  521;  Barb.,  69;  Snyder   v.     Sherman,  23 

Buchanan  v.  Belsey,    65   App.  Div.,  Hun,      139.      See     also     Matter    of 

58;    72     N.    Y.    Supp.,   601;    citing  Murphy,  41   App.  Div.,   153.     In  re 

Delafield  v.  Parish,  supra.    Cf.  con-  Iredale's  Will,  53  App.  Div.,    45;  65 

trary  rule  as  to  contracts  laid  down  N.  Y.  Supp.,  533. 

in   Turner  v.  Houpt,   53   N.  J.  Eq.,  4  In   re   Johnson's   Will    (Surr.),  7 

526;  33  Atl.  R.,  28.  Misc.  R.  (N.  Y.),  220;  27  N.  Y.  Supp., 

*  Delafield  v.  Parish,  supra,  as  ex-  649. 


DEGREE  OF   INTELLECT.  38? 

his  previous  condition,1  and  though  the  testator  was  subject  to 
periods  of  insanity,2  both  before  and  after.3 

The  true  test  of  testamentary  capacity  is  the  competency  of 
the  testator  to  understand  and  comprehend  the  act,  in  relation 
to  his  property,  to  the  natural  objects  of  his  bounty,4  and  those 
whom  he  desires  to  make  objects  of  his  bounty.5 

IN  ENGLAND. 

Sir  James  Ilannen  said,  "The  testator  must  have  a  memory 
to  recall  the  several  pel-sons  who  may  be  fitting  objects  of  his 
bounty,  and  understanding  to  comprehend  their  relationship  to 
himself  and  their  claim  upon  him.  .  .  .  Whatever  degree  of 
mental  soundness  is  required  for  .  .  .  responsibility  for  crime, 
capacity  to  marry,  capacity  to  contract,  capacity  to  give 
evidence  as  a  witness — the  highest  degree  of  all,  if  degrees 
there  be,  is  required  in  order  to  constitute  capacity  to  make 
a  testamentary  disposition  .  .  .  because  it  involves  a  larger 
and  wider  survey  of  facts  and  things  than  any  one  of  those 
matters."8 

And  in  another  case  in  charging  the  jury  he  explained  this 
as  follows: 

"I  never  said  that  it  requires  a  greater  degree  of  soundness  of 
mind  to  make  a  will  than  to  do  any  other  act.  .  .  .  What  I  have 
said  .  .  .  is,  that  if  you  are  at  liberty  to  draw  distinctions  be- 
tween various  degrees  of  soundness  of  mind,  then  whatever  is  the 
highest  degree  of  soundness  is  required  to  make  a  will.7  That  is 
very  different.  .  .  .  From  the  character  of  the  act,  it  requires 
the  consideration  of  a  larger  variety  of  circumstances  than  is 
required  in  other  acts,  for  it  involves  the  reflection  upon  the 
claims  of  the  several  persons  who,  by  nature  or  through  other 
circumstances,  may  be  supposed  to  have  claims  on  the  testator's 

i/n  re  Hall's  Will  (Surr.),  5  Misc.  Will,  56  X.  Y.  State  Ren..  709:  In 

R.  (N.  Y.),  461;  24  X.  Y.  Supp.,  864.  re  Brommcr's  Will.  (K)  id..  234. 

*  In  re  Snelling's  WiU    (Surr.),  78  5  Howe    v.    Richards    (Iowa),    83 

Hun  (N.  Y.),  211;  28  X.  Y.  Supp.,  N.  W.  Hep..  901). 

942.  •  Boughton  r.  Knight,  L.  R.  3  P. 

"ClafTey  v.  Led  with   (N.  J.  Pre.),  and  I).,  64,  72. 

38  All.  Rep.,  433;  56  X.  J.  Eq.,  333.  '  Cf.  (Sable    p.     Ranch,  27  S.     E. 

4Ct.  of  App.,   1881,  Swenarton  v.  Rep.,  555;  50  S.  C.,  95;  where  after 

Hancock,  9  Abb.  X.  ('.,  326;  Abstr.  denning  testamentary  capacity    the 

a.   c.,   84   N.    Y.,   653,    reversing  22  trial  court    added    that  less  mental 

Hun.  38;  In  re  Hlair's  Will.   16  Daly  capacity    was  required    to    make   a 

(N.  Y.  Com.  PL),  540;  In  re  Wheeler's  will  than  a  contract. 


388  MENTAL   UNSOUNDNES3 — BECKER   AND   BOSTON. 

bounty,  and  the  power  of  considering  these  several  claims  and  of 
determining  in  what  proportions  the  property  shall  be  divided 
amongst  the  claimants. "  * 

IN  THE  UNITED  STATES  GENERALLY. 

The  courts  of  the  United  States  all  apply  much  the  same  tests 
as  the  courts  of  New  York  and  England.  The  testator  must  un- 
doubtedly retain  sufficient  active  memory  to  collect  in  his  mind, 
without  prompting,  particulars  or  elements  of  the  business  to  be 
transacted,  and  to  hold  them  in  his  mind  a  sufficient  length  of 
time  to  perceive  at  least  their  obvious  relations  to  each  other, 
and  be  able  to  form  some  rational  judgment  in  relation  to  them. 
The  elements  of  such  a  judgment  should  be  the  number  of  his 
children,  their  deserts,  with  reference  to  conduct  and  capacity, 
as  well  as  need,  and  what  he  had  done  before  for  them,  relatively 
to  each  other,  and  the  amount  and  condition  of  his  property ; 
with  some  other  things,  perhaps.2 

The  testator  must  possess  an  understanding  of  the  business  in 
which  he  is  engaged  in  making  the  will,3  a  recollection  of  the 
property  he  means  to  dispose  of,  of  the  persons  who  are  the  ob- 
jects of  his  bounty,  and  the  manner  in  which  it  is  to  be  distrib- 
uted among  them.  It  is  not  necessary  that  the  testator  should 
view  his  will  with  the  eye  of  a  lawyer  and  comprehend  its  provi- 
sions in  the  legal  form.  It  is  sufficient  if  he  has  such  mind  and 
memory  as  will  enable  him  to  understand  the  elements  of  which 
it  is  composed — the  disposition  of  his  property  in  the  simplest 
form.4 

Demonstrated  ability  to  manage  business  matters  may  be 
proof  of  capacity  to  make  a  will.  On  the  other  hand,  com- 
petency to  engage  in,  or  understand  or  control  complicated,  habit- 
ual,5 or  even  ordinary6  business  matters  or  transactions  is  not 
the  final  test  of  testamentary  capacity,  but  an  understanding  of 
the  business  in  which  the  testator  is  engaged  when  he  prepares 
and  executes  his  will,  the  persons  who  are  the  natural  objects  of 

1  Sir  James  Hannen  in  Burdett  v.          4  Harrison    v.    Rowan,    3     Wash. 
Thompson,  L.  R.  3  P.  and  D.,  72,      C.  C.,  580. 

note.     And  see  Banks  v.  Goodfellow,  5  Crossan  v.  Crossan,  70  S.  W.  R., 

L.  R.  5  Q.  B.,  549.  136  (Mo.). 

2  Converse  v.  Converse,  21  Vt.,  168.  6  Ring  v.  Lawless,  190  111.,  520;  60 

3  Appeal  of  Sturdevant,  71  Conn.,  N.  E.  R.,  881;  Waugh  v.  Moan,  200 
392;  42  Atl.  R.,  70.  111.,  298;  65  N.  E.  R.,  713. 


DEGREE   OP  INTELLIGENCE.  389 

his  bounty,  and  the  manner  in  which  he  desires  the  disposition 
to  take  effect.1 

The  test  of  testamentary  capacity  is  whether  the  testator 
could  comprehend  reasonably  the  condition  of  his  property, 
his  relations  to  the  object  of  his  bounty,  and  the  scope  and 
bearing  of  his  will,  and  whether  he  had  sufficient  active  mem- 
ory to  collect  in  his  mind,  without  prompting,  the  particu- 
lars or  elements  of  the  business  to  be  transacted,  and  hold 
them  a  sufficient  length  of  time  to  perceive  at  least  their  ob- 
vious relations  to  each  other  and  form  a  rational  judgment  con- 
cerning them.2 

A  person  capable  of  comprehending  his  property,  the  natu- 
ral objects  of  his  bounty,  and  the  disposition  he  has  determined 
to  make  of  his  property,  may  make  a  valid  will,  although  he  is 
of  very  moderate  capacity,3  or  is  erratic  or  eccentric4  or  subject 
to  melancholy.5 

A  testator  able  to  comprehend  his  property,  the  natural  ob- 

»Maddox    v.    Maddox,    21    S.    W.  803;  Whitney  r.  Twombly.  1 36  Mass  , 

Rep.,    499;    114    Mo.,    35;    see    also  145;  Cline  v.  Lindsay,  110  Ind.,  337; 

Keithley  v.   Stafford,    126  111.,   507;  see  also  to  the  same  effect  substan- 

18  N.  E.  Rep.,  740;  Perkins  v.  Per-  tially,  though  phrased  in  other  words, 

kins  (Iowa),  90  N.  W.  R.,  55;  Duna-  Hampton  v.  Westcott,  49  N.  J.  Eq., 

way  v.  Smoot  (Ky.),  67  S.  W.  R.,  62.  522;    25  Atl.    Rep.,   254;    Pooler    r. 

Cf.    Green   v.    Green    (111.    Sup.),  33  Cristman,   34   N.    E.  Rep.,    57;    145 

N.  E.   Rep.,  941;   145  111.,  264;  see  111.,   405;   Burney  v.  Torrey    (Ala.), 

also  as  example  of  overstatement  of  14  So.  Rep.,  685;  Howat  r.   Howat's 

testamentary  capacity  by  including  Exr.,  41  S.  W.  Rep.,  771;  19  Ky.  Law 

an  understanding  of  all  testator  had  R.,  756;  Bower  t>.  Bower,  45  N.  E. 

previously  done  for  the  objects  of  Rep.,   595;   146  Ind.,  393;    King    r. 

his    bounty,    Couch    v.    Gentry,    20  King,    42  S.  W.  Rep.,  347:    19  Ky. 

S.W.  Rep.,  89;  113  Mo.,  248.     Sinnet  Law  Ren.,  868;    Howe  r.   Richards, 

v.  Bowman,  37  N.  E.  Rep.,  885;  see  83  N.   W.  Rep.  (Iowa),  909:  Pritch- 

in  re  Cameron's  Est.  (Pa.  Orph.  Ct.),  ard  v.  Henderson,  3  Pennewill  (Del.) 

14  Pa.  Co.  Ct.  R.,  247;  id.  3  Pa.  Dist.  128;  50  Atl.  R.,   217;    Ketteman   r. 

R.,      101,    where     a     demonstrated  Metzger,    23    Ohio    C.    C.    R.,     61; 

business  shrewdness,   taken  in  con-  Berry  v.  Safe  Dep.  &  Tr.  Co.  (Md.), 

nection  with  other  evidence  of  intelli-  53  Atl.  R.,  720. 
gence,  were  held  to  establish  testa-          s  Howell  v.  Taylor  (X.  J.  Prerog. 

mentary  capacity.    Appeal  of  Turner,  Ct.),  50  N.   J.    Eq.    (5    Dick.),  428; 

72  Conn.,  305;  44  Atl.   R.,  310;  see  26  Atl.,   566;     Bennett    r.    Bennett 

Von  de  Veld  v.  Judy  (Mo.),  44  S.  W.  (N.   J.    Prerog.   Ct.),    50  N.   J.    Eq. 

Rep.,     1117,     incompetency    to    do  (5  Dick.),  439;  26  Atl..  573. 
business  not  testamentary  incapacity;          4  Farnuin  v.  Boyd,  56  N.  J.  Eq., 

Petefish  r.  Becker,   176  111.,  448;  52  766;  41   Atl.   H.,  422;    Pilkington  r. 

N.  E.  R.,  71.  Gray.  68  L.  J.  P.  C..  63  (Eng.);App. 

*/n   re    Pitt's    Estate    (Wis.),    55  Cas.,[  1899]  401;   Ketteman  v.  Metz- 

N.  W.,   149;    Martin    r.    Thayer,   37  ger,    23    Ohio    C.     C.,     61;     In    re 

W.  Va.,  38;  16  S.  E.,  489;  Couch  r.  Wright's  Est.  (Pa.),  51  Atl.  R..  1031. 
Gentry,  113  Mo.,  248;  20  S.  W.,  89;  »  In  re  Reed's  Est.  (Minn.),  90 

Bulger  v.  Ross,  98  Ala.,  267;  12  So.,  N.  W.  R.,  319. 


390  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

jects  of  his  bounty,  the  meaning  of  the  business  in  which  he  is 
engaged,  and  the  relation  of  each  of  these  factors  to  the  other, 
and  the  disposition  made  by  his  will,  possesses  testamentary 
capacity,  although  he  is  infirm  of  body  and  there  is  some  abate- 
ment of  his  intellectual  vigor.1 

Actual  knowledge  of  the  extent  of  the  property  is  not  the 
measure,  but  capacity  to  understand  the  extent  and  the  objects 
of  testator's  bounty.2  Consequently  it  does  not  necessarily  show 
testamentary  incapacity  that  testatrix  overstated  the  amount  of 
her  property  in  the  will.3 

The  ability  to  comprehend  testator's  property  may  co-exist 
with  actual  ignorance;  therefore  ignorance,  to  amount  to  lack  of 
testamentary  capacity,  must  be  ignorance  resulting  from  lack  of 
mental  capacity  to  comprehend.4 

And  suicide,  after  repeated  attempts,  is  not  inconsistent  with 
testamentary  capacity.5  Nor  is  monomania  necessarily  incon- 
sistent with  such  capacity.6  Nor  absent-mindedness  and  brood- 
ing.7 

Because  a  testator's  mind  may  be  in  a  partial  sense  unsound 
and  yet  not  incapacitate  him  from  making  a  will,  an  instruction 
which  stated  that  mental  unsoundness  embraces  every  species  of 
mental  incapacity  from  raging  mania  to  delicate  and  extreme 
feebleness  of  mind,  has  been  held  erroneous.  Such  an  instruc- 
tion may  correctly  describe  the  bounds  of  mental  uusoundness  in 

1  Westcott  v.  Sheppard,  51  N.  J.  tions,  the  breach  of  which  would 
Eq.  (6  Dick.),  315.  To  same  effect  not  show  want  of  testamentary  cap- 
Green  v.  Green,  145  111.,  264;  33  N.  acity.  Bulger  v.  Ross,  12  So.  Rep., 
E.,  941;  Taylor  v.  Pegram,  151  111.,  803. 

106;     Francis     v.     Wilkinson,      147  2  Roller  v.  Kling,  49  N.  E.  Rep., 

111.,  370;  Prentiss  v.  Bates,  88  Mich.,  948;    150   Ind.,    59.     Accordingly  it 

567;     O'Connor     v.     Madison,     98  was  not  error  to  modify  a  request 

Mich.,  183:  In  re  Douglass  Est.,  162  that    testator    must    have    a    clear 

Pa.,  567;  Maddoxt?.  Maddox,  114  Mo.,  recollection  of  his  property  by  strik- 

35;  21  S.  \V.,  499;   Norton  v.  Paxton,  ing  out  "clear";  Kischman  v.  Scott, 

110  Mo.,  456;  In  re  Hoover,  19  D.  C.,  166  Mo.,  214;  65  S.  W.  R.,  1031. 

405;  Potter  v.   Jones,   20  Or.,    239;  3  Waugh   v.    Moan,    200   111.,    298; 

Wallis  v.  Luhring,  134  Ind.,  447;  34  65  N.  E.  R.,  713. 

N.  E.,  231;     Carpenter  v.  Bailey,  94  4  In  re  Livingston's  Will   (N.  J.), 

Cal.,    406;  Trezevant    v.    Rains,    85  37  Atl.  Rep.,  770. 

Tex.,  329;   19  S.  W.,  567.    In   Ala-  5  Koegel  v.  Egner  (N.  J.),  54  N.  J. 

bama  it  was  held  to  be  an  error  to  Eq.,    623;    35    Atl.    Rep.,    394;    see 

instruct    a   jury    that    testamentary  further  on  suicide  infra,  p.  549,  p.  556. 

capacity     required     sufficient     mind  6  Young  v.   Miller,    145  Ind.,   652; 

and     memory     to     understand     the  44  N.  E.  Rep.,  757. 

testator's  obligations,  if  any,  toward  7  Ouachita  Baptist  College  v.  Scott, 

any  person,   on   the  ground  that  it  64  Ark.,  349;  42  S.  W.  Rep.,  536. 
gave   undue   prominence   to   obliga- 


WHEN  TESTATOR   MUST  BE   COMPETENT.  391 

its  widest  sense,  but  it  is  not  a  true  measure  of  mental  unsound- 
iiess  as  applied  to  testamentary  capacity.1 

WHEN  TESTATOR  MUST  HK  COMPETENT. 

The  state  of  testator's  mind  at  the  time  he  published  and 
declared  his  will  is  the  only  question  at  issue  when  his  capacity 
is  challenged.2  If  a  testator  re-publishes  a  will  by  a  codicil,  and 
it  be  determined  that  he  was  of  suflicient  testamentary  capacity 
to  make  the  codicil  at  the  time  he  made  it,  it  becomes  imma- 
terial whether  he  was  of  sufficient  capacity  to  make  the  will  at 
the  time  he  executed  it.8 

When  mental  capacity  at  the  time  of  the  execution  of  will  or 
codicil  is  the  question,  condition  at  another  time  may  perhaps  be 
competent  evidence  upon  that  issue.4 

DUTY  OF  COURT  TO  INSTRUCT  THE  JURY. 

The  court  should  define  to  the  jury  testamentary  mental 
competency,  though  it  is  not  necessary  that  the  court  should 
go  further  and  elaborately  explain  what  is  not  such  coni|>e- 
tency.5  But  it  is  error  for  the  court,  on  an  issue  of  testamentary 
capacity,  to  fail  to  give  a  clear  and  careful  definition  of  testa- 
mentary competency.8 

EFFECT  OF  ADJUDICATION  OF  INSANITY  ON  CAPAC- 
ITY TO  MAKE  A  WILL. 

One  under  guardianship  for  insanity  is  prima  fade  incapable 
of  making  a  will.7  But  the  appointment  of  a  guardian  is  not 

1  Heseman  v.  Vogt,   181   111.,  400;  *  In  re   Journeuy's  Will.    15    App. 

55  N.  E.  R.,  151:  and  it  is  error  to  Div.   (X.  Y.),  5(57:  41  N.   Y.  Supp., 

eive    such    an    instruction    as    may  54.S.  alT'd     162  N.   Y.  611,  646;  57 

lead  the  jury  to  In'lieve  that  partial  N.  K.  Hep.,  1113.     Cf.  in  re  Nelson's 

insanity  will  itself  avoid  a  will.     In  Est..  132  Col..  IS'.':  (>4  Par.  It..  294, 

re  Evans'  Est.  (Iowa),  86  X.  W.  II.,  where  the  codicil  was  made  three  days 

283.  after  the  previous  will. 

*  In  re  Hoyt's  Est.,  10  Kulp  (Pa.),  4  Infra,  p.  510. 

166;  Von  de  Veld  r.  Judy  (Mo.).  44  &  Deanr.  Phillips.  22  Ky.  Law  Rep., 

S.  W.  R..  1117,  Smith  r.  Day  (Del.)  1621;  01  S.  W.  Hop.,  10. 

45  All.  R.,  396;  In  re  King's  Will,  29  *  In  rr  Evans'  Est.  (Iowa).  86  X.  W. 

Misc.   (X.  Y.),  268;  61    Supp.,  238.  R.,    283;    S|»enrer    r.    Terry's    Eat., 

Buchanan  v.   Belsey,   65  App.    Div.  (Mich.),  8  Det.  Leg.  X.,  392;  86  X. 

(X.  Y.),  58;  72  Supp.,  001  ;  Pritchard  W.  R.,  99S. 

v.  Henderson,  3  Pcnne.   (Del.),  128;  '  In   re   Fenton'a   Will.   66  X.   W. 

50  All.   R.,  217;    James  White  Me-  Rep..   99:   97    Iowa.    192:   see   in   re 

morial  Home  ?•.  Hacg,  68  X.  E.  R.,  Widmay.-r's  Will,  34   Misc.  K..   439; 

568;   204  111.,  422.  69  X.  V.  Supp.,   1014. 


392  MENTAL   UNSOUNDNESS— BECKER   AND   BOSTON. 

conclusive  evidence  of  want  of  testamentary  capacity.1  The 
statutes  which  declare  a  person  adjudged  a  lunatic  incapable 
of  contracting  do  not  go  so  far  as  to  declare  him  incompetent 
to  make  a  will.  A  will  may  be  made  during  a  lucid  interval, 
provided  the  testator  then  has  a  mind  answering  the  measure 
of  mental  competency,  notwithstanding  adjudged  incompe- 
tency.2 

EEVOCATION  OF  WILL. 

The  capacity  to  revoke  is  substantially  the  same  as  the 
capacity  to  make ;  it  requires  a  full  and  intelligent  knowledge  of 
testator's  property,  of  those  naturally  entitled  to  his  bounty, 
and  of  the  nature  of  the  act, 2  and  such  capacity  may  exist,  though 
one  has  not  capacity  to  make  contracts  and  is  under  guardian- 
ship.3 

THE  CHARACTER  OF  THE  WILL  DOES  NOT  NECESSARILY  DE- 
TERMINE ITS  VALIDITY  EVEN  IF  UNREASONABLE  OR  UN- 
JUST. 

Where  a  testator  has  mind  and  memory  to  understand  his 
property  and  his  relations  to  other  persons,  his  will  must  stand, 
and  it  is  not  sufficient  to  impeach  his  competency  that  the  will  is 
not  such  in  all  respects  as  might  have  been  expected.4 

The  fact  that  the  will  is  unreasonable  or  unjust  on  its  face,5 

1  See  in  re  Evans'  Will,  37  Misc.  58  S.  W.  Rep.,  773;  Daly  v.  Daly, 

R.,  337;  75  N.  Y.  Supp.,  491;  also  183  111.,  269;  55  N.  E.  R.,  671.  Or 

Barbey  v.  Boardman,  202  Pa.  St.,  whether,  if  the  distribution  is  directed 

185;  51  Atl.  R.,  756  (will  valid,  though  according  to  the  fixed  purpose  of  the 

testator  had  been  attacked  with  testator,  that  purpose  is  rational, 

paresis,  and  adjudged  incompetent,  Warren's  Devisees  v.  O'Connell,  23 

but  the  adjudication  vacated).  Ky.  Law  R.,  260;  62  S.  W.  R.,  890. 

*  Matter  of  Goldsticker,  192  N.  Y.,  5  N.  Y.  Chan.,  1828,  Clarke  Fisher, 

35.  1  Paige,  171;  N.  Y.  Supr.  Ct.,  1863; 

3  Linkmeyer  v.  Brandt,  77  N.  W.  Gamble  v.   Gamble,   39  Barb.,   373; 
Rep.,  493;  107  Iowa,  750.  N.  Y.  Ct.  of  App.,  1868,  Jackson  v. 

4  N.  Y.  Supr.  Ct.,  1859,  Watson  v.  Jackson,  39  N.  Y.,  153,  reversing  1 
Donnelly,    28  Barb.,    653;    Bennett  Tuck.,    259;     Hallenbeck    v.    Cook, 
v.  Hibbert,  88  Iowa,  154;  55  N.  W.,  180   111.,    65;    54   N.    E.    Rep.,    154; 
93;  Morris  v.  Morton's  Exrs.,  14  Ky.  In  re  Finn's  Est.,    1   Misc.    (N.    Y. 
Law  R.,  360;  20  S.  W.   Rep.,  287.  SUIT.),  280;  22  N.  Y.   Supp.,    1066; 
Therefore  it  is  not  proper  to  sub-  Bennett  v.  Bennett  (N.  J.  Prerog.), 
mit  to  the  jury  the  question  whether  26  Atl.  Rep.,  573;  50  N.  J.  Eq.,  439; 
the    will    is    unnatural    or    uniust,  Trezevant  v.  Rains  (Tex.  Civ.  App.), 
Sharp  v.  Merriman  (Mich.),  66  N.  W.  25  S.  W.  Rep.,  1092;    In  re  Skaat's 
Rep.,    372;    or    is    reasonable    and  Will,  74  Hun,  462;  26  N.  Y.  Supp., 
proper,    Heseman  v.   Vogt,    181   111.,  494;  In  re  Trich's  Will,  165  Pa.  St., 
400;    55   N.    E.    R.,    151;  Wilson   v.  586;  30  Atl.  Rep.,  1053;  McClary  r. 
Hay's  Exr.,  22  Ky.  Law  Rep.,  897;  Stull,  62  N.  W.  Rep.,  501;  44  Neb., 


CHARACTER    OF   THE    WILL.  393 

or  capricious,1  when  taken  in  connection  with  the  amount  of 
property  and  situation  of  relatives,  is  not  alone  snllicient  to 
avoid  the  will.3 

Thus,  a  gift  of  one  dollar  to  children,  coupled  with  an  expla- 
nation that  they  had  received  their  share  during  testator's  life- 
time, is  no  reason  at  all  for  setting  aside  a  will.3 

A.  codicil  made  by  an  old  man  disinheriting  a  child  is  valid 
when  it  was  the  voluntary  act  of  a  competent  mind.  The  fact 
of  disinheritance  is  not  of  itself  sufficient  to  prove  the  deceased 
incompetent.4 

Unequal  partition  of  property,  or  leaving  the  same  to  stran- 
gers on  whom  the  testator  has  depended,  does  not  necessarily 
show  incapacity.  The  fact  that  the  testatrix  was  a  woman  of 
advanced  age,  somewhat  enfeebled  in  body  and  mind,  and  that 
she  gave  her  property  to  strangers  instead  of  collateral  relatives 
from  motives  of  gratitude  or  personal  attachment,  does  not  show 
want  of  testamentary  capacity  or  undue  influence,  so  long  as  her 
mental  powers  enabled  her  to  understand  and  appreciate  the 
amount  and  condition  of  her  property  and  to  comprehend  the 
nature  and  consequences  of  her  act  in  executing  the  will.5 

Where  testatrix  executed  two  wills  within  ten  days  of  her 
death,  and  when  she  was  in  feeble  condition  and  very  sick,  and 
by  the  first  she  made  her  husband  the  sole  luMieficiary,  but  by  the 
last  he  was  given  only  some  furniture  and  the  residue  of  the 
estate  was  left  to  one  upon  whom  she  had  been  accustomed  to 
rely  in  the  management  of  her  affairs,  she  having  had  trouble 
with  her  husband — held,  that  she  being  of  testamentary  capacity 
and  free  from  undue  influence,  the  second  will  should  stand.* 

Where  a  provision  was  made  for  masses  for  the  dead,  to  the 

175;  Farmer  r.  Fanner,  31  S.  W.  Nor  is  more  singularity  of  the  pro- 
Rep.,  926;  12!)  Mo..  530;  In.  re  visions.  Coffin  r.  Coffin,  23  N.  Y.. 
Lang's  Will.  9  Misc.  Rep.  (X.  Y.),521;  9;  Matter  of  Finn.  54  N.  Y.  State 
30  N.  Y.  Supn..  388;  Kllis  t».  Kllis.  Rep..  301;  Mclaughlin  Will,  2  Redf.. 
20  Ky.  Law  R..  438;  40  S.  W.  Rep.,  504. 

521;  Cutler  r.  Cutler,  103  Wis.,  258;  'Matter  of  Snclling.    136   N.    Y., 

79  N.  W.  Rep..  240.  515.     49     State     Hep..    695,     citing 

1  In   re   Kaufman's  Kst.,  1 17  Cal.,  Horn    r.    Pullman.    72   N.    Y.,    276; 

288;   49  Pac.  Rep..  192.  Clapp    v.     Fuljerton.    34    id.,     190; 

*See  note  5,  p.  392.  Hollis  r.  Drew  Theological  Seminary, 

J  Kntwistle  r.  Meikle,    180  111.,  9;  95  id..    166;    Marx   r.    McClynn,   88 

54  N.  E.  Rep.,  217.  id.,  370. 

4  Jefferson  Surr.  Ct.,   1863.  Clarke  «  Matter  of  Clark.  5  Misc..  68,  citing 

».    Davis.   5  N.    Y.   Surr.    (1    Redf.),  Matter  of  C.reen.  67  Hun,  527;  Mat- 

249,    citing   30   Barb.,    134;    Hall   r.  ter    of     Williams,     46    State     Rep., 

Perry.  87  Me.,  569;  33  All.  Rep.,  160.  775. 


394  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

exclusion  of  relatives,  the  court  directed  a  verdict  establishing 
the  will,  saying  that  whether  any  or  how  much  good  the  disposi- 
tion would  do  is  not  a  question  for  judge  or  jury.1 

UNREASONABLE  OR  UNNATURAL  PROVISIONS  IN  A  WILL  MAY 
BE  EVIDENCE  OF  MENTAL  DEFECT. 

Where  a  will  is  in  fact  contrary  to  the  dictates  of  the  natural 
affections  and  is  unnatural  in  its  dispositions,  its  provisions  are 
evidence  of  mental  defect,  obliquity,  or  perversity  of  mind 
which  may,2  together  with  other  evidence,3  establish  incapacity.4 

DELUSIONS  —  INSANE   DELUSIONS   OR   HALLUCINATIONS  MAY 

INCAPACITATE. 

In  respect  to  testamentary  capacity,  aside  from  cases  of 
dementia  or  loss  of  mind  and  intellect,  the  true  test  of  insanity 
is  mental  delusion5  or  hallucination.6 

Mistaken  Belief  or  Unjustifiable  Ill-Feeling. — The 
will  is  not  invalid  because  its  terms  are  the  result  of  a  mis- 
taken belief,  provided  that  belief  is  not  an  insane  delusion; 
even  where  it  is  based  upon  an  erroneous  belief  that  the  natural 
object  of  testator's  bounty  had  been  guilty  of  an  act  of  which  he 
was  innocent,7  or  is  hostile  to  testator,8  or  is  planning  to  get  his 
property,9  or  that  his  wife's  child  is  not  his  own.10  But  other- 

1  Martin  v.  Bowdoin,  158  Mo.,  379;  N.  Y.,  619,  affirming  4  Barb.,  625, 
59  S.  W.  R.,  227.  citing  3  Add.  Ecc.  R.,  79. 

2  Matter  of  Budlong,    126  N.   Y.,  6  N.   Y.   Supm.   Ct.,    1869,  Matter 
423;  s.  c.,  38  State  Rep.,  436;  Lamb  of  Foreman,  54  Barb.,  274,  affirming 
v.  Lamb,  105  Ind.,  456;  Caldwell  v.  1  Tuck.,  205. 

Anderson,  104  Pa.  St.,  199.  7  Martin  v.  Thayer,  37  W.  Va.,  38; 

3Manatt  v.  Scott,  106  Iowa,  203;  16  S.  E.  Rep.,  489;  O'Dea's  Will,  84 

76  N.  W.  Rep.,  717;  Howe  v.  Rich-  Hun  (N.  Y.),  591;  33  N.  Y.  Supp., 

ards   (Iowa),   83  N.  W.   Rep.,   909;  463;   In     re    Kendrick's     Est.,    130 

Henrich  v.  Saier  (Mich.),  82  N.  W.  Cal.,  360;  62  Pac.  R.,  605. 

Rep.,   879;  but   only  in    connection  8  In   re    Ruffino's   Est.,    116  Cal., 

with     other    evidence,   Kaenders   v.  304;  48  Pac.  Rep.,  127. 

Montague,    180   111.,   300;   54  N.   E.  9  Skinner  v.  Lewis  (Or.),  67  Pac. 

Rep.,  321.  R.,  951. 

4  Howe    v.    Richards    (Iowa),    83  10  In   re  Smith's   Will  (Sun-.),    24 
N.  W.  Rep.,  909;  Pergason  v.  Etcher-  N.  Y.  Supp.,  928;  but  where  there  is 
son,  91  Ga.,  785;  18  S.  E.  Rep.,  29;  some  evidence  tending  to  show  that 
infra,  p.  516;  Sim  v.  Russell,  90  Iowa,  such  a  mistaken  belief  is  due  to  an 
656;  57  N.  W.   Rep.,   601;   Henrich  insane  delusion,  the  jury  should  be 
v.    Saier    (Mich.),   82   N.    W.    Rep.,  instructed  upon  the  effect  as  well  of 
879.  an  insane  delusion  as  of  a  mistaken 

5  N.    Y.    Ct.    of  App.,    1865,    Sea-  belief,  Layer  v.  Layer,  22  Ky.  Law 
men's  Friend  Society  v.  Hopper,  33  Rep.,  1936;  62  S.  W.  Rep.,  15. 


DELUSIONS.  395 

wise  where  the  mistaken  belief  wius  an  insane  delusion.1  In  such 
cases  the  question  is  not  whether  the  foundations  of  the  Itclief 
are  true  or  false,  or  whether  the  circumstances  are  or  are  not 
misleading,  but  whether  they  are  of  such  character  as  might 
fairly  have  induced  the  belief  in  a  rational  mind.1 

A  mistaken  or  false  l>elief  is  not  insanity  nor  is  it  neeessari 
an  insane  delusion;3   nor  is  unjustified  ill  feeling  toward  tl 
natural   objects    of     testator's  bounty  •*    nor  an  unreasonabl 
prejudice;  nor  an  absurd  mistake  of  fact.5 

What  are  Insane  Delusions;  Insane  Delusions  and 
Mistaken  Belief  Contrasted. — The  difference  between  an 
insane  delusion  and  a  mistaken  belief  is  illustrated  in  Haines 
r.  Hayden  (Mich.),8  where  the  jury  were  instructed  that  ua  per- 
son persistently  believing  supposed  facts  which  have  no  real 
existence  against  all  evidence  and  probability,  and  conducting 
himself  on  the  assumption  of  their  existence,  is,  so  far  as  such 
facts  are  concerned,  under  an  insane  delusion.'7 

In  Connecticut  an  insane  delusion  was  defined  as  a  false  be- 
lief for  which  there  is  no  reasonable  foundation,  and  which  would 
l>e  incredible  under  the  given  circumstances  to  the  same  JHTSOU  if 
of  sound  mind,  and  concerning  which  the  mind  was  not  open  to 
permanent  correction  through  evidence  or  argument ;  it  was  also 
said  that  it  is  only  where  false  beliefs  are  such  as  a  reasonable 
man  would  not  under  the  circumstances  entertain,  that  they  be- 
come insane  delusions.7 

There  may  be  an  insane  delusion,  though  the  belief  is  not 
an  impossibility;  if  such  belief  is  entertained  against  all  evi- 
dence and  probability  and  after  argument  to  the  contrary,  it 
may  be  inferred  that  the  person  is  suffering  from  an  insane 
delusion.8 

1  Sec  in  re  Gannon's  Will,  2  Misc.  mingway's    Kst..    7    North.    Co.    R. 

Rep.  (N.  Y.),  329;  21   V  Y.  Supp.,  (l'*.\  93. 

931;  infra,  n.   397.  rote  2 ;  O'Dea's  4  In   re   Suydam's   Will,   84    Hun, 

Will.    84    Hun  (N.    Y.)    591,  supa,  514;  32  N.  Y.  Supp.,  449. 

p.  394,  note  1.  *  In   re   Olx'itlorfs   Kst.,   2   Lack. 

s  In  re  Bennett's  Kst.,  201  Pa.,  485;  Leg.  N.,  43. 

51  Atl.  R.,  336;  10  Pa.  Dist.  R.,  145.  •  54  N.  W.  R..  911:  see  also  »u/»ra, 

3/n  re  ling's  Will  (Surr.),  9  Misc.  p.  394,  '-Mistaken  Micf." 

Rep.    N.   Y.,    30;   Appeal    of    Kim-  '  Apj>eal  of   Kiraberty,  08  Conn., 

lx>rly,  68  Conn.,  428:  36  Atl.  R.,  847;  428;  36  Atl.  Hop.,  847;  37  L.  R,  A., 

37  L.  R.   A.,  261,  275;   In   re    Ken-  261. 

drick's  Est.,  130  Cal.,  300;  62  Pac.  -  Mcdill    r.   Snyder,   01    Kan.,    15; 

R..605.     See  Haiti  r.    Clitic,   24  Or.,  58  Pac-.  H.,  962. 
175;   33    Pac.    R.,    542;    In   re    He- 


396  MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON. 

In  Pennsylvania  it  was  said  that  an  insane  delusion  must  be 
that  something  exists  which  does  not  exist,  and  which  no  rational 
person  in  the  absence  of  evidence  would  have  believed  existed.1 

And,  in  California,  where  the  evidence  showed  that  testatrix 

vas  not  fully  convinced  of  the  truth  of  an  unjustified  suspicion 

•hich  she  entertained,  it  was  held  proper  to  find  therefrom  that 

er  suspicion,  though  groundless  and  unreasonable,  was  not  an 

nsaiie  delusion.2     And  where  it  did  not  appear  how  a  testatrix 

aad  acquired  her  belief,  or  that  she  had  ever  been  reasoned 

with  about  it  to  convince  her  of  its  falsity,  the  belief,  it  was 

said,  could  not  be  deemed  an  insane  delusion,  because  an  insane 

delusion  is  the  spontaneous  production  of  a  diseased  mind  so 

firmly  fixed  that  neither  argument  nor  evidence  can  convince  to 

the  contrary.3 

Where  the  facts  show  some  ground  for  the  belief,  though 
slight,  it  is  not  an  insane  delusion  ;4  and,  it  is  said,  that  where  an 
instruction  to  a  jury  fails  to  distinguish  between  a  mistaken  be- 
lief and  an  insane  delusion,  and  thereby  confuses  them,  or  omits 
to  indicate  that  an  insane  delusion  is  created  without,  and  ad- 
hered to  against,  reason  and  evidence,  it  is  error.5 

A  simulated  opinion  or  fleeting  vagary  is  not  an  insane  de- 
lusion.6 

The  existence  of  an  insane  delusion  is  not  shown  by  evidence 
that  testator's  sentiments  toward  a  relative  underwent  a  sudden 
change,  changing  to  fear  and  dislike,7  nor  by  evidence  showing 
a  dislike  for  cause,  even  though  it  be  accompanied  by  denuncia- 
tion of  testator's  son  as  a  bastard.8 

The  Delusion  Must  Affect  the  Will.— The  delusion 
or  hallucination  will  not  establish  incapacity  unless  it  relates 
to  the  persons  or  objects  affected  by  the  will,9  or  to  his  property 

1  In  re  Hemingway's  Est.,  7  North.  '  In  re  McGovern's  Est.,   185  Pa. 
Co.  R.,  93  (Orphs.'  Ct.);  195  Pa.  St.,      St.,  203;  39  Atl.  Rep.,  816. 

91;  45  Atl.  R.,  726.  8  Dobie  v.  Armstrong,   160  N.  Y., 

2  In  re  Scott's  Est.,   128  Cal.,  57;  584;   55  N.   E.   Rep.,   302,  affg.,  27 
67  Pac.  R.,  527.  App.  Div.,  520;  50  N.  Y.  Supp.,  801; 

3  In  re  Kendrick's  Will,   130  Cal.,  and  the  fact  that  testator  is  not  on 
360;  62  Pac.  R.,  605.  friendly  terms  with  his  children  will 

4Ibid.;  Buchanan  v.  Belsey,  65  App.  not  authorize  an  instruction  on  insane 

Div.,  58;  72  N.  Y.  Supp.,  601;    In  re  aversion;  Powers  Exr.  v.  Powers,  52 

Brush's  Will,  35  Misc.   R.    (N.   Y.),  S.  W.  Rep.,  845;  21  Ky.  Law,  597. 
689;  72  N.  Y.  Supp.,  421.  9  In  re   Re  Ifield's  Est.,    116  Cal., 

5  In  re  Kendrick's  Will,  supra.  637;    48   Pac.    R.,    794;     Peninsular 

6  In  re  Redfield's  Est.,  116Cal.,637;  Trust  Co.  v.  Barker  (Mich.),  74  N. 
48  Pac.  R.,  794.  W.  Rep.,  508. 


DELUSIONS. 


897 


or  its  disposition,1  or  i9  such  as  is  likely  to  have  influenced  the 
testator  in  making  the  will  in  question.  A  number  of  illustra- 
tive cases  are  stated  in  the  note.1 

Though  thevdelusion  be  an  insane  delusion  and  concern  the 
natural  object  of  testator's  bounty,  it  does  not  incapacitate  if  it 
does  not  appear  that  the  delusion  affected  the  disposition  of  the 
property.3 

In  Pennsylvania,  the  court  held,  where  the  allegation  was  that 
a  testator  was  incompetent  because  of  an  insane  delusion,  that  the 


1  In  re  Richardson's  Will,  51  App. 
Div.,  637:  64  N.  Y.  Supp.,  944. 

J  See  Hunks  t>.  GoodfeUow,  L.  R.,  5 
O.  B.,  548;  Smith  r.  Smith,  48  X.  J. 
Eq.,  566;  25  All.  Rep.,  11;  Gilrnan 
v.  Ayer  (N.  J.  Pre.),  47  Atl.  R.,  1049; 
Shreiner  v.  Shreirier,  178  Pa.  St.,  57; 
35  Atl.  Rep.,  974;  Englert  v.  Englert, 
198  Pa.  St.,  326;  47  Atl.  R.,  940; 
Genl.  Conv.  of  New  Jerusalem  Ch.  v. 
Crocker,  7  O.  Co.  Ct.,  327.  In  re 
Jones  Will  (Sum).  5  Misc.  R.  (N.  Y.), 
199;  25  N.  Y.  Supp.,  109,  the  testator 
had  declared  that  he  had  more 
property  than  any  one  knew  of, 
enough  to  make  all  his  relatives  rich, 
and  that  he  would  a^ive  a  necklace 
of  $20  gold  pieces  that  would  go 
round  the  neck  and  reach  to  the 
ground;  held,  not  to  show  an  insane 
delusion  as  to  the  amount  of  his 
property.  Nor  does  the  mere  fact 
of  a  cash  legacy  in  excess  of  testator's 
personal  property  afford,  by  itself, 
evidence  of  an  insane  delusion  as  to 
the  amount  of  that  property;  Hall 
v.  Perry,  87  Me.,  .569;  33  Atl.  Rep., 
160;  the  delusion  of  a  testator,  other- 
wise of  good  mind  and  memory,  that 
his  family  was  trying  to  kill  him, 
was  held  insufficient  to  avoid  the 
will;  Edwards  r.  Davis  (Ohio),  30 
Wkly.  Law  Bull.,  283;  cf.  re  Lap- 
ham's  Will,  19  Misc.  R.  (N.  Y.), 
71;  44  N.  Y.  Supp.,  90;  c/.  C.annon's 
Will,  2  Misc.  R.  (N.  Y.).  329;  21 
N.  Y.  Supp.,  960.  In  the  last  men- 
tioned ^ase  the  jury  found  that  the 
deceased  had  testamentary  capacity, 
but  that  he  also  had  a  delusion  as  to 
the  fidelity  of  his  wife,  which  led 
him  to  deprive  her  of  any  portion  of 
his  property;  held,  it  was  not  error 
to  set  aside  the  will. 

In   Hope  v.  Campbell,   App.  Cas. 


(1899),  1  (Eng.).  it  was  alleged  that 
testator  was  subject  to  insane  delu- 
sions respecting  his  duty  to  ad- 
vance total  abstinence  and  oppose 
the  Church  of  Rome,  using  his  prop- 
erty to  these  ends,  under  direct 
divine  command,  which  dominated 
his  mind  and  overmastered  his  judg- 
ment so  as  to  render  him  incapable 
of  making  reasonable  and  proper 
settlement  of  his  means  and  estate, 
or  of  taking  a  rational  view  of  the 
matters  to  oe  considered  in  making 
a  will;  held  to  present  a  relevant  case 
for  trial.  Also  c/.  Martin  r.  Thayer, 
37  W.  Va.,  38,  where  a  will  was  held 
valid  though  the  testator  had  a 
mistaken  belief  as  to  the  dishonesty 
of  a  grandchild;  sufira,  p.  394;  and 
in  re  Bedlow's  Will,  67  Hun  (N.  Y.), 
408;  22  N.  Y.  Supp.,  290,  where  mis- 
take of  testator  as  to  his  family's  con- 
duct toward  him  was  held  to  be  no 
ground  for  setting  aside  his  will 
disinheriting  them;  and  in  re  Smith's 
Will  (Surr.),  24  N.  Y.  Supp.,  928, 
where  the  testator  had  a  belief 
which  might  have  been  a  mistake, 
that  he  was  not  the  father  of  his 
wife's  child;  as  to  insufficiency  of 
evidence  to  show  insane  delusion 
in  case  where  the  alleged  delusion 
is  not  inconsistent  with  a  possibility 
see  in  re  Zieglcr's  Will,  65  Hun,  621; 
19  N.  Y.  Supp.,  947.  See  also 
Bain  r.  Cline,  33  Pac.  Rep.,  542;  24 
Or.,  175. 

*  In  re  Hemingwav's  Est.,  195  Pa. 
St.,  291;  45  Atl.  R.,  726;  In  re 
Kendrick's  Estate,  130  Cal.,  360;  62 
Pac.  R.,  605  (this  is  an  essential 
part  of  an  instruction  to  a  jury  on 
the  subject).  In  re  Iredale  s  Will, 
53  App.  Div.  (N.  Y.),  45;  65  N.  Y. 
Supp.,  533. 


398 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


question  was  not  alone  whether  the  testato'r-'s  views  were  unsound, 
but  also  whether  they  so  impressed  his  mnid  as  to  control  his 
judgment  in  the  disposition  of  his  property  so  as  to  prevent  his 
appreciating  the  duty  to  his  family.1 

Where  there  is  an  insane  delusion  directly  affecting  the  dis- 
position provided  in  the  will,  the  will  is  invalid,  notwithstanding 
the  testator's  mind  is  sound  in  regard  to  his  dealings  in  general2 
or  in  other  respects.3 

It  is  proper,  in  a  jury  trial,  for  the  court  to  define  "insane 
delusion, " 4  and  it  is  deemed  improper  to  use  instead  the  term 
"insane  prejudice,"  as  "insane  delusion"  is  a  term  having  a 
recognized  legal  meaning,  while  "insane  prejudice"  has  not.5 

Opinions  and  Mental  Peculiarities  as  Distinguished 
from  Incapacitating  Delusions — Questions  of  Relig- 
ious Belief  Are  Irrelevant. — Belief  on  a  question  which  is 
entirely  within  the  domain  of  opinion  or  faith,  and  not  of  knowl- 
edge, such  as  the  opinion  as  to  a  future  state,  cannot  in  any 
respect  be  deemed  evidence  of  insanity.  On  such  a  question, 
there  is,  in  a  logical  sense,  no  major  premise  of  knowledge.6 

2  In  re  Trich's  Will,  165  Pa.  St., 
586;  30  Atl.  Rep.,  1053. 

2  In  re  Segur's  Will  (Vt.),  44  Atl. 
R.,  342;  Thomas  v.  Carter,  170  Pa. 
St.,  272;  33  Atl.  Rep.,  81;  cf.  Gwin 
v.  Gwin  (Idaho),  48  Pac.  R.,  295. 
On  the  subject  of  mistaken  belief 
as  distinguished  from  insane  delu- 
sions see  supra,  p.  394. 

3Orchardson  v.  Cofield,  171  111., 
14;  40  L.  R.  A.,  256;  49  N.  E.  Rep., 
197. 

4  Appeal   of   Kimberly,    68  Conn., 
428;  36  Atl.  Rep.,  847;  see 37  L.  R.  A., 
261   n. ;  cf.   Layer  v.   Layer,   22  Ky. 
L.  R.,  1936;  62  S.  W.  R.,  15. 

5  In  re  Kendrick's  Est.,  130  Cal., 
360;  62  Pac.  R.,  605. 

6N.  Y.  Surr.  Ct.,  1872,  Bonard's 
Will,  16  Abb.  Pr.,  N.  S.,  128;  ex- 
plained in  Brown  v.  Ward,  36  Am. 
R.,  422,  426;  53  Md.,  377. 

An  Englishman  who  had  lived 
many  years  in  India,  and  had  at 
different  times  expressed  himself  a 
believer  in  the  Hindu  and  Moham- 
medan faiths,  and  who  had  to  a 
great  degree  adopted  the  habits  of 
life  of  the  latter,  provided  by  his 
will  for  the  erection  of  a  cenotaph 
at  Constantinpole,  with  a  light 


burning,  and  a  description  of  the 
testator  engraved  thereon.  This  will 
was  sustained  as*  being  rational 
in  view  of  the  history  and  opinions 
of  the  testator.  Austen  v.  Graham, 
8  Moore  P.  C.,  493;  1  Spinks,  357. 

In  the  Bonard  will  case  the  testa- 
tor, it  was  alleged,  believed  that  the 
souls  of  men  after  death  passed  into 
animals,  and  he  having  no  family 
nor  known  relations,  devised  and 
bequeathed  his  property  to  the  Soci- 
ety for  the  Prevention  of  Cruelty  to 
Animals.  But  it  did  not  appear 
that  he  made  any  declaration  of  his 
peculiar  opinions,  in  connection 
with  his  intended  testamentary  dis- 
position. Held  that  these  opinions 
were  not  evidence  of  insanity  or  in- 
sane delusions,  even  though  the  tes- 
tamentary intention  might  not, 
otherwise  than  for  the  alleged  delu- 
sion, have  been  entertained.  Bo- 
nard's Will,  16  Abb.  Pr.,  N.  S., 
128. 

In  another  will  contest,  it  ap- 
peared that  more  than  twenty  years 
before  making  his  will,  and  nearly 
thirty  years  before  his  death,  testa- 
tor was  confined  to  an  insane  asy- 
lum for  a  few  months  for  religious 


DELUSIONS. 


809 


Belief  in  Spiritualism,  in  Christian  Science,  or  in  Witchcraft, 
unleaa  cat  *ati  rely  affecting  Subject -Matter  of  the  H'i7/,  dot-it  not  Inca- 
pacitate.— The  belief  in  spiritualism  is  at  this  time  so  common 
that  the  law  must  regard  its  followers,  when  their  testamentary 
capacity  is  in  question,  the  same  as  those  who  have  a  different 
religious  Ixjlief.1  But  where  the  will  is  the  offspring  of  the 
belief,2  or  rather,  of  imposition  practised  on  the  credulity  in- 
spired by  the  belief,3  it  may  be  invalidated,  011  the  ground, 
principally,  of  undue  influence. 

Belief  in  witchcraft,*  or  Christian  Science,5 or  in  spiritualism 
does  not  incapacitate,  especially  where  it  has  nothing  to  do  with 


insanity:  that  he  was  a  great  reader 
of  the  Bible  and  of  a  religious  paper; 
that  before  making  his  will  he 
prayed  much  at  night,  and  professed 
to  nave  seen  three  lights  typifying 
different  religious  denominations; 
that  in  the  heat  of  discussion  he 
talked  of  religion  in  an  excited 
manner;  that  he  sometimes  had  a 
wild  look,  and  lost  much  sleep. 
//<•/</,  that  these  facts  did  not  sup- 
port a  verdict  of  insanity,  rendering 
void  the  will  which  devised  his 
property  to  a  religious  society, 
where  it  further  appeared  that  he 
amassed  a  considerable  fortune  after 
his  release  from  the  asylum;  that 
his  relatives,  the  contestants  of  the 
will,  often  procured  him  to  go  on 
their  bond  as  surety;  and  that  they 
joined  him  in  business  transactions, 
and  allowed  him  to  look  after  their 
interests;  and  where  many  wit- 
nesses, who  hat!  known  testator  in- 
timately for  years,  testified  that  he 
was  perfectly  rational  on  all  sub- 
jects, and  that  he  had  perfect 
health,  slept  well,  and  was  a  fine 
business  man.  Williams  r.  Williams 
(Ky.),  23  S.  VV.,  789.  See  also  fol- 
lowing paragraph  and  cases  cited. 

1  Keeler  v.  Heeler,  20  \.  Y.  State 
Rep.,  439;  s.  c.  as  in  re  Heeler's 
Will,  3  N.  Y.  Sunn.,  629,  citing 
Brown  r.  Ward,  53  Md.,  377;  Rob- 
inson r.  Adams,  02  Me..  309;  16 
Am.  Rep.,  473;  Smith's  Will.  52 
Wis.,  544;  38  Am.  Rep..  750;  8  N.  W. 
Rep.,  Girt;  9  N.  W.  Rep.,  005;  Ad- 
dington  v.  Wilson.  5  Ind.,  137;  Ved- 
der's  Will,  14  X.  Y.  State  Rep.,  470; 
Foreman's  Will.  54  Barb..  274; 
Bonard'a  Will.  10  Abb.  Pr.,  N.  S., 


128.  And  see  note,  36  Am.  Rep., 
426.  In  re  Dunahugh's  Will  (Iowa), 
107  N.  W.  R.,  925.  In  re  Halbert's 
Will,  15  Misc.  R.,  308;  37  X.  Y. 
Supp.,  757;  so  also  of  belief  in  witches 
in  case  of  a  deed,  Schueitter  r.  Car- 
man, 98  Iowa,  276;  67  N.  W.  Ren.. 
249 ;  Steinkuehler  r.  Wernpner  (Ind.), 
81  N.  E.  R.,482;  Buchanan  r.  Pierce, 
54  Atl.,  383;  205  Pa.  123.  But  sec 
In  re  Beach,  23  App.  Div.  (X.  Y.), 
411;  48  N.  Y.  Supp.,  437.  where  it 
was  held  that  a  presumptive  can 
was  made  out  for  an  inquiry  into 
sanity,  when  the  petition  and  affi- 
davits showed  that  on  advice  which 
he  Ixjlieved  came  from  spirits  of  dead 
persons,  he  was  about  to  dis|xwe  of 
proj>erty  to  a  medium  through  whom 
the  advice  was  given. 

1  See  in  re  Rohe'a  Will,  22  Misc. 
Rep.  (N.  Y.),  415;  50  X.  Y.  Supp., 
392;  in  re  Mcllroy's  Kst..  10  Pa. 
Dist.  R.,  78;  see  also  the  following 
cases  on  the  general  subject,  Thomp- 
son v.  Hawks,  II  Bias.,  440;  14  Fed. 
R.,  902;  in  re  Storey.  20  111.  App., 
183:  Baylies  r.  Spaulding  (Mass,),  6 
N.  K.  Rep.,  62;  1  New  Fng.  Rep., 
914;  Turner  r.  Rusk,  53  Md..  65; 
Greenwood  r.  ('line,  7  Or.,  18;  Lyon 
v.  Home,  L.  R.  6  Kq..  655. 

'Orchardaon  r.  Cork-Id.  171  III., 
14;  49  N.  K.  Rep.,  197.  40  L.  R.  A., 
256. 

Stcinkuehlcr  r.  Wempner  (Ind.), 
81  N.  K.  R.,  482.  And  eee  below, 
Uluiue  Influence,  p.  416. 

4  Fielbnght  r.  Perry  Co.,  145  Mo., 
432;  40  S.  W.  Hep..  955. 

*/n  re  Brush's  Will,  35  Misc.  R, 
(N.  Y.),  few;  "-  N-  Y.  Supp.,  421. 


400  MENTAL   UNSOUNDNESS — BECKER   A^'D    BOSTON. 

the  making  of  the  will,1  and  this  is  so  even  if  the  ibelief  in  super- 
natural spiritual  manifestations  is  founded  on  delusive~appear- 
auces,2  or  leads  to  unreasonable  dispositions  of  property.3 

The  mind  of  John  Banks,  a  testator,  had  long  been  dis- 
turbed by  two  delusions,  the  one  that  he  was  pursued  by  spirits, 
the  other  that  a  certain  Featherstoue  Alexander,  a  man  long 
since  dead,  came  personally  to  molest  him.  Neither  of  these  de- 
lusions— the  dead  man  not  having  been  in  any  way  connected 
with  1  im — had  or  could  have  any  influence  upon  him  in  making 
the  will  in  question.  Held  that  the  existence  of  a  delusion, 
compatible  with  the  retention  of  the  general  powers  and  facul- 
ties of  the  mind,  is  not  sufficient  to  overthrow  the  will,  unless 
it  is  such  as  is  calculated  to  influence  the  testator  in  making 
it.4 

The  following  case  may  also  be  regarded  as  typical : 
Eliza  Ann  Yedder  died  January  19th,  1887,  at  the  age  of 
seventy-seven  years,  leaving  a  will  by  which  nearly  all  the  prop- 
erty of  the  decedent  was  devised  and  bequeathed  to  her  husband, 
the  proponent.  The  nephews  and  nieces  of  decedent  opposed 
the  probate  on  the  ground,  among  others,  that  she  was  not  of 
sound  mind,  memory,  and  understanding.  There  was  no  issue 
of  the  marriage.  The  will  in  question  was  executed  in  August, 
1883,  at  the  house  of  decedent  and  proponent.  At  the  same 
place,  Mr.  .Vedder,  the  proponent,  made  and  executed  a  will 
whereby  he  gave  all  his  property  to  his  wife,  the  testatrix. 
Among  the  principal  facts  proved  by  the  contestants  were  the 
following :  That  the  testatrix  was  in  gradually  failing  physical 
condition ;  that  she  believed  in  witches  and  witchcraft ;  that  she 
told  a  neighbor  that  she  had  seen  a  headless  horseman  riding 
across  her  field ;  that  she  said  she  could  not  keep  her  horses  fat 
because  the  witches  rode  them  at  night ;  that  she  put  irons  in  the 
cream  and  marked  the  bottom  of  the  churn  with  the  sign  of  the 
cross,  to  make  the  butter  come,  etc. ,  etc.  On  the  other  hand, 
the  proponent  proved  that,  in  the  performance  of  her  household 

lRe  Spencer's  Estate,  96  Cal.,  448;  Eq.,  726;    17   At.,    826;    4  L.  R.  A., 

31  Pac.,  453;    and  see  Otto  v.  Doty,  783. 

61   Iowa,  23;    15    N.    W.   R.,     578:  2  N.   Y.   Supm.   Ct.,    1871,   Fowler 

Robinson  v.  Adams,  62  Me.,  369;    16  v.  Ramsdell,  4  Alb.  L.  J.,  94. 

Am.    Rep.,   473;     McClary  v.    Stull,  3  Whipple  v.  Eddy,   161  111.,   114; 

44  Neb.,    175;    62  N.   W.   R.,   501;  43  N.  E.  Rep.,  789. 

Middleditch  v.    Williams,    45    N.  J.  4  Banks  v.   Goodfellow   (1870),   L. 

R.,  5  Q.  B.,  548. 


Y. 

PHYSICAL    PAIN    OR   DISEASE.  401 


duties  and  farm  business,  the  testatrix  \vasa  prudent, 
woman.  The  subscribing  witnesses  were  dear  in  their  belief 
that  the  testatrix  was  of  .sound  mind  and  memory  when  she  exe- 
cuted the  will. 

Woods,  surrogate,  expressed  the  following  opinion:  "There 
is  no  evidence  whatever  to  show  that  any  or  all  of  these  beliefs, 
delusions,  eccentricities,  or  peculiarities  had  the  slightest  con- 
nection with,  or  influence  upon,  her  testamentary  act  here  in 
question.  Scarcely  two  centuries  ago  the  great  body  of  Chris- 
tians believed  in  witchcraft.  Profound  theologians  contended 
that  a  disbelief  in  it  was  rank  heresy,  and  they  cited  Scripture 
to  their  purpose.  The  Bible  was  the  book  of  books  to  the  testa- 
trix. It  is  not  strange  that  the  ancient  belief  in  witchcraft  sur- 
vived in  her.  Her  belief  did  not  disqualify  her  from  disposing  of 
her  property  by  will,  and  I  hold  that  she  wasVowj;>o* 


PHYSICAL   PAIN;   DISEASE. 

Great  pain  does  not  of  itself  destroy  testamentary  capacity,* 
nor  does  disease  which  might  affect  the  brain,  but  is  not  shown 
to  have  affected  it.3 

Partial  Loss  of  Memory,  or  Impairment  of  Facul- 
ties, or  Existence  of  Nervous  Disease,  Does  not  of 
Itself  Incapacitate  —  Highest  Degree  of  Mental  Sound- 
ness not  Required.  —  "The  highest  degree  of  mental  sound- 
ness is  not  required  in  order  to  constitute  capacity  to  make  a 
testamentary  disposition.  A  person's  mind  may  be  impaired  by 
grief,  disease,  melancholy,  or  old  age,  yet  if  he  has  sufficient 

1  Matter  of  Vedder,  6  Dem.,  92.  See  stated,  than  that  pains,  even  though 

Stewart  Chaplin,  "Principles  of  the  they  result  in  death,  or  lx«  incident 

Law  of  Wills."  New  York,   1892.  to    approaching    death,    should    in- 

*  Stevens  r.  Leonard,  154  Ind.,  07;  validate   a    will:    in    short,  that  the 

56  N.  E.  R..  27.  situation   and   condition   of   testator 

3  In  re  Gihon's  Will,  44  App.  L)iv.  are  evidence  from  which  his  mental 

(X.  Y.),  621;  GO  N*.  Y.  Supj>.,  65.      In  state  can  he  determined  in  a  given 

Ohio,   it   has  been   said   that    a   will  case,  rather   than    that    where   pain 

must  be  made  while  the  testator  is  of  very  serious  portent  exists,  the  ex- 

absolutely    free    from    the   pains    of  istence  of  the  pain   precludes  testa- 

death,  and  that  the  law  will  make  a  mentary  comjx«tency.     The  decision 

will,   rather  than   that    a   will   made  of  this  case  appears  to  be  correct,  but 

under  such  circumstances  shall  stand.  the  language  of  the  Court   is  some- 

But  it  is  apprehended  that  the  true  what  unguarded.     In     rr     Burrow's 

rule  is.  rather,  that  a  person  in  such  Kst.,   II  Ohio  S.  A-  C.   V.   I>rc..  229; 

a  condition  as  the  testator  in  that  8  Ohio    N.    P.,    358;   cf.    in  re  Nel- 

case  was  at    the  time  mentally  in-  son's  Kst.,  132  Cal.,  182;  64  Pac.  R,, 

competent     by     the     rules     alrea.ly  294. 
III.—  20 


402 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


ability  to  weigh  and  consider  intelligently  the  act  of  making 
the  will,  and  its  surrounding  circumstances,  the  will  will  be 
valid."1 

Defect  of  memory,  unless  it  is  total  or  appertains  to  things 
very  essential,  is  not  sufficient  to  create  inconipeteucy ; 2  nor  is 
old  age,  however  extreme.3  Impairment  of  faculties  by  age  or 
injury,  to  a  considerable  degree,  does  not  necessarily  affect  tes- 
tamentary capacity.4 

In  testimony  given  as  to  the  eccentric  mental  condition  of  a 
school  teacher,  who  was  in  the  habit  of  making  wills  in  favor  of 
schoolgirls,  it  was  shown  that  he  was  subject  to  changes  in 
political  opinion,  was  childish  in  his  tastes,  and  of  defective 
memory,  but  that  he  could  make  clever  addresses,  and  success- 


1  "The  Am.  and  Eng.  Encycl.  of 
Law,"  vol.  xi.,  p.  153  (1st  ed.).  See 
also  in  re  Gatley's  Est.,  16  Pa.  Co. 
Ct.  Rep.,  69;  4  Pa.  Dist.,  R.,  52; 
Pritchard  v.  Henderson,  3  Penne. 
(Del.),  128;  50  Atl.  R.,  217;  Perkins  v. 
Perkins  (Iowa),  90  N.  W.  R.,  55.  In 
re  Rapplee's  Will,  66  Hun,  558;  21 
N.  Y.  Supp.,  801,  the  testator  was 
held  to  have  sufficient  testamentary 
capacity,  though  he  had  suffered 
from  an  epileptic  fit,  to  which  he  was 
subject,  two  weeks  prior  to  the  execu- 
tion of  his  will,  and  his  fits  usually 
kept  him  weak  in  body  and  mind 
for  two  or  three  days,  .after  which 
he  resumed  his  usual  avocation. 
In  Howell  v.  Taylor  (N.  J.  Prerog.), 
26  Atl.  Rep.,  566,  the  testator  was 
almost  imbecile,  but  his  will  was 
just  and  rational,  and  he  told  one  of 
the  witnesses  that  he  knew  its  con- 
tents; held  valid,  though  one  of  the 
legatees  gave  instructions  to  the 
draughtsman  an  1  two  other  legatees 
were  present  at  its  execution.  In  re 
Flansburgh's  Y/ill,  82  Hun,  49;  31 
N.  Y.  Supp.,  177,  testator  was  held 
competent,  though  he  was  irritable, 
excitable,  subject  to  epileptic  fits, 
not  cleanly,  partially  blind,  acted 
childishly,  shed  tears,  and  sometimes 
got  lost.  In  Cutler  v.  Cutler,  79 
N.  W.  Rep.,  240;  103  Wis.,  258,  it 
was  held  that  bad  spells,  fainting 
fits,  foolish  remarks,  and  memory 
not  active  as  formerly  do  not  es- 
tablish incapacity.  In  Hutchinson 
».  Hutchinson,  157  111.,  347;  38  N.  E. 
Hep.,  926,  testator's  health  was  im- 


paired, and  he  was  peculiar,  eccentric, 
dissipated,  and  melancholy;  yet  he 
was  competent.  See  also  in  re 
Buchan's  Will,  16  Misc.  R.  (N.  Y.), 
204;  38  N.  Y.  Supp.,  1124  (impair- 
ment of  faculties,  followed  by  death 
from  Bright's  disease,  following  day). 

2  In  re  Mabie's  Will  (Surr.),  5 
Misc.  R.  (N.  Y.),  179;  24  N.  Y.  Supp., 
855,  where  the  competent  testatrix 
was  impaired  in  memory,  eccentric 
in  conduct  and  conversation,  and  was 
not  able  to  conduct  her  household 
duties  without  assistance;  White- 
man  v.  Whiteman,  152  Ind.,  263;  53 
N.  E.  Rep.,  225. 

3N.  Y.  Surr.  Ct.,  1851,  Bleecker 
v.  Lynch,  1  Bradf.,  458;  see  infra,  p. 
410. 

4  Reynolds  v.  Root,  62  Barb.,  250. 
In  Wood  v.  Lane,  29  S.  E.  Rep.,  180; 
102  Ga.,  199,  the  court  granted 
a  second  new  trial,  though  the  jury 
had  twice  found  against  the  validity 
of  the  will,  where  the  only  evidence 
of  incapacity  was  that  testator  had 
been  long  bedridden,  had  a  poor 
recollection,  repeated  the  same  stories 
frequently,  and  had  difficulty  in 
understanding  his  accounts. 

Where  a  testatrix  died  of  inanition 
at  the  age  of  68,  but  kept  her  will  be- 
fore her  for  several  days  for  reflection, 
and  knew  its  contents  and  the  value 
of  her  property,  her  debilitated  con- 
dition was  held  not  to  deprive  her, 
as  matter  of  law,  of  the  will  power 
essential  to  make  a  valid  will.  In 
re  Adans,  10  Pa.  Dist.  R.,  237. 


PHYSICAL   PAIN   OR    DISEASE. 


*  a 


fully  managed  his  large  property,  lldd  not  sufficient  to  justify 
setting  aside  a  will  disinheriting  his  next  of  kin.1 

Mental  incapacity  to  make  a  will  is  not  shown  by  the  facts 
that  testator  wsis  hysterically  deranged2  or  fidgety  and  excited, 
and  suffered  from  paroxysms  and  that  these  were  aggravated  by 
despondency  over  the  loss  of  money.*  Feeble  and  weak-minded 
people  are  not  necessarily  precluded  from  making  valid  wills.' 

Nor  does  "moral  insanity"  incapacitate,1  nor  imbecility  or 
weakness  of  mind,  if  there  be  sufficient  understanding  to  com- 
prehend the  condition  of  his  property  and  testator's  relations 
toward  the  persons  who  are  or  might  be  the  objects  of  his 
bounty,  and  the  scope  and  bearing  of  the  provisions  of  his  will." 
But  where  a  i>ersou  was  in  a  dying  condition  from  consumption 
and  had  not  sufficient  mental  capacity  to  discriminate  clearly 
between  the  objects  of  her  affection,  she  was  deemed  incom- 
petent.7 Where  testator  was  very  ill,  incapable  of  transacting 
business  on  account  of  the  frequent  administration  of  morphine, 
and  experts  were  of  opinion  that  he  was  not  in  condition  to 


1  Matter  of  Merriam,  42  N.  Y. 
State  Rep.,  619;  16  N.  V.  Supp., 
738,  citing  Horn  r.  Pullman,  72 
N.  Y.,  270;  Uelafield  v.  Parish,  25 
id.,  9. 

*  Beresford  v.  Stanley,  6  Ohio  N. 
P.,  38. 

3  In  re  Speller's  Estate  (Pa.  Co. 
Ct.),  2  Pa.  Uist.  R.,  513.  But 
evidence  that  testatrix  was  er- 
ratic, eccentric,  rambling,  discon- 
nected in  conversation,  flighty  in 
her  notions,  unsettled,  excited  in 
manner,  could  not  comprehend  con- 
nected conversation,  ran  about  the 
house  screaming,  though  n^t,  per- 
haps, sufficient  itself  to  show  testa- 
mentary incapacity  is  competent  to 
be  considered  with  other  evidence. 
Prentis  v.  Hates,  93  Mich.,  234;  53 
N.  W.  Rep.,  153. 

4  Matter  of  Williams,  40  N*.  Y. 
State  Rep.,  356;  2  Connolly,  579;  !5 
N.  Y.  Supp.,  828;  aff'd  46  State 
Rep.,  791;  19  N.  Y.  Supp.,  778; 
citing  re  (Jray,  5  N.  Y.  Supp.,  464; 
re  dross,  14  State  Rep.,  429.  In  re 
Iredale's  Will.  53  App.  Div.  (N.  Y.), 
45;  65  N.  Y.  Supp.,  533;  Pritchard  v. 
Henderson.  3  Prune.  (Del.).  128;  50 
Atl.  R.,  217.  A  verdict  of  incapacity 
was  set  aside  where  the  evidence 


merely  showed  that  testatrix  was 
forgetful,  had  temporary  lapses  of 
understanding,  made  incoherent  and 
irrelevant  remarks,  was  given  to 
repetition,  hut  also  that  she  dis- 
cussed matters  intelligently,  under- 
stood what  she  was  talking  about  and 
her  relations  to  her  property,  and 
her  children,  and  had  an  intelligent 
perception  of  how  she  desired  to 
dispose  of  her  proj>erty.  Holmberg 
v.  Phillips  (Iowa),  78  N.  W.  Rep., 
66. 

*  In  re  Jones's  Will  (SunO.  5  Misc. 
R.  (N.  Y.),  199;  25  N.  Y.  Supp..  109. 
(Jorkow's    Kst.,   20   W;ish.,   563;   56 
Pac.  R.,  385.  testator  man  of  violent 
passions,  dissipated,  physical  wreck, 
associating  with  vile  associates,  not 
incom|>etent. 

*  Wade    r.     Ilolbrook,     2     Redf., 
(NT.  Y.),  378.  Lack  of  cleanliness  and 
mere   mental     |>eculiarities    are    not 
sufficient  to  raise  an  issue.      In    re 
Knight'?  Kst..   167  Pa.  St.,  453;  31 
Ail.   Rep.,  682;  and  where  the  evi- 
dence shows  imlxM'ility  only  it  is  not 
error  to  refuse  an  instruction  on  in- 
sanity, Mitchell  r.  I'openning  (N.  C.). 
32  S.  K.  Ron.,  798. 

1  Schieffehn    r.    Schieffelin    (Aln.). 
28  So.   Rep.,  687;  see  infra,  p.  406. 


404  MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

transact  business,  the  finding  of  testamentary  capacity  was  sus- 
tained where  he  had  given  the  draughtsman  instructions,  had 
caused  the  will  to  express  his  intentions,  had  directed  as  to  the 
residue  and  as  to  executor.1 

Actual  Disease  of  the  Brain  Does  Not  Necessarily 
Incapacitate. — A  will  giving  all  testator's  real  and  personal 
property  to  his  wife,  who  had  been  dutiful  and  faithful,  to  the 
exclusion  of  his  only  heirs-at-law,  his  sister  and  brother,  the 
latter  of  whom  had  been  in  the  habit  of  vilifying  the  wife,  was 
sustained  where  the  testator  was  competent  to  transact  business  up 
to  a  very  short  time  before  his  death.  The  will  was  made  eight 
months  prior  thereto,  and  the  question  of  incompetency  was  not 
raised  until  after  the  autopsy  on  his  body,  which  showed  tumors 
on  his  brain,  which  it  did  not  appear  affected  testator's  mind.2 

In  a  case  where  softening  of  testator's  brain  had  gone  on  for 
several  years  before  the  making  of  the  will,  but  had  not  yet  brought 
him  to  the  state  of  idiocy,  although  his  disease  caused  serious 
nervous  disturbances  and  at  intervals  he  suffered  from  nervous 
prostration,  continuing  two  or  three  days,  and  in  common  con- 
versation he  would  frequently  lose  the  train  of  ideas,  but  between 
the  attacks  his  mind  was  reasonably  clear — held  that  testator  had 
sufficient  capacity  to  make  a  will.3 

Testator  was  confined  to  an  insane  asylum  in  1886  as  being 
afflicted  with  general  paresis.  In  1887  he  was  taken  out,  and  in 
1888  married  to  the  proponent.  It  was  not  objected  that  he  was 
incompetent  to  marry,  and  the  will  was  executed  shortly  after. 
In  1889  he  was  again  confined  to  the  asylum,  where  he  died  in 
1890.  During  the  time  he  was  not  confined  to  the  asylum  he 
transacted  business.  The  testimony  of  experts  was  conflicting. 
Held  that  the  testator  was  competent  to  make  a  will.4 

1  Slingloff    v.  Brunei-,  174111.,  561;  ing's  Est.,  4  Pa.    Dist.    Ct.    R.,    94; 
51  N.  E.  Rep.,  772;  cf.  in  re  Wilde's  36  W.    N.     C.,    118,    testatrix    was 
Will,  38  Misc.   R.   (N.  Y.),   149;  77  eighty  years  old,  had  acted  strangely 
N.  Y.  Supp.,  164.  and  was  confused  as  to  location  of 

2  Matter  of  Frick,   47  N.  Y.  State  her  room,  and  experts  testified  that 
Rep.,     10;    19    N.    Y.    Supp.,     315,  she  had  begun  two  years  previously 
citing  Cudney  v.  Cudney,  68  N.  Y.,  to  pass  into  a  state  of  senile  dementia 
148;    Brick    v.     Brick,   66  id.,    149;  which  greatly  increased  six  months 
Matter  of  Smith,  95  id.,   516;    Mat-  after    the    execution    of    the    will— 
ter   of  Martin,  98  id.,   193;  Clapp  v.  issue  of  mental  incapacity  was  de- 
Fullerton,  34  id.,  190;  Horn  v.  Pull-  nied;   see  also  Hill  v.   Fly   (Tenn.), 
man,  72  id.,  269.  52  S.  W.  Rep.,  731. 

3  In  re  Silverthorn,  68  Wis.,  372;  4  Will    of    Kiedaisch,     13    N.    Y. 
32  N.    W.    Rep.,    287.     In    re  Len-  Supp.,  255;    see  also  somewhat  sim- 


PHYSICAL   PAIN   OR    DISEASE.  405 

Testator  for  some  years  l>efore  making  his  will  had  had  syph- 
ilis and  had  become  a  physical  wreck,  losing  his  hair,  teeth,  eye- 
sight partially,  and  the  use  of  his  lower  limbs.  To  relieve  his 
pain  he  used  a  large  quantity  of  morphine,  and  while  suffering 
was  extremely  profane.  He  was  able,  however,  to  conduct 
business  transactions,  dictated  the  will  himself,  and  left  his 
property  to  a  sister  who  took  care  of  him.  llrld  that  the  evi- 
dence did  not  show  want  of  testamentary  capacity  or  undue 
influence.1 

Paralysis,  and  Aphasia  or  Other  Brain  Diseases, 
Do  not  Necessarily,  but  May,  Incapacitate. — The  will 
of  a  paralytic  was  sustained  where,  though  unable  to  talk 
at  the  time  of  its  execution,  he  was  unimpaired  in  mind, 
and  the  scrivener  ascertained  his  wishes  by  asking  him  questions 
as  to  the  provisions  for  his  wife  and  children  which  could  be 
answered  by  yes  or  no,  and  he  signified  his  assent  to  each  item 
of  the  will  by  an  affirmative  nod  of  the  head  as  it  was  read  to 
him,  and  he  was  asked  if  it  suited  him.2 

It  is  thus  seen  that  although  a  well-defined  mental  disease 
such  as  gener.il  paralysis  is  present,  or  the  existence  of  cerebral 
hemorrhage  is  shown  by  paralysis  and  loss  of  speech,  these  con- 
ditions are  insufficient  to  invalidate  a  will,  provided  it  can  be 
proved  that  the  testator  possessed  a  disposing  mind,  memory,  and 
understanding.' 

Where  testatrix  made  her  will  during  an  illness,  when  in  ap- 
parently sound  mental  condition,  the  fact  that  on  recovery  she 
could  not  remember  anything  which  occurred  during  her  illness, 
did  not  prove  want  of  capacity.4 

ilar  case  of  Barbey  v.  Boardrnan,  202  in  enjoyment  of  his  faculties,  but 
Pa.  St.,  185;  51  Atl.  It.,  756.  during  same  illness;  hrld  competent. 
1  Bush  r.  Lisle.  89  Ky..  393;  12  *  Rothrock  r.  Rothrock,  22  Or., 
S.  W.  Rep.,  702.  Use  of  Opiates:  551;  30  Pac.,  453. 
In  Miller  v.  Oestrich.  15<  Pa.  St.,  » See  Cheney  r.  Price,  90  Hun.  238; 
264;  27  Atl.  Rep.,  742.  the  testatrix  37  N.  Y.  Supp.,  117,  where  testator 
being  an  invalid,  was  in  the  habit  of  was  held  competent  although  he  had 
taking  morphia  in  reasonable  quan-  suffered  a  stroke  of  a|xiplexy  result- 
tities  to  relieve  pain,  and  when  ing  in  partial  paralysis;  In  re- 
awakening from  the  sleep  caused  finger's  Will.  36  Misc.  R.,  477;  73 
thereby  was  occasionally  confused;  N.  Y.  Supp.,  812,  where  the  will  was 
she  was  held  competent.  In  re  holographic  and  testator  was  para- 
Hamilton's  Kst.,  4  Pa.  Dist.  R.,  161;  lyzcd  of  s|>eech  and  otherwise  pnysi- 
16  Pa.  Co.  C't.  R..  303.  in  the  begin-  cally  weak. 

ning  of  an  illness  testator  was  kept  4  Henry  r.   Hall,   106  Ala.,  84;  17 

under    influence    of    narcotics,    and  So.  Rep.,  187. 
subsequently    made    his    will,    while 


406  MENTAL    UNSOUNDNESS — BECKER   AND   BOSTON. 

However,  where  a  testator  was  suffering  with  aphasia  and 
could  mumble  only  "yes,"  "no,"  and  "ah,"  and  the  will  was 
elicited  from  him  by  asking  questions  to  which  he  only  nodded, 
his  codicil,  executed  under  such  conditions,  and  in  the  presence 
of  two  persons  who  had  a  controlling  influence  over  him,  was  set 
aside.1 

Extreme  Weakness  of  Mind  or  Body,  or  Approach- 
ing Death,  Does  not  Incapacitate  where  Evidence 
Shows  that  Testator  Was  Rational. — A  testator  is  not 
to  be  regarded  as  incapable  of  executing  his  will,  because 
at  the  time  of  its  execution  he  was  approaching  his  end,  and 
was  so  physically  weak  that  he  was  unable  to  make  his  mark 
without  assistance,  where  there  is  evidence  to  show  that  he  was 
entirely  rational.2 

Where  testatrix  could  understand  and  dispose  of  ordinary 
business  matters  and  remember  the  particulars  of  a  transaction 
and  give  a  rational  judgment  upon  it,  although  she  was  forgetful 
about  household  affairs  and  failed  to  recognize  acquaintances,  it 
was  held  that  she  had  sufficient  testamentary  capacity.3 

In  the  following  case  the  will  was  sustained  notwithstanding 
an  extreme  degree  of  physical  and  mental  weakness :  For  some 
months  before  executing  the  codicil  testator  began  to  drink,  after 
having  abstained  for  ten  years.  On  several  occasions  he  was  a 
voluntary  inmate  of  an  inebriate  asylum,  but  did  not  overcome 
the  habit.  For  some  time  before  making  the  codicil  he  was  con- 

1  Smith  v.  Henline,   174  111.,   184;  related  to  him,  and  the  disposition 
51  N.  E.  Rep.,  227;  see  also  infra,  p.  he    was    making,    though    he    di%- 
418.  criminated   against  his  children   by 

2  Supm.  Ct.,  Matter  of  Patterson,  a  first  wife,  in  favor  of  a  second  wife 
26  Abb.  N.  C.,  395;  36  State  Rep.,  and    her    children;    held,    that    the 
813;    13    N.    Y.    Supp.,    463.      See  question    of    incompetency    should 
also  in  re  Seagrist's  Will  (Surr.),  11  not  be  submitted  to  jury. 

Misc.  R.  (N.  Y.),  188;  32  N.  Y.  Supp.,          3  Matter  of  Mabie,  5  Misc.,  179;  24 

1095;   In   re   Dixon's  Will,  42  App.  N.  Y.  Supp.,  855,  citing  Horn  v.  Pull- 

Div.  (N.  Y.),  481;  59  N.  Y.  Supp.,  man,  72  N.  Y.,  269;  Van  Guysling  v. 

421;  Skinner  v.  Lewis  (Or.),  67  Pac.  Van  Kuren,  35  id.,  70;  Cornwell   v. 

R.,  951 ;  In  re  Cruger's  Will,  36  Misc.  Riker,  2  Dem.,  354;  Matter  of  Will- 

R.,  477;  73  N.  Y.  Supp.,  812.    InSehr  iams,  19  N.  Y.  Supp.,  778;  Matter  of 

v.  Lindemann,   153  Mo.,  276;  54  S.  Snelling,  136  N.  Y.,  515;  Matter  of 

W.  Rep.,  537,  the  testator  was  too  Stewart,  15  N.  Y.  Supp.,  601;  Matter 

blind  to  see  to  write,  was  partially  of  Fricke,    19  id.,  315;  in  re  Gray, 

deaf,    was    sick    with    intermittent  5  id.,  464;  in  re  Bartholick,  id.,  842; 

fever,  and  was  thought  to  be  dying,  in  re  Darling,  6  id.,  191;  in  re  Bennett, 

but  it   appeared   that   he   knew  he  id.,  199;  in  re  Berrien,  5  id.,  37;  12 

was  making  a  will,   what  property  id.,  385;  Matter  of  Merriam,  16  id., 

he  had,  Hs  value,  the  names  and  ages  738. 
of    those    dependent    on    him    and 


PHYSICAL   PAIN   OR   DISEASE.  40? 

fined  to  his  room  by  nn  illness  resulting  from  the  use  of  liquor. 
The  attending  physician  was  unable  to  say  whether  IIP  was  drunk 
or  sober  when  he  executed  the  codicil,  but  testified  that  he  was 
so  incoherent  as  to  be  unable  to  alter  a  will,  and  was  troubled 
with  delusions,  thinking  he  saw  figures  and  heard  voices.  The 
nurse,  attorney,  and  others  testified  as  to  his  capacity.  Jit  Id 
that  an  issue  to  a  jury  as  to  the  validity  of  the  will  w:is  proi»erly 
denied.1 

In  another  case  a  verdict  that  testatrix  was  of  unsound  mind 
when  she  made  a  will  disinheriting  an  only  child  who  was  in 
straitened  circumstances,  was  set  aside  when  the  evidence 
showed  that  after  her  husband's  death  she  lived  for  the  greater 
part  of  her  life  by  herself,  occasionally  staying  with  friends; 
that  at  various  times  she  named  as  heir  different  persons,  stran- 
gers and  relatives,  including  her  son,  that  a  few  hours  before  her 
death,  and  while  in  a  very  exhausted  condition,  she  made  her 
will  ill  favor  of  her  nephew,  whose  father  had  persistently  and 
for  a  long  time  pressed  her  to  do  so.2 

In  New  York  a  will  has  been  admitted  to  probate  though  the 
testatrix  became  unconscious  after  signing  the  will  and  died  next 
day,  and  was  so  weak  as  to  be  unable  to  assent  to  the  will  when 
read  to  her,  or  to  request  the  witnesses  to  sign  it  except  to  nod 
assent  when  asked  if  she  wished  them  to  sign,  but  her  will  was 
in  accordance  with  a  previously  drawn  memorandum  of  her  in- 
tention.3 

1  Appeal  of  Harmony  Lodge,  etc.,  Rep.,  536;  56  X.  J.  Eq.,  365,  testatrix 

127  la.  St.,  269;   18  Atlantic   Rep.,  was  seventy-two  years  old,  unable  to 

10.    See  also  i«  re  Rowson'a  Kst.,  4  retain  nourishment,  and  slowly  dying 

Pa.  Dist.  t't.  Rep.,  91,  where  an  issue  of  starvation,  ami  was  under  the  in- 

was  denied,  though  testator  had  two  fluence    of    morphine,    hut    could  !H% 

strokes  of  apoplexy  within  one  week  aroused  to  intelligence;  she  hat!  made 

before    making    his    will,    and    died  different  provision  by  a  former  will 

three  days  afterward,  but  witnesses  made  a  month  before,  but  explained 

testified  that  at  the  time  of  the  execu-  that  she  did  not  understand  that  one 

tion  testator  understood   what   was  because  in  Knglish.  which  shescarcely 

said  to  him,  answered  questions,  and  understood;    the    later    will    was  in 

was    angry     at     being     considered  German,  her  native  tongue;  AeU  that 

mentally    weak.     See   in   re   Miller's  she  had  capacity. 

Kst.,  179  Pa.  St.,  645;  36  Atl.  Rep.,  *  T.arley   »'.    Park    (Ind.   Sun.),   35 

139;  39  W.   X.  ('.,  397,   where  evi-  X.  K.,  279.     See  additional  illustra- 

dence     of    great     discrimination     in  tions  in     rr  Wilson's   Kst.,    117  Cal. 

favor  of  one  child  against  five  others.  R..   262;   49   Par.    Rep..    172;    In    re 

and    that    testator    drank    to    gross  Harris's  Will  <Surr.  X.  Y.),  19  Misc. 

excess  for  ten  years  and  was  afflicted  R,,  38S;  44  \.  Y.  Simp.,  341. 

with  locomotor  ataxia,  did  not  make  *  In  re  Wilde's  Will.  38  Misc.  R., 

a  case  to  go  to  the  jury.     In  Dieffen-  149;  77  X.  Y.  Supp..  164. 
bach  v.  C.rece  (X.  J.   Pre.).  39  Atl. 


408  MENTAL   UNSOUNDNESS— BECKER  AND   BOSTON. 

Extreme  Physical  and  Mental  Weakness  May 
Incapacitate,  if  Testator  Is  not  Rational — Illustra- 
tive Cases. — Testatrix  was  very  sick  and  so  weak  that  she 
was  unable  to  make  her  mark  without  assistance.  Her  physi- 
cian, who  saw  her  shortly  after  she  made  the  will,  stated  that 
she  did  not  recognize  him ;  that  she  spoke  to  no  one  unless  aroused 
and  showed  no  interest  in  anything  around  her.  Other  witnesses 
testified  that  she  was  in  a  dazed  and  stupefied  condition,  and 
that  during  the  day  her  mind  wandered.  She  died  four  days 
after  the  wTill  was  executed.  Reid  that  the  deceased  did  not 
have  testamentary  competency.1 

There  was  evidence  that  the  testator  was  bedridden,  subsist- 
ing mostly  on  morphine  and  whiskey.  That  the  day  before 
making  the  will  disinheriting  a  daughter  if  she  should  marry  a 
certain  person,  as  well  as  on  the  day  of  making  the  will,  he  had 
taken  sufficient  morphine  to  make  him  drowsy.  There  was  also 
evidence  in  support  of  testator's  capacity.  Held  that  a  finding 
against  the  will  would  not  be  disturv^d.2 

A  decision  by  the  surrogate  that  the  testator  was  non  compos 
mentis,  based  on  evidence  that  he  was  eighty-two  years  old,  ill 
of  incurable  disease  of  which  his  physician  informed  him  he 
could  never  recover,  was  helpless,  of  feeble  mind,  and  unable 
to  carry  on  conversation  at  the  time  he  executed  the  will — sus- 
tained.3 

A  decree  admitting  to  probate  a  will  made  by  a  paralytic 
who  was  unable  to  write  or  speak,  where  a  draughtsman  who  at- 
tempted to  draw  a  previous  will  had  failed  to  understand  testa- 
tor's wishes — reversed  and  a  trial  by  jury  ordered.4 

In  a  case  where  testatrix  was  paralyzed,  though  she  afterward 
regained  the  use  of  some  of  her  limbs,  but  was  bedridden  and 
speechless,  except  that  she  could  say  "Yes,"  "No,"  and  "Well." 
Some  of  her  neighbors  testified  that  they  believed  her  competent 
to  make  a  will.  Her  physician  testified,  "  I  am  satisfied  that 

1  In  re  Coop's  Will,  6  N.  Y.  Supp.,  3  Matter   of  McCarthy,    48     State 

664;    see     also     Johnson    v.    Coch-  Rep.,  315;  20  N.  Y.  Supp.,  581;  65 

rane,     91     Hun,     165;     36      N.     Y.  Hun,  624. 

Supp.,  283;  In  re  Barbineau's  Will,  4  Matter  of  Raynor,  44 State  Rep., 

27  Misc.  R.,  417;  59  N.  Y.  Supp.,  375;  468;  18   N.  Y.    Supp.,    426;    distin- 

cf.  in  re  McGraw's  Will,  9  App.  Div.,  guishing  Rollwagen    v.     Rollwagen, 

372,  41  N.  Y.  Supp.,  481.  3  Hun,  132;    63  N.  Y.,  518. 

*  Carlin  v.  Baird  (Ky.),   13  S.  W. 
Rep.,  434. 


PHYSICAL    PAIN    OR    DISEASE. 

she  understood  in  ;i  measure  what  was  said  to  her  in  regard  to 
the  will,"  and  "I  think  she  had  an  idea  of  the  drift  of  it — a 
vague  idea."  The  draughtsman,  by  a  series  of  sj>eeulative  ques- 
tions suggested  by  her  children,  succeeded  in  producing  the  will. 
All  her  property  was  left  to  her  children,  except  a  small  sum, 
with  which  she  cut  off  an  absent  grandchild,  a  daughter  of  a 
deceased  son.  Held  that  testatrix  was  not  competent  to  make  a 
will.1 

Where  testator  at  the  time  he  executed  the  will  was  in  au 
intermittent  stage  of  mental  disorder,  and  afterward  died  in  an 
insane  asylum — held  that  a  verdict  finding  him  incapacitated  to 
make  a  will  should  not  be  disturbed.2 

Weakness  of  mind  may  incapacitate  without  actual  mental 
disease,  if  it  deprives  the  testator  of  the  degree  of  intelligence 
which  has  been  stated  above  as  the  measure  of  competency.3 

Delirium  of  Fever  May  also  Incapacitate,  if  Testa- 
tor Is  not  Bational — Illustrative  Cases. — Testator  had 
a  high  fever  the  day  he  executed  the  will  and  was  delirious, 
sometimes  getting  out  of  bed,  and  refusing  cider  he  had  asked 
for,  on  the  ground  that  it  was  something  else.  One  witness 
testified  that  before  the  will  was  drawn  he  seemed  bewildered, 
and  did  not  know  what  was  said  to  him,  and  talked  incoherently 
to  himself.  Held,  that  the  jury's  finding  against  the  will  would 
not  be  disturbed.4 

1  Mendenhall  v.  Tungate,   95  Ky.,  day  and  seemed  to  have  no  clear  idea 

208;   24   S.  W.,    431;   see  also  Hud-  of  its  contents.     In  re  Hound's  Will, 

son    v.    Hughan,   56   Kan.,    152;    42  25  Misc.   R.  (X.  Y.),   101;  54  N.  Y. 

Pac.,  701.  Supp.,710.  Testator  twice  paralyzed, 

*  Matter  of  Loewenstein,  2  Misc.,  deteriorated  mentally  and  physically, 

323;  51  State    Rep.,  423;  21    X.    Y.  became     violently    insane    four    or 

Supp.,  931.     Additional  illustrations  five    days    after    making    will,    died 

of  want  of  mental  capacity:  testatrix  within  two  weeks.     Johnson  v.  Coch- 

nervous,    feared   insanity,    twice   at-  rane,  1">9  NT.  Y.,  555;  54  N.  K.    Rep. 

tempted  to  commit  suicide,  had  been  aff'g  91  Hun,  168:  36  X.  Y.  Supp., 

in  asylum,  wavered  as  to  disposition  283. 

of   property,    was    confined    to   her  3  Manatt  r.  Scott,   106  Iowa,  203; 

bed    with   creeping   palsy,    was   en-  76  X.  W.  Rep.,  717. 

tirely    helpless,    had    epileptic    fits;  4  Keithley    r.    Stafford,     126  111., 

five    physicians    testified    she    was  507;     18    N.     E.     Rep..     740.     But 

mentally   unsound,    will   was  drawn  see   Tii-eeii    v.    Green,    145    111.,    264; 

five  days  before  her  death,  when  she  33  X.  E.,  941. 
was  too  feeble  to  sign  till  following 


410 


MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON 


DEAFNESS  OR  DEAF-MUTISM  NOT  CAUSING  IDIOCY  DOES  NOT 

INCAPACITATE. 

No  presumption  of  testamentary  incapacity  arises  from  deaf- 
ness.1 A  deaf  and  dumb  person  is  not  necessarily  an  idiot.2 

A  deaf  aud  dumb  person  may  make  a  will  if  all  the  statutory 
requirements  are  carried  out  in  their  spirit  and  intent  in  such 
manner  as  is  practicable  under  the  conditions  existing.3 


No  PRESUMPTION  OF  TESTAMENTARY  INCAPACITY  ARISES  FROM 
OLD  AGE  AND  FEEBLENESS4 — ILLUSTRATIVE  CASES. 

The  following  cases  illustrate  the  tendency  of  the  courts  to 
lind  capacity  even  where  the  testator's  mind  has  been  affected 
by  age  and  other  unfavorable  conditions : 5 

Where  testator,   eighty-four  years  old,   without  direct  de- 


1  Matter  of  Williams,  40  N.  Y. 
State  Rep.,  356;  2  Connolly,  579; 
15  N.  Y.  Supp.,  828;  aff'd  46  State 
Rep.,  791;  19  N.  Y.  Supp.,  778;  cit- 
ing Gombault  v.  Public  Adminis- 
trator, 4  Bradf.,  226. 

2  Brower  v.  Fisher,  4  Johns.  N.  Y. 
Ch.,  441. 

3  Matter  of  Perego,  65   Hun,  478; 
48  State  Rep.,  496;  20  N.  Y.   Supp., 
394,  citing   Matter    of    Becket,    103 
N.    Y.,    167;    Matter     of    Stillman, 
29  State  Rep.,  213. 

4  In  re  Iredale's  Will,  53  App.  Div. 
(N.  Y.),  45;  65  N.  Y.  Supp.,  533; 
Riggin    v.    Bd.    of    Trustees,    West- 
minster College,    160   Mo.,    570;    61 
S.  W.  R.,  803;  see  infra,  p.  549,  "Pre- 
sumptions." 

5  Old  age,  feeble  health,  blindness, 
and  a  mind  not  so  strong  as  formerly, 
O'Connor  v.  Madison,  98  Mich.,  183; 
57   N.    W.    Rep.,    105.     Irritability, 
excitability,    epileptic    fits,    unclean 
habits,  partial    blindness,  occasional 
childishness,  and  shedding  of  tears, 
and    getting     lost.     In     re     Flans- 
burgh's  Will,  82  Hun,  49;  31  N.  Y. 
Supp.,  177.     Impaired  health,  pecul- 
iarities, eccentricity,  dissipation,  and 
melancholy.    Hutchinson   v.    Hutch- 
inson,  152   111.,  347;   38  N.  E.    Rep., 
926.     Cancer    and    old    age.     In  re 
Metcalf's  Will,  16  Misc.  Rep.  (N.  Y.), 
180;  38  N.  Y.  Supp.,  1131.  Testatrix 


a  childless  widow,  eighty  years  of  age, 
devised  her  property  to  her  hus- 
band's relatives  to  the  exclusion  of 
her  own,  but  she  had  derived  her 
estate  from  him,  and  had  a  fixed 
purpose  so  to  dispose  it;  she  was  on 
friendly  terms  with  her  own  rela- 
tives, but  they  were  not  notified  of 
her  last  illness;  a  strange  lawyer 
wrote  her  will,  a  strange  physician 
attended  her;  a  mistake  was  made 
in  the  name  of  a  beneficiary;  she 
was  delirious  at  times,  and  en- 
feebled; held  insufficient  to  submit 
to  the  jury,  because  at  most  the 
facts  created  only  a  suspicion  of  in- 
capacity. Davis  v.  Cox  (Ky.),  67 
S.  W.  R.,  261.  Old,  feeble,  not 
competent  to  do  business,  mind  not 
what  it  once  was.  Von  de  Veld  v 
Judy  (Mo.),  44  S.  W.  Rep.,  1117;  143 
Mo.,  348.  Testator,  91  years  old,  with 
cataract,  bad  memory.  Stevenson  v. 
Kingsley,  8  Pa.  Dist.  R.,  245.  Testa- 
trix at  seventy  married  her  fourth 
husband,  half  her  age,  while  suffering 
from  disease  which  shortly  caused 
death.  O'Dwyer's  Will,  61  N.  Y. 
Supp.,  903.  See  also  infra,  p.  419.  See 
following  cases  where  the  facts  were 
sufficient  to  take  the  question  to  the 
jury:  Hegney  v.  Head,  29  S.  W.  Rep., 
587;  126  Mo.,  619;  Bever  v.  Spangler 
(Iowa),  61  N.  W.  Rep.,  1072;  In  re 
Rowson's  Est.,  4  Pa.  Dist.  Rep.,  91. 


NO   TESTAMENTARY    INCAPACITY    ARISES   FROM   OLD  AGE.     411 

scendauts,  left  his  entire  estate  to  his  second  wife  u  year  after 
he  married  her  in  1887,  the  will  was  contested  by  his  nephew 
for  lack  of  testamentary  capacity,  and  the  evidence  showed  that 
testator  was  addicted  to  the  use  of  intoxicating  liquors,  but  was 
sober  when  he  executed  the  will,  and  was  of  good  business 
ability;  held,  that  the  will  should  be  admitted  to  probate.1 

The  will  of  a  man  who  died  at  the  age  of  eighty-six,  six 
months  after  he  had  executed  it,  when  he  was  in  feeble  health, 
contested  on  the  ground  of  incapacity;  held,  on  the  evidence 
entitled  to  probate.2 

That  testatrix  was  ninety-eight  years  of  age  at  the  time  she 
made  her  will  is  insufficient  to  sustain  an  appeal  against  the  ad- 
mission of  the  will  to  probate.3 

That  a  testator  was  seventy  years  of  age  and  of  filthy  and 
profane  habits  and  many  eccentricities,  accounted  for  by  his 
inclinations  and  education,  was  held  insufficient  to  show  want  of 
testamentary  capacity.4  Testamentary  incapacity  was  not  shown 
by  the  facts  that  testatrix  was  eighty-four  years  old,  that  her 
will  was  in  favor  of  persons  with  whom  she  boarded,  that  she 
excluded  nephews  and  nieces,  that  she  had  previously  made  sev- 
eral such  wills  in  favor  of  persons  with  whom  she  temporarily 
boarded,  and  that  she  was  somewhat  feeble  in  body  and  mind.5 

1  Matter  of  Jones,  5  Misc.  (N.  Y.),  Dist.  R.,  817;   167  Pa.  St.,  498;  31 

199,  citing   Delafield   v.    Parish,    25  Atl.  Rep.,  732;  35  W.  X.  C.,  543. 

N.  Y.,  9;  VanGuyslingv.  Van  Kuren,  8  In  re  Snelling's  Will,  136  N.  Y., 

35  id.,  70;  Horn  v.  Pullman,  72  id.,  515;  32  N.  K.  Rep.,  1006.    The  cases, 

269;    Matter    of    Tracy,     11    State  of  course,  all  differ  in  their  individual 

Rep.,  103;   In  re  Stewart,  59   Hun,  facts.     Additional     illustrations  are 

618;    Peck    v.   Gary,    27   N.  Y.,   9;  afforded  by  Bain  r.  ('line,  33  Pac. 

Matter  of  Schreiber,  22  State  Rep.,  Rep.,  542;  24  Oregon,  175;  Pooler  t'. 

892;  Matter  of  Watson,  39  id.,  42.  Christman,  34  N.  K.   Rep..  57;   145 

*  Matter  of  Wheeler,  5  Misc.,  279,  111.,  405;     7n  re  Carver's  Will  (Surr. 

citing  Horn  v.  Pullman,  72  N.  Y.,269;  N.  Y.),  3  Misc.  Rep.,  567;  23  N.  Y. 

VanGuyslingv.  Van  Kuren,  35 id.,  70;  Supp.,    753;     In    re    Henry's    Will 

Bleeckert*.  Lynch,  1  Bradf.,  458;  Van  (N.  Y.  Surr.),  18  Misc.  Ren.,  149;  41 

Alst  v.   Hunter,   5  Johns  Oh.,    148;  N.     Y.     Supp.,     1096;     Shreiner    v. 

Delafield   v.    Parish,    25   N.    Y.,    10;  Shreiner,  178  Pa.  St,,'57;  35  Atl.  Rep.. 

Tunison  v.  Tunison,  4   Bradf.,    138;  974;  In  re  Bowers,  27    Pittsb.    Leg. 

Cornwall  v.  Riker,  2  Dem.,  354.  J.   (N.  S.),  237;   Riley  r.  Sherwood, 

3  Collins  v.  Townley  and  Johnson,  144  Mo.,  354;  45  S.  W.   Rep..  1077; 
21  N.  J.  Eq.,  353  (N.J.  Prerog.  Ct.).  In  re  Murphy's  Will,  41   App.   Div. 

4  Bennett  r.  Hibbert.  HS  Iowa,  154;  (N.  Y.),   153;  58  N    Y.  Supp.,  450; 
56  N.  W.  Rep.,  93;  see  in  re  Knight's  In  re  Dbcon'a    Will,  42   App.    Div. 
Est.,  167  Pa.  St.,  453;  31  Atl.  Rep.,  (N.  Y.),  481;  59  N.  Y.  Supp..  421; 
682;     In    re    Lening's    Est.,    4    Pa.  In  re  Carter's  Will  (N.  J.  Pro.),  51 
Dist.    Rep.,   94;  36  W.   N.  C.,    118;  Atl.     R.,    65;     Perkins    r.     Perkins 
In  re  Loesen's  Est.,   16    Pa.  Co.  Ct.  (Iowa),    90    N.    W.    R.,    55;     In   re 
Rep.,  49;  In  re  Loeser's  Est.,  3  Pa.  Reed's  Est.   (Minn.),  90  N.  W.   R., 


412  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

There  is  no  presumption  against  a  will  because  it  was  made 
by  a  person  of  advanced  age,  and  incapacity  to  make  a  will  can- 
not be  inferred  merely  from  an  enfeebled  condition  of  mind  or 
body.1  But  where  the  evidence  shows  that  the  aged  testator 
was  actually  incompetent  by  reason  of  age,  it  is  proper  to  refuse 
probate.2 

HABITS  OF  INEBRIJ:TY  OR  THE  USE  OF  DRUGS  MAY  DESTROY 
MENTAL  SOUNDNESS  AND  DISPOSING  CAPACITY. 

Mere  habits  of  insobriety  on  the  part  of  the  testator  are  alone 
not  sufficient  to  invalidate  a  will,  though  to  be  considered  as 
affecting  mental  capacity.3 

To  defeat  a  will  on  the  ground  of  drunkenness  of  the  testator, 
his  condition  at  the  time  of  making  it  and  not  before  and  after 
must  be  shown.4 

Where  the  testimony  showed  that  testator  was  rendered  in- 
capable of  performing  intelligently  the  ordinary  pursuits  of  life 
at  the  time  of  executing  his  will,  by  the  use  of  drugs,  the  refusal 
to  admit  it  to  probate  was  sustained.5 

For  long-continued  habits  of  intemperance  may  gradually 

319;  In  re  Case  (Conn.),  52  Atl.  R.,  pacity  was  refused,  though  it  was 
403.  shown  that  testatrix  was  in  bad 
^nyderv.  Sherman,  23  Hun,  139;  health,  suffering  from  dyspepsia, 
Matter  of  Hurlbut,  26  Misc.,  461;  catarrh,  headache,  insomnia,  and  oc- 
57  N.  Y.  Supp.,  648;  Dobie  v.  casional  lapses  of  memory;  In  re 
Armstrong,  160  N.  Y.,  584;  Matter  Jones's  Will  (Surr.),  5  Misc.  Rep. 
of  Dixon,  42  App.  Div.,  481;  59  (N.  Y.),  199;  25  N.  Y.  Supp.,  109, 
N.  Y.  Supp.,  421;  In  re  Otis's  Will,  where  the  testator  was  old,  licentious, 
1  Misc.  R.  (N.  Y.  Surr.),  258;  22  indecent  in  conversation,  and  boasted 
N.  Y.  Supp.,  1060;  In  re  Wheeler's  of  amorous  exploits. 
Will  (Surr.),  5  Misc.  R.,  279;  25  2  In  re  Widmayer's  Will,  34  Misc. 
N.  Y.  Supp.,  313;  In  re  Loeser's  R.,  439;  69  N.  Y.  Supp.,  1014;  see 
Est.,  3  Pa,  Dist.  Ct.  R.,  817;  167  Pa.  also  Davis  v.  Denny,  94  Md.,  390; 
St.  Rep.,  498;  31  Atl.  Rep.,  732;  35  50  Atl.  R..  1037. 
W.  N.  C.,  543;  Entwistle  v.  Meikle,  3  Matter  of  Peck,  42  State  Rep., 
180  111.,  9;  54  N.  E.  Rep.,  217;  see  898;  17  N.  Y.  Supp.,  248,  citing 
also  McFadin  t>.  Catron,  120  Mo.,  252;  Peck  v.  Gary,  27  N.  Y.,  9;  In  re 
25  S.  W.  Rep.,  506,  where  the  com-  Hewitt's  Will,  31  Misc.  R.  (N.  Y.), 
petent  testatrix  was  eighty-three  81;  64  N.  Y.  Supp.,  571;  Fluck  v. 
years  old  and  a  great  sufferer  from  Rea,  51  N.  J.  Eq.,  233;  27  Atl.  Rep., 
cancer;  In  re  Skaats's  Will,  74  Hun  636;  In  re  Schiesler's  Est.,  198  Pa. 
(N.  Y.),  462;  26  N.  Y.  Supp.,  494,  St.,  81;  47  Atl.  Rep.,  966. 
where  the  competent  testator  was  4  In  re  Dimond's  Est.  (Pa.  Orph. 
sixty-five  years  old,  suffering  from  dis-  Ct.),  3  Pa.  Dist.  Rep.,  554;  Hen- 
ease,  had  ceased  to  give  attention  to  nessy's  Heirs  v.  Woulfe,  49  La.  Ann., 
the  details  of  business,  and  acted  in  1376;  22  So.  Rep.,  394. 
an  eccentric  manner;  In  re  Douglass's  3  In  re  D'Avignon's  Will,  12  Colo. 
Est.,  162  Pa.  St.,  567;  29  Atl.  Rep.,  App.,  489;  55  Pac.  Rep.,  936. 
715,  where  an  issue  of  mental  ca- 


INTOXICATION    DOES   NOT   INCAPACITATE.  413 

impair  the  mind  ami  destroy  the  faculties,  so  as  to  produce  in- 
sanity which  may  l»e  of  a  i>ermanent  form.  Where  such  insan- 
ity so  ensues  the  incompetency  is  as  complete  as  if  the  same 
condition  resulted  from  any  other  cause.1 

BUT  INTOXICATION  NOT  RESULTING    IN   MENTAL  UNBOUND- 
NESS  DOES  NOT  INCAPACITATE. 

A  will  made  by  one  who  is  at  the  time  under  the  influence  of 
intoxicating  liquor  is  not  for  that  reason  void.  To  avoid  such  a 
will  it  must  be  proved  that  the  testator  was  so  excited  by  liquor, 
or  that  he  so  conducted  himself  during  the  particular  act,  as  to 
be,  at  the  moment,  legally  disqualified  from  giving  effect  to  it.1 

The  point  of  time  for  investigation  is  the  time  when  the  will 
was  made;  if  then  sober,  the  testator  was  not  incompetent  be- 
cause of  drunkenness  at  another  time,3  even  though  the  will  was 
made  during  a  lucid  interval  in  an  attack  of  delirium  tremens.4 

The  mere  fact  that  a  man  is  an  habitual  drunkard,  and  '-non 
cowpox"  in  his  drunken  tits,  is  not  enough  to  invalidate  any  par- 
ticular act — c.y.,  the  execution  by  him  of  a  will.5  But  otherwise 
where  the  alcoholism  results  in  insanity.' 

An  habitual  drunkard,  even  after  an  adjudication  of  habitual 
drunkenness,7  or  even  though  he  continues  to  use  liquors  to  ex- 
cess,7 or  while  in  the  charge  of  a  committee,  is  not  incompetent 
to  make  a  will.8 

An  habitual  drunkard,  even  if  at  the  time  under  the  influ- 
ence of  liquor,  may  make  a  will  if  he  comprehends  the  nature, 
extent,  and  disposition  of  his  property,  his  relation  to  those  who 
have  or  might  have  a  claim  on  his  bounty,  and  is  free  from 
undue  influence,  fraud,  or  coercion." 

'Howe    r.     Richards    (Iowa),    83  *  Ct.   of  Errors.    1839.  Gardner  r. 

N.  W.  Rep.,  909.  Gardner,    22    Wend..    526.    rev'g     7 

1  Peck    r.    Cary,    27    N.    Y..    9;  Paige;  112.     But  compare  Burritt  r. 

affirmine  38  Barb.,  77;  In  re  John-  Silliman,    10    Barb..    198;    rev'd    13 

son's  Will.  57  X.  Y.  State  Hep..  846.  N.  Y.,  93. 

»  Hcnnessy's   Heirs   r.    Woulfe,   49  •  In   re  Kly's   Kst..    16  Misc.    Rep. 

La.   Ann..    J376;  22  So.    Rep.,  394;  (N.  Y.).  228;  39  X.  Y.  Supp..  177. 

see    Schierbaum    r.    Sohemme,    157  '  In  re  Dugan's  Kst.,  6  Pa.   Died. 

Mo.,    1;   57  S.   W.    R..   526;   Ball  r.  R.,  222. 

Kane  (Del.).  39  All.   R..  788;  In  re  *  Lewis    r.  Jones.   SO  Barb.,  645; 

Gilliam's  Estate  (X.  J.),  52  Atl.  R..  r/.    as   to    an    adjudicated    lunatic, 

690.  infra,  p.  525. 

4  Succession  of  Crouzeilles.  106  La.,  'Matter  of  Reed.  20  X.  Y.  Supp., 

442;  31  So.  R.,  64;  see  note  to  In  re  91;   2  Connolly.  403.     But  otherwise 

Miller  (Pa.),  39  L.  R.  A.,  220.  when    there    is    no    evidence    that 


414  MENTAL   UNSOUNDNKSS — BECKER   AND   BOSTON. 

If  it  does  not  appear  but  that  the  habitual  drunkard  was  al- 
ways able  to  talk  coherently  and  understand  what  he  was  about, 
and  it  appears  that  he  was  entirely  rational  when  the  will, 
draughted  by  himself,  was  executed,  it  should  not  be  rejected.1 

A  slight  degree  of  intoxication  and  of  mental  and  physical 
disease  induced  by  habitual  indulgence  in  intoxicants,  will  not 
necessarily  destroy  testamentary  capacity.2 

That  testator  was  a  drunkard  does  not  prove  his  incapacity 
to  make  a  will.3 

UNDUE   INFLUENCE. 

On  the  one  side  the  comfort  of  the  weak,  the  dependent, 
and  the  aged  depends  largely  on  their  testamentary  capacity 
being  sustained.  If  they  cannot  leave  property  to  persons 
kind  to  them,  they  may  often  be  left  to  suffer  from  want  of 
kindness.  On  the  other  side,  if  a  person  of  feeble  intellect  is 
to  be  so  exposed  to  the  coercion  or  fraud  of  others  as  by  valid- 
ating testamentary  provisions  made  by  him  under  the  pressure 
of  such  coercion  or  fraud,  then  not  only  may  his  life  be  made 
miserable,  but  he  may  become  instrumental  in  perpetrating 
great  wrongs.4 

While  courts  should  see  that  the  testamentary  act  is  freely 
exercised  by  the  aged,  weak,  and  infirm  without  restraint,  force, 
or  fraud,  so  as  to  promote  their  own  comfort  and  enjoyment,  and 
should  guard  and  protect  them  with  the  greatest  care  and  cir- 
cumspection from  imposition  and  improper  influence,  they  should 
hesitate  to  find  that  undue  influence  has  been  practised  when  the 
will  is  fair  and  reasonable,  according  to  the  common  instincts  of 
mankind,  and  such  as  might,  with  propriety  and  justice,  be  made 
by  a  decedent.5 

he    comprehended,    and    the    facts  702;    17    Atl.,    692;     In    re  Suther- 

justify   an   inference    of    undue   in-  land's  Will,   28  Misc.    R.,    424;    59 

fluence.     In  re  Rintelen,  37  Misc.  R.  N.  Y.  Supp.,  989. 

(N.  Y.),  562;  75  N.  Y.  Supp.,  1062;  3  Re  Levis's  Estate,  140  Pa.,   179; 

aff'd,  78  N.  Y.  Supp.,  1092.  21  Atl.,  242;    In  re  Halbert's  Will, 

1  McLaughlin's  Will,  2  Redf.,  N.  Y.  15  Misc.   R.   (N.  Y.),  308;  37  N.  Y. 

Surr.  Ct.,  504;  Estate    of    Monney-  Supp.,    757;   In    re    Schusler's  Est., 

penny,    1  Month.   L.  Bui.,  7.     Julke  198  Pa.  St.,  81;  47  Atl..  Rep.,    966, 

v.  Adam,  1  Redf.,  454.  4  Wharton    and      Stille's      "Med. 

Thick  v.   Rea,   51  N.  J.   Eq.    (6  Jurisp.,"  4th   ed.,  Phil.,    1882,    vol. 

Dick.),     233;     Bannister     v.    Jack-  i.,  p.  20. 

son,    46   N.    J.    Eq.  (1  Dick.),   593;  5  Children's  Aid   Society  of  N.  Y. 

affirming  45    N.   J.    Eq.  (18  Stew.),  v.  Loveridge,  70  N.  Y.,  387. 


UNDUE   INFLUENCE.  415 

An  illustration  is  afforded  by  a  New  Jersey  case  in  which  the 
testatrix  was  ninety-eight  years  of  age  at  the  time  she  made  the 
will  in  question.  The  caveator  was  a  son  of  the  testatrix ;  he 
resided  not  far  from  his  mother.  More  than  one  unsuccessful 
attempt  to  procure  an  inquisition  of  lunacy  against  her  in  the 
last  years  of  her  life  had  been  made  and  failed.  The  will  gave 
the  bulk  of  the  property  of  testatrix  to  one  child,  and  very  little 
to  herpther  children;  yet  this  child  was  a  daughter,  with  whom 
she  had  lived  for  many  years,  and  who  had  taken  care  of  her 
before  and  after  she  acquired  her  property  upon  the  death  of 
another  sou.  No  unsoundness  or  imbecility  of  mind  was  shown 
of  a  kind  that  approached  to  defects  of  testamentary  capacity, 
nor  was  there  any  proof  of  any  fraud,  circumvention,  or  undue 
influence  in  procuring  the  will.  The  court  held  that  there  was 
no  ground  to  sustain  the  appeal  against  the  admission  of  the  will 
to  probate.1 

Undue  Influence  to  Preclude  the  Admission  of 
Will  to  Probate. — Undue  influence  has  been  defined  to  be  any 
means  employed  upon  and  with  the  testator,  which,  under  the 
circumstances  and  conditions  by  which  he  was  surrounded,  he 
could  not  well  resist,  and  which  controlled  his  volition  and  in- 
duced him  to  do  what  otherwise  would  not  have  IKHMI  done.1 
The  means  may  be  flattery,  importunity,  threats,3  superiority  of 
will,  mind,  or  character,  or  whatsoever  art,  human  thought, 
ingenuity,  or  cunning  may  employ  which  would  give  dominion 
over  the  will  of  the  testator  to  such  an  extent  as  to  destroy  his 
free  agency  or  constrain  him  to  do  against  his  will  what  he  is 
unable  to  refuse.4  Such  influence  the  law  condemns  as  undue 
when  exercised  by  any  one  over  the  testamentary  act,  whether 
by  direction  or  indirection,  and  whenever  attained.4 

1  Collins  i?.  Townley  and  Johnson,  fluencc  and  mental  incapacity.    Mess- 

21   N.  J.  Eq.,  353.  ner  r.   Elliott,    184   Pa.   St.,   41;  39 

'Chappell  v.  Trent,  90  Va.(  849;  Atl.  Rep.,  46. 

19  S.   E.   Rep.,  314;   Riley  v.  Sher-  'See    in   re   Sickles's   Will    (N.  J. 

wood,  144  Mo.,  354;  45  S.  W.  Rep.,  Pre.),  50  Atl.   R.,  577;  Robinson  v. 

1077.     But  it  must  be  the  efficient  Robinson,  203  Pa.  St.,  400;  53  Atl. 

cause  without  which  the  will  would  R.,  253. 

not  have  been  made  as  it  was  made.  4  Dean    r.    Phillips,    22    Ky.    Law 

In  re  Holman's  Est.,  70  Pac.  R.,  908.  Rep.,    1621;    61    S.    W      Rep.,    10; 

Where    the    testimony    shows    that  Oberdorfer  r.   Newberger  (Ky.),  67 

testatrix  was  so  far  under  the  con-  S.  W.   R.,  267.     In  another  case  it 

trol  of  others  as  to  exclude  all  in-  was  said  that  where  through  weak- 

dividuality,     all     thought,  and     all  ness,  ignorance,  or  implicit   reliance 

action,  it  points  to  both  undue  in-  on  the  good  faith   of   another    the 


416  MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON. 

Any  general  discussion  of  the  subject  of  undue  influence 
belongs  to  a  treatise  on  wills.  We  are  concerned  here  mainly 
with  those  aspects  of  it  where  the  element  of  some  mental  uu- 
soundness  on  the  part  of  the  testator  is  blended  with  the  influ- 
ence of  a  stronger  mind. 

Testamentary  incapacity  and  undue  influence  are  issues  fre- 
quently interwoven  in  contested  will  cases ;  they  often  go  hand 
in  hand,  and  both  questions  can  and  should  be  submitted  to  the 
jury.1 

Undue  influence  combined  with  mental  weakness  may  incapaci- 
tate.— A  weakness  which  would  not,  if  solely  to  be  considered, 
affect  testamentary  capacity,  may,  when  combined  with  undue 
influence,  lead  to  a  decree  refusing  probate.  Where  there  not 
only  is,  on  the  part  of  the  testator,  age,  infirmity,  and  disease, 
but  such  advantage  has  been  taken  of  his  condition  that  the 
execution  of  will 2  or  codicils  may  well  be  ascribed  to  necessity 
and  compulsion  rather  than  a  voluntary  disposition,  they  cannot 
stand,  and  must  be  refused  probate.3  The  same  was  held  true 
where  similar  influence  was  exercised  upon  a  person  who  had 
just  reached  the  age  at  which  he  could  make  a  will,  and  was 
an  invalid  and  weak  in  mind  ;4  and  where  practised  through  the 
credulity  inspired  by  a  belief  in  the  authority  derived  by  the 
beneficiary  from  the  spirits  of  the  dead.5 

Physical  force  is  not  necessary.6  All  influences  are  not  un- 
lawful, but  pressure  or  importunity,7  so  exerted  as  to  overpower 

latter  obtains  an  ascendency  which  295.     And,  of  course,  it  will  be  im- 

prevents  the  exercise  of  an  unbiassed  material   whether  there   was  undue 

judgment,    undue    influence    exists;  influence  if  the  testator  lacked  testa- 

and  though,  if  applied  under  ordi-  mentary     capacity.      Schieffelin     v. 

nary    circumstances    such    influence  Schieffelin  (Ala.),  28  So.  R.,  687. 

would    be    regarded    as   innocent,  if  *  Jones  v.  Simpson,  50  N.  E.  Rep., 

it  resulted  in  the  particular  case  in  940;  171  Mass.,  474. 

a  disposition    contrary  to  testator's  3  Swenarton  v.  Hancock,  9  Abb. 

desire  it  was  undue  influence.     Cog-  N.  C.,  326;  mem.  s.  c.,  84  N.  Y.,  653, 

hill  v.   Kennedy,  24  So.   Rep.,  459;  affirming    22   Hun,    38;    Coghill   v. 

119  Ala.,  641;  see  additional  defini-  Kennedy,  24  So.  Rep.,  459;  119  Ala., 

tion,  of  the  same  substantial  import,  641. 

in  Gordon  v.  Burns,   153  Mo.,  223;  4  In  re  Curland,  15  Misc.  Rep.,  355 

54  S.  W.  Rep.,  546;  see  case  where  (N.  Y.);  37  N.  Y.  Supp.,  922. 

testator   signed   to    avoid    anger    of  5  Orchardson    v.  Cofield,    171    111., 

beneficiary,  Edwards  v.  Millsaps,  70  14;  49  N.  E.  Rep.,  197;  40  L.  R  A 

S.  W.  R.,  357  (Tex.  Civ.  App.).  256. 

1  Dunaway  v.  Smoot,  67  S.  W.  R.,  6  Estes  v.  Bridgforth,  21  So.  Rep  , 

62;  Smith  v.    Henline,  174  111.,  184;  512;  114  Ala.,  22. 

51   N.    E.    R.,   227;   but  see  contra,  7  Ledwith  v.  Claffy,  18  App.  Div 

Givin  v.  Givin  (Idaho),  48  Pac.  R.,  115;  45  N.  Y.  Supp.,  612. 


UNDUE  INFLUENCE.  417 

the  volition  without  convincing  the  judgment  is  a  Hpecies  of  re- 
straint; and  importunity  which  the  testator  luus  not  the  strength 
of  will  to  resist  and  to  which  he  yields  for  peace  and  quiet,  if 
carried  to  a  degree  in  which  his  judgment,  discretion,  or  wish 
are  overborne,  will  constitute  undue  influence,  though  no  force 
is  used  or  threatened.1  It  must  amount  to  overpersuasion, 
coercion,  or  force  destroying  the  free  agency  of  the  testator* 
and  contrary  to  his  will,  and  which  he  was  unable  to  refuse  or 
too  weak  to  resist.* 

It  must  IT  made  to  appear  that  the  importunity  or  influence 
was  such  as  to  deprive  the  testator,  at  the  time,  of  the  free  ex- 
ercise of  his  will.4 

To  invalidate  for  undue  influence  a  will  to  which  the  testator 
has  made  a  codicil  it  must  be  shown  that  such  influence  con- 
tinued and  operated  on  the  mind  of  the  testator  at  the  time  the 
codicil  was  executed.5  This  follows  from  the  legal  principle 
that  the  execution  of  a  codicil  amounts  to  a  re-affirmation  of  the 
will  to  which  the  codicil  relates.  The  time  when  the  influence 
was  exercised  is  immaterial,  if  it  actually  operated  at  the  time  of 
execution  of  the  will.9 

And  generally  such  influence  as  will  invalidate  a  will  must 
be  shown  to  have  been  exercised  at  or  before  the  execution  of 
the  will7  and  in  relation  to  the  will.8 

1  See  note  2,  supra,  p.  415;  Robin-  So.    Rep.,   72.     Undue  influence  to 

son  v.  Robinson,  203   Pa.,  400;    53  render  a  will  invalid  must  be  con- 

Atl.  R.,  253.  nected    with   the   execution   of   the 

*  McFadin  v.  Catron,  120  Mo.,  252;  will  and  operating  at  the  time  of  its 
25  S.  W.   Rep.,  506;   see  Schieffelin  execution.    Pooler  r.  Christman  (III. 
v.  Schieffelin  (Ala.),  28  So.  Rep..  687.  Sup.),  34  N.  E.  Rep..  57:  Robinson 

*  Appeal  of  Turner,  72  Conn.,  305;  v.    Robinson,   203   Pa.   St.,   400;   53 
44  Atl.  R.,  310;  in  re  Gilham's  Will  Atl.   R.,  253.     The  undue  influence 
(N.  J.  Pre.),  52  Atl.  R.,  690;  Pritch-  may  be  such  as  extends  only  to  a 
ard  v.   Henderson,  3  Penne.   (Del.),  part  of  the  will.    Morris  v.  Morton's 
128;  50  Atl.   R.,  217;  r/.  Bacop  v.  Exrs.  (Ky.),  20  S.  W.  Rep..  287.     It 
Bacon   (Mass.).   62  N.   E.    R.,   990,  is  not   the  equivalent,   however,  of 
where     an     instruction     was     held  force  or  coercion.     Higginbotham  r. 
erroneous    as    recognizing    influence  Higginbotham   (Ala.),    17  So.    Rep., 
upon  a  person  competent  to  make  a  516. 

will  if  left  alone  to  be  undue    in-  'Campbell   v.    Ban-era  (Tex.   Civ. 

fluence.  App.),    32    S.    W.    Rep.,    724;    see 

4  "Undue  influence  must  be  such  Henvick  v.  Lai.^ford,  108  Cal.,  606; 

as  in  some  measure  destroys  the  free  41  Pac.  Rep.,  701. 

agency  of  the  testator,  and  prevents  '  Dunaway    v.    Smoot    (Ky.),    67 

the  exercise  of  that  discretion  which  S.  W.  R.,  62. 

the    law    requires    a    party    should  *  dable  r.  Ranch,  50  S.  C.,  95;  27 

fXMMBB,  as  essential  to  a  valid  testa-  S.  E.  Rep..  555. 

mentary  disposition  of  the  property,"  'Schieffelin    r.    Schieffelin    (Ala.), 

Johnson    v.    Armstrong    (Ala.),     12  28  So.  Hep  .  6X7;  see  same  rule  as  to 
III.— 27 


418  MENTAL  UNSOUNDNESS —  BECKER   AND   BOSTON. 

Illustrations  of  Undue  Influence  Practised  upon 
Persons  Mentally  "Woak. — A  woman,  ninety-four  years  of 
age,  suffering  with  a  complaint  which  caused  her  intense  pain 
when  she  was  not  under  narcotics,  which  made  her  drowsy  and 
lethargic  or  put  her  to  sleep,  being  so  enfeebled  that  she  could 
not  rise  in  bed  or  read  or  write,  within  four  days  of  her  death, 
and  after  her  physician  had  pronounced  her  dying,  at  the  in- 
stance of  a  nephew  made  a  will  which  gave  her  entire  estate  to 
that  nephew,  taking  it  from  her  husband  and  only  brother, 
between  whom  she  had  divided  it  by  will  about  a  mouth  be- 
fore. It  did  not  appear  that  proponent  had  ever  spoken  with 
his  aunt  about  a  will,  or  anything  except  directions  for  her 
burial,  which  he  said  he  could  not  follow  unless  he  had  some 
written  authority.  When  deponent  and  his  witnesses  entered 
her  room  testatrix  expressed  surprise,  and  proponent  said  that 
there  were  some  "papers  to  file,"  and  began  to  speak  of  the 
place  where  she  wished  to  be  buried.  Proponent  and  his 
mother  testified  that  said  will  had  been  read  to  testatrix,  but 
the  latter's  testimony  was  inconsistent.  Held,  that  testatrix 
was  induced  to  sign  by  fraud,  and  in  ignorance  of  the  paper's 
contents.1 

A  testatrix  eighty-one  years  of  age,  but  of  sound  disposing 
mind,  having  two  sons,  one  of  whom  had  five  grandchildren, 
after  going  to  reside  with  the  other  son  revoked  a  previous  will 
by  which  she  had  divided  her  estate  equally  between  her  sons, 
and  executed  a  new  will  drawn  by  the  one  with  whom  she  was 
living,  and  giving  her  estate  to  him,  to  the  exclusion  of  her  other 
son  and  all  her  grandchildren.  Held,  that  on  the  question  of 
undue  influence  in  such  a  case  as  this  it  was  proper  to  inquire 
into  the  reasons  for  such  a  disposition  of  the  property ;  the  prob. 
ability  that  it  was  stimulated  by  the  suggestions  of  those  attend- 
ing her,  and  the  fact  that  they  refused  to  allow  the  disinherited 
son  to  have  private  interviews  with  the  testatrix  were  pertinent; 

fraud:  in  re  Benton's  Est.,  131  Cal.,  Rep.,  590.  See  in  re  Coleman's  Est., 

472;  63  Pac.  R.,  775;  in  re   Black's  6  Pa.  Dist.  R..  535;  Knox  v.  Knox, 

Est.,  132  Cal.,  392;  64  Pac.  R.,  695;  95  Ala.,  495;   11  So.  R.,   125.     B,ut 

in  re  Kaufman,    117    Cal.,   288;   49  cf.    Steadman    v.    Steadman    (Pa.), 

Pac.,   192;  in  re  Shell  (Col.),   53  L.  14  Atl.  R.,  406;  Hartman  v.  Strickler, 

1.  A.,  387;  63  Pac.  R.,   413;  in   re  82  Va.  R.,  225;  Overall  v.  Bland,  11 

Oberdorf,    2    Lack.    Leg.     N.,     43;  Ky.  Law  R.,  371;  12  S.  W.  R.,  273. 
Pooler  v.  Christman,    145  111.,   405;          '  N.    J.    Prerog.    Ct.,    Hildreth    v. 

34    N.    E.    Rep.,    57;    McCulloch    v.  Marshall,  51  N.  J.  Eq.,  241:  27  Atl. 

Campbell,    49    Ark.,  367;   5  S.    W.  Rep.,  465. 


WHAT   IS   NOT    UNDUE   INFLUENCE.  419 

and  that  under  all  the  circumstances  a  verdict  annulling  the 
will  for  undue  influence  must  be  sustained. l 

The  question  of  undue  influence  is  peculiarly  one  to  be  passed 
on  by  the  jury,  under  proper  instructions,  and  a  verdict  of  undue 
influence  will  not  be  set  aside  on  appeal  unless  palpably  against 
the  weight  of  evidence.2  In  the  absence  of  any  evidence  of 
undue  influence,  it  has  been  held  reversible  error  for  the  court 
to  instruct  the  jury  on  that  subject  at  all.3 

An  action  to  nullify  a  will  on  the  ground  of  undue  influence 
may  be  barred  by  a  statute  of  limitations.4 

Undue  influence  has  been  exercised  to  procure  the  revocation 
and  destruction  of  a  will,  in  which  case  the  revocation  will  be 
held  void  and  proof  of  the  contents  of  the  will  permitted.5 

Undue  influence  affecting  the  whole  will,  though  exerted 
only  for  the  benefit  of  one  beneficiary,  invalidates  the  will.6 

What  Is  not  Undue  Influence. — It  is  not  undue  influ- 
ence for  the  beneficiaries  to  request  a  third  persoji  to  induce  the 
testator  to  make  a  will,  nothing  being  said  about  what  it  is  to 
contain;7  nor  to  advise,  persuade,8  or  appeal  to  the  affections.9 
The  test  is  whether  the  beneficiary  has  by  fair  means  influenced 
rather  than  overcome,  persuaded  rather  than  compelled,  the 
testator's  judgment.9  Even  if  the  provision  would  not  have 
been  made  without  the  beneficiary's  solicitation,  undue  influ- 
ence is  not  implied,  for  any  one  has  a  right  to  exercise  all  the 
honest  arts  of  persuasion  so  long  as  he  does  not  substitute  his 
volition  for  that  of  the  testator.10 

1  Marvin  v.  Marvin,  3  Abb.  N.  Y.  36  Misc.  R.,  272;  73  N.  Y.  Supp.,  412; 

Ct.  of  App.  Dec.,  192.  cf.  Campbell  v.  Carlisle,  162  Mo.,  634; 

'Howat  v.  Howat's  Exr.,  19  Ky.  63  S.  W.  R.,  701. 

Law  R.,  756;  41  S.  W.   Rep.,  771.  9  Sullivan    v.    Foley    (Mich.),    70 

Appeal   of   Brooks,    68   Conn.,   294;  N.  W.  R.,  322;  in  re  Halbert's  Will, 

36  Atl.   Rep.,  47;  Campbell   v.  Me-  15  Misc.  (N.  Y.),  308;  37  Supp.,  757; 

Quiggan  (N.  J.),  34  Atl.  R.,  383.  Robinson  v.  Robinson,  203  Pa.  St., 

3  Boone  v.  Ritchie,  21  Ky.  L.  R.,  400;    53    Atl.    R.,    253;    Barlow    v. 
864;  53  S.  W.  R.,  518.  Waters,  16  Ky.  L.  R.,  426;  28  S.  W. 

4  See  Zerega  v.  Percival  (La.),  15  R.,  785;  Appeal  of  Turner,  72  Conn., 
So.  Rep.,  476.  305;  44  Atl.  R.,  310. 

5  See  Mclntosh  v.  Moore,  22  Tex.  10  Perkins    v.    Perkins  (Iowa),    90 
Civ.  App.,  22;  53  S.  W.  R.,  611.  N.  W.  R.,  55;  Ketteman  v.  Metzger, 

8  Coghill  v.  Kennedy,  119  Ala.,  641 ;  23  Ohio  Cir.  Ct.,  61 ;  in  re  Journeay's 

24  So.  Rep.,  459.  Will,  80  Hun  (N.  Y.),  315;  30  Sunn., 

1 1n  re  Seagrist's  Will,  1  App.  Div.  80;  Bevelot  v.  Lestrade,  153  111., 

(N.  Y.),  615;  37  N.  Y.  Supp.,  496.  625;  38  N.  E.  R-,  1050;  Clausseniufl 

8  For  instance,  a  childless  wife  v.  Claussenius,  17!)  111.,  545;  53  N.  E. 

persuades  her  husband  to  leave  her  R.,  1006;  Henrich  r.  Langford,  108 

his  whole  estate;  in  re  Cruger's  Will,  Cal.,  608;  41  Pac.  R.,  701;  Riley  v 


420  MENTAL.  UNSOUNDNESS — BECKER   AND   BOSTON. 

It  has  been  held  not  undue  influence  to  excite  to  anger  against 
another,1  without  employing  any  deceit. 

Nor  is  influence  undue  which  merely  tends  to  induce  the 
testator  to  make  the  will ;  the  influence  must  be  the  operating 
cause  of  the  will  in  order  to  be  sufficient  to  overthrow  it,  and 
must  subordinate  the  will  of  the  testator  to  the  will  of  the  person 
exercising  the  influence.2 

A  provision  in  a  will  is  not  invalid  on  account  of  an  attempt 
to  exercise  undue  influence,  if  it  does  not  appear  that  the  at- 
tempt was  the  proximate  cause  of  the  provision.3  And  it  must 
usually  appear  that  the  devisee  improperly  solicited  the  testator,4 
or  wrote  or  procured  the  will  to  be  written,  or  the  allegation  of 
undue  influence  will  fail  for  lack  of  proof  connecting  the  devisee 
with  the  will.5 

Influence  gained  by  kindness  and  affection  will  not  be  re- 
garded as  undue,  in  the  absence  of  fraud  or  imposition,  though 
it  induce  inequality  and  injustice,  if  it  be  voluntary  on  the  part 
of  the  testator,8  and  this  rule  applies  as  well  to  friends  as  to 
relatives.7 

Where  the  will  is  made  under  the  Louisiana  law  the  notary 
may  address  questions  to  develop  and  render  the  testator's  ex- 
pressed will  more  clear,  and  may  suggest  words,  that  testator  may 
better  express  his  intent,  but  these  suggestions  should  not  influ- 
ence the  disposition.8  And  such  a  will  will  not  be  annulled  be- 
cause the  appropriate  phraseology  is  suggested  by  the  notary.8 

EXECUTION  OP  A  WILL  PROCURED  BY  FRAUDULENT  DEVICES. 

Actual  fraud  also  has  the  same  effect  in  invalidating  a  will 
as  undue  influence;  when  it  is  practised,  and  the  evidence 
shows  it,  the  invalidity  springs  from  the  deceit  or  fraud  operat- 
ing to  produce  the  execution  of  the  testamentary  instrument ; 
it  is  not  necessary,  therefore,  in  such  cases  to  show  that  the  fraud 

Sherwood,  144  Mo.,  354;  45  S.  W.  R.,  «  Miller  v.   Oestrich,    157  Pa.   St., 

1077,    Boggs    v.    Boggs    (Neb.),    87  264;  27  Atl.  R.,  742. 

N.  VV.  R.,39.  "Harp  v.   Parr,    168  111.,   459;  48 

1  In  re  Corbli's  Will  (N.  J.  Pre.  Ct.),  N.  E.  R.,  113;  Cutler  v.  Cutler,  103 
52  Atl.  R.,  996;  Salter  v.  Ely  (N.  J.  Wis.,  258;  79  N.  W.  R.,  240. 

Pre.  Ct.),  56  N.  J.  Eq.,  357;  39  Atl.  •  Towson  v.  Moore,  11  App.  D.  C., 

R.,  365.  377. 

2  Bacon  v.  Bacon  (Mass.),  62  N.  E.  7  Campbell  v.  Carlisle,  162  Mo.,  634; 
Rep.,  990.  63  S.  W.  R.,  701. 

4  Trezevant   v.    Rains    (Tex.    Civ.          8  Hennessy's  Heirs  v.  Woulfe,   49 
App.),  25  S.  W.  R.,  1092.  La.  Ann.,  1376;  22  So.  Rep.,  394. 


INSANE   PERSONS  AS   WITNESSES.  421 

"overpowered  the  volition  without  convincing  the  judgment."1 
Mental  impairment  usually  plays  a  small  part  in  such  cases. 

THE  EFFECT  OF  MENTAL  UNSOTJNDNESS  ON  COMPETENCY 
OF  WITNESSES. 

INSANE  PEESONS  AS  WITNESSES. 

Insane  persons  during  a  lucid  interval  are  competent  wit- 
nesses. 

The  question  of  their  competency  is  for  the  court  to  deter- 
mine when  the  witness  is  produced  to  be  sworn.2  When  a  wit- 
ness is  produced,  and  it  appears  that  he  has  been  insane,  and 
there  is  no  evidence  of  recovery,  the  court  should  upon  timely 
request  inquire  into  his  sanity,  before  permitting  him  to  testify.3 
And  upon  such  examination  it  is  largely  in  the  discretion  of  the 
court  whether  the  witness  will  be  permitted  to  testify.3 

Where  one  offered  as  a  witness  has  been  adjudged  insane,  the 
inquiry  of  the  court  as  to  his  competency  is  limited  to  his  under- 
standing of  the  obligations  of  an  oath  and  his  ability  to  compre- 
hend the  examination  as  a  witness;  if  the  court  adjudges  him 
competent  as  a  witness  on  this  examination,  the  effect  of  his  in- 
sanity upon  his  credibility  is  then  for  the  jury.4 

Where  one  offered  as  a  witness  of  what  occurred  in  an  insane 
asylum  was  a  person  who  had  been  regularly  committed  as  in- 
sane, and  who  had  not  been  discharged,  but  allowed  to  leave  on 
parole,  he  was,  in  Delaware,  on  examination  by  the  court,  held 
competent  on  his  own  showing,  notwithstanding  the  opinion  of 
the  physician  by  whom  he  was  committed  and  of  a  medical  at- 
tendant at  the  asylum  that  he  was  incompetent.5 

'For   illustrations   of   the   law   in  54  Pac.  R..  698:    sec   People  ex  rel. 
cases  of  fraud  see  in  re  Cummins's  Norton   v.  N.  Y.    Hospital,  3    Abb. 
Est.,  20  Pa.  Co.  Ct.  R.,  575;  7  Pa.  N.  C.,  229,  and    authorities  cited  in 
Dist.  R.,  198;  in  re  Burns's  Will,  28  opinion    and  in  note,  in   which  the 
S.  E.  Rep.,  519;  121  N.  C.,  336;  but  proper  practice  in  such  cases  is  fully 
the  evidence  must  show,  before  the  described  and  explained, 
will    will    be    declared    invalid    for  3  Mills  v.  Cook,  57  S.  W.  Rep.,  81 
fraud,  that  the  will  is  induced  by  the  (Tex.  Civ.  App.). 
fraud,  in  re  Benton's  Est.,  131  Cal.,  4  Wright  v.  Southern  Exp.  Co.,  80 
472;  03  Pac.   R.,  775;  but  the  par-  Fed.  Rep.,  85;  see  same  case  for  effect 
ticular  time  at  which  the  fraud  is  of    failure    to    conduct    preliminary 
prartised    is    immaterial,    if    it    so  examination  of  such  witness.    Pitts- 
operates;  mere  false  representations,  burgh,  etc.,  Hy.  Co.  r.  Thompson,  82 
therefore,    will    not,    of   themselves,  Fed.  Rep..  720;  27  C.  C.  A.,  333. 
constitute  such  fraud,  ibid.  *  State  r.  Brown,  3(5  Atl.  Rep.,  458; 

'City  of  C.uthrie  v.  Shaffer  (Okl.),  see  infra,  p.  529,  upon  opinion  evi- 


422  MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON. 

And  where  a  person  offered  as  a  witness  had  been  judicially 
declared  insane  and  was  still  an  inmate  of  an  asylum,  it  was  held 
that  while  he  was  not  therefore  necessarily  incompetent  as  a  wit- 
ness, still  it  was  prima-facie  evidence  of  disqualification,  and  cast 
the  burden  of  proving  his  competency  on  the  party  offering  him. 
And  it  was  proper  for  the  court  to  hear  evidence  as  to  his  men- 
tal unsounduess  and  to  allow  him  to  be  examined  on  the  ques- 
tions at  issue  in  the  suit  to  determine  the  extent  of  the  impair- 
ment of  his  mind  and  memory ;  if  it  appears  that  he  suffers  from 
a  delusion,  but  his  evidence  is  clear,  coherent,  and  consistent, 
it  may  be  admitted  and  then  the  question  of  its  weight  is  for  the 
jury.1 

Where  a  prosecuting  witness  was  adjudged  insane  on  the  day 
of  a  verdict,  that  fact  did  not  render  incompetent  his  declara- 
tions made  two  months  before,  there  being  nothing  to  indicate 
that  he  was  not  then  sane.2 

In  California,  where  the  statute  authorizes  a  discharge  of 
a  person  from  an  insane  asylum  on  the  ground  of  restoration  or 
of  improper  commitment,  the  fact  of  discharge  was  held  prima- 
facie  evidence  of  restoration  so  as  to  make  a  person  a  com- 
petent witness.3 

Although  a  witness  had  been  judicially  declared  to  be  of  feeble 
mind,  he  was  nevertheless  held  a  competent  witness  where  the 
nature  and  extent  of  the  impairment  was  not  shown,  and  it  ap- 
peared that  at  the  time  of  testifying  he  had  an  intelligent  appre- 
ciation of  his  responsibility  as  a  witness,  and  the  testimony  of 
other  witnesses  showed  that  he  had  a  fair  recollection  and  un- 
derstanding of  the  matters  involved  in  his  testimony.4 

Where  in  order  to  impeach  the  competency  and  credibility  of 
a  witness  by  evidence  of  his  insanity,  testimony  was  offered  of 
prior  temporary  delusions  and  of  insanity  of  ancestors  and  rela- 
tives, it  was  held  that  this  was  insufficient  to  take  the  question 
of  his  sanity  to  the  jury,  and  that  in  the  absence  of  other  evi- 
dence it  was  not  error  to  reject  it.5 

In  Texas,  it  is  provided  under  the  Code  of  Criminal  Prece- 
dence on  the  mental  competency  of  3  Clements  v.  McGinn  (Cal.),  33 
witnesses.  Pac.  Rep.,  920. 

1  Pittsburgh    &    W.    Ry.    Co.    v.          4  Tucker  v.    Shaw,    158   111.,    326; 
Thompson,   82   Fed.    Rep.,    720;   27      41  N.  E.  Rep.,  914. 
C.  C.  A.,  333.  6  State  v.  Hay  ward,  65  N.  W.  Rep., 

*  State  v.   Smith,  26  Wash.,  354;      63;  62  Minn.,  474. 
37  Pac.  11.,  70. 


INTOXICATED   PERSONS   AS   WITNESSES.  423 

dure,  article  768  (formerly  article  730,  subdivisions  1  and  2), 
that  persons  who  are  insane  when  they  are  offered  as  witnesses, 
or  who  were  insane  when  the  event  happened  of  which  they  are 
called  to  testify,  are  incompetent  as  witnesses;  accordingly,  it 
has  been  held  that  an  insane  woman  cannot  testify  as  to  a  rape 
alleged  to  have  been  committed  on  her.1 

In  Ohio,  a  statute  excepts  persons  of  unsound  mind  from 
those  who  are  competent  as  witnesses.2  This  is  held  to  be  merely 
declaratory  of  the  common  law,  which  requires  that  the  unsound- 
ness  be  such  that  the  witness  is  incapable  of  understanding  the 
nature  of  an  oath  or  giving  a  coherent  statement  of  the  matter 
on  which  he  is  examined.3 

In  Oklahoma,  a  similar  statute  was  interpreted  to  mean  per- 
sons whose  minds  are  so  defective  that  they  cannot  correctly 
relate  facts  and  do  not  understand  or  realize  what  they  are  say- 
ing or  doing.4 

The  character  of  the  evidence  which  is  admitted  to  determine 
the  competency  of  witnesses  is  illustrated  by  the  cases  cited.  It 
permits  the  examination  of  medical  men  in  charge  of  an  asylum 
where  the  witness  is  confined.5 

In  a  direct  inquiry  into  lunacy  the  alleged  incompetent  can- 
not be  examined  as  to  facts  without  administering  to  him  the 
oath,8  nor  as  to  facts  on  which  the  jury  are  not  to  act.9 

INTOXICATED  PERSONS  AS  WITNESSES. 

Intoxication  is  said  to  go,  not  to  the  competency  of  a  witness 
who  is  intoxicated  while  testifying,  but  to  his  credibility;7 
probably,  however,  this  is  not  true  where  his  intoxication  is  such 
as  to  deprive  him  of  the  understanding  of  the  nature  of  an  oath, 
or  of  the  nature  of  the  examination. 

1  Lopez  v.   State,   30  Tex.   App.,  333.     And   cf.    State   v.    Simes,    12 

487;  17  S.  W.  R.,  1058;    and  where  Ida.,  310;  85  Par.,  914. 

the    indictment    charges    that    the  4  City  of  Guthrie  v.  Shaffer  (Ok.), 

woman  was  so  mentally  diseased  as  54  Pac.  R.,  698. 

to  have  no  will  to  oppose  the  act  of  *  Pittsburgh,  etc., Ry. Co.  v.  Thomp- 

carnal  knowledge  she  is  not  a  com-  son,  82  Fed.  Rep.,  720;  27  C.  C.  A., 

petent  witness  to  prove  the  offence,  333;    see  infra,  p.   531,  n.   5,  as  to 

Lee   v.   State    (Tex.    Cr.   App.),    64  the  limits  upon  such  examination. 

S.  W.  R.,  1047;  see  infra,  p.  000.  •  In  re  Rush,  53  N.  Y.  Supp.,  581. 

»  Rev.  St.  Ohio,  §  5240.  '  Myers  v.  State  (Tex.  Cr.  App.), 

3  Pittsburgh,  etc.,  Ry.Co.  v. Thomp-  39  S.  W.  Rep.,  111. 
son,  82  Fed.  Rep.,  720;  27  C.  C.  A., 


424  MENTAL   UNSOUND  NESS — BECKER   AND   BOSTON. 

PERSONS  STUPEFIED  BY  DRUGS  AS  WITNESSES. 

It  is  apprehended  that,  in  general,  the  rules  applicable  to  in- 
toxicated witnesses  apply.  In  Texas,  a  statute  renders  incom- 
petent as  witnesses  persons  who  were  insane  at  the  time  of  the 
events  as  to  which  they  are  interrogated.1  This  was  held  not  to 
disqualify  a  person  who  was  stupefied  by  drugs.2 

THE  EFFECT  OF  MENTAL  TJNSOTJNDNESS  ON  INCUMBENCY 

OF  OFFICE. 

^SANITY  VACATES  AN  OFFICE. 

It  has  been  a  mooted  question  whether  the  insanity  of  the  in- 
cumbent of  a  public  office  renders  such  office  vacant  so  that 
a  successor  can  be  appointed.  This  question  has  been  fully 
considered  by  the  Supreme  Court  of  the  State  of  Kentucky, 
under  a  statute  providing  that  the  term  "vacancy  in  office" 
means  such  as  exists  "when  there  is  an  unexpired  term  without 
a  lawful  incumbent."  The  court  held  that  an  adjudication  that 
one  holding  the  office  of  assessor  was  a  lunatic,  and  that  he  should 
be  confined  in  an  asylum,  created  a  vacancy  in  his  office.3 

VOLUNTARY  INTOXICATION  while  in  the  performance  of  an 
official  duty  has  been  held  to  be  legal  ground  for  removal ; 4  so, 
also,  habits  of  intemperance.5 

THE   EFFECT    OF  MENTAL    TJNSOTTNDNESS   ON    LIABILITY 
TO  TAXATION. 

On  the  principle  of  equality  of  taxation,  there  is  no  distinc- 
tion between  the  liability  of  a  lunatic's  property  and  of  the  prop- 
erty of  others ;  but  the  question  of  the  sufficiency  of  notice  may 
become  a  matter  of  controversy. 

1  Code  Cr.  Pro.,  Art.  768.  5  In  re  Peters  (Pa.),  10  Kulp.,  93. 

-Pones  v.  State  (Tex.  Cr.  App.),  In  Kentucky,  where  a  statute  (Ky. 

63  S.  W.  Rep.,  1021.  St.,  £  3749)  provides  for  punishment 

3  Long  v.  Bowen,  94  Ky.,  540;  23  of  an  officer  intoxicated  while  in  the 
S.  W.  Rep.,  343.    On  the  effect  of  in-  discharge  of  his  duties  or  so  drunk  as 
sanity  upon  the  office  of  administra-  to  be  disqualified  from  discharging 
tion  and  the  procedure    for   the  ap-  the  duties  of  his  office,  he  may  be 
pointment  of  a  successor  see  in  re  punished  though  he  never  be  drunk 
Blinn,  99   Cal.   216;    33  Pac.    Rep.,  while    attempting   to    perform    any 

official  act.     Johnson    v.    Common- 

4  State  v.  Welsh  (Iowa),  79  N.  W.      wealth,    23  Ky.  Law  R.,  856;  64  S. 
Rep-,  369.  W.  R.,  467. 


LIABILITY   OF   INSANE   PERSON   FOR   HIS   OWN   TORTS.        425 

Where  a  person  who  has  not  been  adjudged  insane,  even 
though  he  be  insane,  owns  property  subject  to  taxation,  and  due 
notice  is  given  him,  and  the  property  is  assessed  by  a  proper 
officer,  the  assessment  is  prima  facie  valid.1 

In  Indiana,  a  special  rule  is  provided  in  favor  of  idiots  or 
insane  persons  to  enable  them  to  redeem  laud  from  tax  sales 
within  two  years  from  the  removal  of  their  disabilities,2  and  a 
court  cannot  order  a  sale  to  satisfy  the  tax  purchaser's  lien.3 

In  West  Virginia,  an  insane  person  may  redeem  from  a  tax 
sale  within  one  year  from  the  removal  of  his  disability,  but  this 
does  not  deprive  his  committee  of  the  power  to  redeem.4 

In  Iowa,  a  judgment  against  an  insane  owner,  at  the  suit  of 
grantees  at  a  tax  sale,  clearing  their  title,  was  set  aside  after  his 
death  at  the  suit  of  his  heirs.5 


THE    EFFECT   OF    MENTAL   TJNSOTJNDNESS   ON   CIVIL   LIA- 
BILITY. 

LIABILITY  OF  INSANE  PERSON  FOR  HIS  OWN  TORTS. 

An  insane  person  is  liable  in  damages  for  any  torts  that  he 
may  commit.6  The  damages  are  limited  to  an  amount  sufficient 
to  compensate  the  injured  party  for  the  actual  injury  suffered, 
and  punitive  damages  cannot  be  recovered  in  such  cases.7  Al- 
though a  lunatic  is  not  punishable  criminally,  he  is  liable  in  a 
civil  action  for  any  tort  he  may  commit,8  including  libel  and 
slander,9  except  those  depending  upon  actual  malice. 

In  Jewell  v.  Colby  (N.  H.)  10  it  was  held  that  an  insane  person 
is  liable  for  causing  the  death  of  another  by  an  act  which  would 

1  Hennell  v.  Board  of  Comrs.,  132  Rep.,  215;  Mclntyre  v.  Sholty,  121 

Ind.,  32;  31  N.  E.  R.,  462.  And  see  111.,  660,  13  N.  E.  Rep.,  239;  Behrens 

also  People  v.  Barker  (N.  Y.  Sup.  v.  McKenzie,  23  Iowa,  333;  92  Am. 

CO,  67  Hun,  649;  33  N.  E.  R.,  745.  Dec.,  428;  Cross  v.  Kent,  32  Mil.,  581; 

*  Ristine  v.  Johnson,  143  Ind.,  44;  Morain  v.  Devlin,  132  Mass.,  87;  42 

42  N.  E.  Rep.,  310;  Rev.  St.,  1894,  Am.  R.,  423;  Ward  v.  Conataer,  4 

£§  8610,  8611.  Baxt.  (Tenn.),  64;  Morse  v.  Craw- 

3  Wagner  v.  Stewart,  143  Ind.,  78;  ford,  17  Vt.,  499;  44  Am.  Dec.,  349. 
42  N.  E.  Rep.,  469.  7  Krom  v.  Schoonmakcr,  3  Barb., 

4  Powell  v.   Smallwood,   37  S.    E.  647;  Ullrich  v.  N.  Y.  Press  Co.,  infra. 
Rep.,  551.  8  Mclntyre  ».  Sholty,  121   111.,  660; 

J  Hawley  v.  Griffin,  92  N.  W.  R.,  13  N.  E.  R..  239. 

113.  'Ullrich   v.   N.   Y.    Press  Co.,   23 

6  Re  Wolf,    9     Kulp.,  523;  Avery  Misc.   Rep.   (N.  Y.),   168;  50  N.  Y. 

r.   Wilson,  20  Fed.   R.,  856;  White  Supp.,  788. 

v.     Farley,    81     Ala.,     563;    8    So.  '» 24  All.,  902;  66  N.  II.,  399. 


426  MENTAL    UNSOUNDNESS — BECKER   AND   BOSTON. 

be  felonious  except  for  his  insanity,  and  that  in  an  action  against 
an  insane  person  for  his  torts  the  damages  are  limited  to  the 
actual  loss  sustained. 

In  Williams  v.  Hays1  the  court  said  that  an  insane  person  is 
liable  for  his  torts  the  same  as  a  sane  person,  except  for  those 
torts  in  which  malice,  and  therefore  intention,  is  a  necessary  in- 
gredient. In  respect  to  this  liability  there  is  no  distinction  be- 
tween torts  of  non-feasance  and  malfeasance,  and  so  an  insane 
person  is  liable  for  injuries  caused  by  his  tortious  negligence, 
and  so  far  as  this  liability  is  concerned,  is  held  to  the  same  de- 
gree of  care  and  diligence  as  a  person  of  sound  mind.  But  on 
a  second  appeal  it  was  held  that  the  defendant  was  not  liable, 
it  appearing  that  the  insanity  was  caused  by  the  stress  of  his 
efforts  to  save  a  ship,  lost  as  the  result  of  his  negligence  during 
temporary  insanity  solely  so  caused.2 

In  Mutual  Fire  Ins.  Co.  v.  Showalter 3  an  insurer  who  had  paid 
a  loss  by  fire  occasioned  by  a  lunatic  was  permitted  to  recover 
from  the  lunatic. 

But  where  the  mental  unsoundness  is  caused  by  the  person  on 
whom  the  injury  is  inflicted,  he  and  those  who  would  also  ordi- 
narily have  rights  of  action  with  respect  to  such  injury,  cannot 
recover ;  for  example,  where  a  father  sued  for  causing  the  death 
of  his  son,  and  it  appeared  that  deceased  had  attacked  the  de- 
fendant and  impaired  his  consciousness  and  while  in  that  state 
defendant  committed  the  wrongful  act,  the  act  of  the  deceased 
excused  the  defendant  from  liability  to  the  plaintiff.4 

LIABILITY  OF  OTHERS   FOR  THE  TORTS  OF   INSANE 

PERSONS. 

A  person  may  owe  a  duty  to  another  to  protect  him  from  the 
injurious  acts  of  an  insane  person.  Meyer  v.  Saint  Louis  I.  M. 
&  S.  Ry.  Co.5  was  an  action  against  the  railroad  company  for  the 
killing  of  plaintiff's  intestate  by  an  insane  passenger.  There 
was  proof  that  the  insane  passenger  was  recognized  by  the  offi- 

1  143  N.    Y.,    442;  38  N.  E.    R.,      Feld  v.  Borodofski,  87  Miss.,  72:    40 
449;  26  L.  R.  A.,  153.  So.  R.,  816. 

2  Williams   v.    Hays,    157    N.    Y.,          3  3  Pa.  Super.  Ct.,  452;  40  W.  N.  C., 
541;  52  N.  E.   Rep.,  589,  reversing      80. 

contrary  statement  of  the  law  in  2  4  Jenkins  v.  Hankins,  98  Tenn., 
App.  Div.,  183;  37  N.  Y.  Supp.,  708;  545;  41  S.  W.  Rep.,  1028. 

S54  Fed.  Rep.,  116. 


LIABILITY    OF   ATTENDANTS.  427 

cials  of  the  car  as  having  been  transported  over  the  line  nineteen 
days  before,  at  which  time  he  was  in  chains  and  violent,  and  in 
charge  of  police  officials.  He  was  unattended  at  the  time  of 
the  killing  and  had  made  various  remarks,  etc.,  indicative  of 
his  insanity.  The  company  was  held  bound  to  exercise  the  high- 
est degree  of  care.  An  instruction  that  the  railroad  company 
had  no  right  to  refuse  transportation  on  suspicion  that  a  person 
was  dangerous  to  others  from  insanity  or  any  other  cause,  if 
such  person  at  the  time  of  offering  to  become  a  passenger  was  ap- 
parently harmless  and  conducted  himself  in  no  way  different  from 
other  passengers  applying  for  passage,  was  held  to  be  erroneous ; 
and  it  was  said  that  a  reasonable  possibility,  as  well  as  proba- 
bility of  danger,  might  require  action  on  the  part  of  the  carrier, 
and  in  order  to  charge  the  company  with  the  duty  of  restraint  it 
need  not  have  been  foreseen  that  the  killing  would  take  place 
without  such  restraint. 

When  one  of  several  conspirators  is  insane,  his. co-conspira- 
tors are  none  the  less  liable  for  his  acts  in  furtherance  of  the 
conspiracy.1 

LIABILITY  OF  ATTENDANTS  FOR  THE  ACTS  OF  THE 
INSANE  UNDER  THEIR  CARE;  LIABILITY  TO 
SUCH  INSANE  PERSONS. 

Such  liability  becomes  a  question  of  interest  when  it  is  sought 
to  hold  the  attendant  responsible  for  negligence  in  permitting 
his  patient  to  do  or  suffer  injury.  The  duty  of  the  attendant  is 
to  exercise  a  degree  of  care  commensurate  with  his  undertaking, 
but  the  law  imposes  no  unreasonable  obligation.2 

1  Tucker  v.  Hyatt,  51  N.  E.  Rep.,  Pierce,  141  Mass.,  203;  Perry  v. 

469;  151  Ind.,  332.  House  of  Refuge,  63  Md..  20;  Fire 

*See  Presumptions,  p.  549,  infra;  Ins.  Patrol  v.  Boyd,  120  Pa.  St.,  624; 

see  for  method  of  pleading  facts  to  Downs  v.  Harper  Hosp.  (Mich.),  60 

show  obligation,  Walter  v.  Mitchell  N.  W.  R.,  421;  Leavi-11  r.  W.  Ky. 

(Mont.),  65  Pac.  R.,  5;  and  see  Herr  Asy.  for  Ins.,  28  Ky.  L.  R.,  1129:  91 

v.  Cent.  Ky.  Lun.  Asyl.,  17  Ky.  L.  S.  W.  R.,  671;  Corbett  r.  St.  Vin- 

R.,  320;  30  S.  W.  R.,  971.  For  the  cent's  In.  S.,  177  N.  Y.  16;  and  the 

rules  of  liability  of  institutions  for  State  is  not  liable  for  the  negligence 

the  care  of  the  insane  for  the  negli-  of  an  attendant  in  one  of  its  state 

gent  injury  of  patients  see  infra,  hospitals  for  the  insane,  Martin  r. 

Care  and  Custody  of  Incompetent  State  of  N.  Y.,  120  App.  Div.  (N.  Y.). 

Persons,  p.  606.  It  has  been  gener-  633.  See  on  this  subject  Care  and 

ally  held  that  eleemosynary  institu-  Custody  of  Incompetent  Persons, 

tions  are  not  liable.  Farnham  v.  infra,  p.  606. 


428        MENTAL  UNSOUNDNESS — BECKER  AND  BOSTON. 

TORTS  OF  OTHERS  AGAINST  INSANE  PERSONS. 

It  is  tortious  to  acquire  property  from  a  lunatic  incapable  of 
understanding  the  transaction,  if  the  grantee  knows  of  the  lunacy 
and  takes  advantage  of  it  to  obtain  the  property.1 

INTOXICATION   IK  ITS   BELATION  TO  TOETS, 
ESPECIALLY   NEGLIGENCE. 

Intoxication,  if  it  in  no  way  causes  an  accident,2  does  not  of 
itself  constitute  contributory  negligence ; 3  it  is  error  to  instruct 
a  jury  that  if  plaintiff  was  intoxicated  he  cannot  recover,  for 
intoxication  is  not  negligence  as  a  matter  of  law.4  As  bearing 
on  the  question  of  contributory  negligence,  intoxication  may  be 
a  fact  to  be  considered,5  but  even  though  it  be  a  statutory  off ence, 
it  in  no  way  affects  the  duty  of  care  owed  to  such  a  person,  ex- 
cept perhaps  to  require  an  unusual  degree  of  care  to  prevent  in- 
jury to  an  intoxicated  person,  whose  ability  to  look  out  for  him- 
self is  thereby  diminished.6  On  the  other  hand,  an  intoxicated 
person  may  not  plead  his  own  condition  to  avoid  the  consequences 
of  his  negligence  which  actually  contributed  to  the  accident  to 
himself.7  He  is  held  to  the  same  degree  of  care  for  himself  as  a 
sober  person,  at  least  where  the  defendant  had  no  notice  of  his 
condition.8  Nor  can  he  recover  if  his  intoxication  was  the  cause 
of  the  accident,9  or  contributed  to  it,  through  his  voluntary  ex- 
posure to  danger,  where  ordinary  prudence  on  his  part  could 
have  avoided  it;10  unless,  notwithstanding  his  intoxication  and 
negligence,  the  tort-feasor  by  the  exercise  of  due  care  after 
discovering  his  condition  could  have  prevented  the  injury.11 

1  Sander  v.  Savage,  75  App.  Div.          6  Wheeler  v.  Grand  Trunk  R.  Co., 
(N.  Y.),  333;  78  N.  Y.  Supp.,  189.          70  N.  H.,  607;  50  Atl.  R.,  103;  54 

2  Galveston,  etc.,  Ry.  Co.  v.  Harris,       L.  R.  A.,  955. 

22  Tex.  Civ.  App.,  16;  53  S.  W.  R.,  '  Denver   Tramway   Co.    v.    Reid, 

599.  (Col.),  35  Pac.  R.,  269. 

3  Ward  v.  Chicago,  St.  P.,  M.  &  O.  *  Louisville  &  N.  R.  Co.  v.  Cummins 
Ry.  Co.,  85  Wis.,  601;  55  N.  W.  R.,  Admr.,  23  Ky.  L.  R.,  681;  63  S.  W. 
771;  Morris  v.  Eighth  Av.  R.  Co.,  68  R.,  594. 

Hun    (N.    Y.),    39;    22   Supp.,    666;          9  Galveston,  etc.,  Ry.  Co.  v.  Harris, 

Sylvester  v.  Town  of   Casey  (Iowa),  22  Tex.  Civ.  App.,  16;  53  S.  W.  Rep., 

81  N.  W.  R.,  455.  599;  see  Ronker  v.  St.  John,  21  Ohio 

4  Kingston   v.    Fort   Wayne,    etc.,  C.  C.,  339 

R.  Co.,  112  Mich.,  40;  70  N.  W.  R.,          "  Bageard  v.  Consolidated  Traction 

Co.  (N.  J.),  45  Atl.  R.,  620. 

5Trumbull  v.    Erickson,    97   Fed.  "  Wheeler  v.  Grand  Trunk  Ry.  Co., 

Rep.,  891;  38  C.  C.  A.,  536;  Wabash      70  N.  H.,  607;  50  Atl.  R.,   103;  54 
Ry.  Co.  v.  Monegan,  94  111.  App.,  82.       L.  R.  A.,  955. 


THE   EFFECT   ON   RESPONSIBILITY    FOR   CRIME.  429 

"Whether  drinking  has  contributed  to  a  negligent  injury  is  prop- 
erly left  to  a  jury  to  determine.1 

Where  an  intoxicated  person  falls  on  a  railroad  track,  he 
becomes  a  trespasser  and  the  railroad  company  is  not  liable  if 
it  uses  due  care  to  prevent  injury  after  it  discovers  him,2  though 
injury  ensues  notwithstanding  such  care.2  An  employer  is  not 
chargeable  with  neglect  of  duty  to  an  intoxicated  employee,  if 
unaware,  personally,  or  through  the  knowledge  of  his  ser- 
vants, of  his  condition.3 

In  some  States  it  is  a  misdemeanor  to  give  or  sell  liquor  to 
an  intoxicated  person,  and  in  some  a  right  of  action  therefor  or 
for  the  sale  of  intoxicating  liquors  is  given  to  an  injured  person. 
In  Indiana,  an  extreme  illustration  of  the  extent  of  this  right  is 
afforded  by  the  case  of  Honiire  v.  Half  man,4  where  the  wife  of 
an  intoxicated  man  recovered  damages  from  a  saloon-keeper  for 
loss  of  support,  because  her  husband  while  drunk  had  obtained 
liquor  from  defendant  and  had  then  committed  a  ho,micide  while 
drunk,  and  was  convicted  therefor  and  sentenced  to  imprison- 
ment. 

THE   EFFECT    OF    MENTAL    UNSOTTNDNESS   ON   RESPON- 
SIBILITY  FOB   CRIME.5 

i 

It  is  not  within  the  scope  of  this  article  to  discuss  at  length 

the  methods  of  legal  practice  in  the  treatment  of  insane  persons 
accused  or  convicted  of  crime.  They  will  be  found  in  works  on 
crimes,  and  in  the  statutes  of  the  several  States  (see  this  vol- 
ume, p.  6Q7  et  seq.  ).8 

1  Bradwell  v.  Pittsburgh  &  W.  E.  Me.,  558;  50  Atl.  R.,  892;  McNary  v. 

Pass.  Ry.  Co.,  153  Pa.  St.,  105;  25  Blackburn,  180  Mass.,  141;  61  N.  E. 

Atl.  Rep.,  623;  see  Rhyner  v.  Rep.,  885;  Breeding?'.  Jordan  (Iowa), 

Menasha.  73  N.  W.  Rep.,  41;  97  Wis.,  88  N.  W.  R.,  1090:  Lucas  v.  Johnson 

523.  (Tex.  Civ.  Apn.),  64  S.  W.  R.,  823; 

*  Louisiana  W.  E.  Ry.  Co.  v.  Me-  Bellison  v.  Apland  (Iowa),  89  N.  W. 

Donald  (Tex.  Civ.  App.),  52  S.  W.  Rep.;  22;  Boydan  v.  Haberstumpf, 

Rep.,  649.  8  Det.  Leg.  N.,  906;  88  N.  W.  R., 

3  Parker  v.   Winona  &  St.   P.   R.  386;    Borgasen    v.   Eklund,    96     111. 
Co.,  83  Minn.,  212;  86  N.  W.  Rep.,  2.  App.,     443;     Stafford     v.     Levinger 

4  156  Ind.,  470;  60  N.  E.  Rep.,  154;  (S.  D.),  91  N.  W.  R.,  462;  Jaroszewski 
see  also  for  examples  of  the  statutory  v.  Allen    (Iowa),  91  N.  W.  R.,  941. 
remedies  for  injury  resulting  to  the  'For  the  treatment  of  persons  in- 
drunkard   or  a    third    person   from  sane  at  the  time  of  trial  see  statutes, 
the  sale  of  intoxicating  liquors  and  6  But  the  practice,  which  varies  in 
the   limits  and  application  of  such  the  several  States,  is  illustrated   by 
remedies:    Waxmuth    v.    McDonald,  the  following  recent  cases: 

96  111.  App.,  242;  Gardner  v.  Day,  95          California.    People   v.   Cieiger,    116 


430 


MENTAL   UN8OUNDNESS — BECKER   AND    BOSTON. 


Cal.,  440;  48  Pac.  Rep.,  389;  People 
v.  Knott,  122  Cal.,  410;  55  Pac.  Rep., 
154;  People  v.  Lee  Fook,  85  Cal., 
300;  24  Pac.  R.,  654;  People  v. 
Travers,  88  Cal.,  233;  26  Pac.  R.,  88. 
See  also  infra,  p.  433. 

Georgia.  Carr  v.  State,  98  Ga., 
89;  27  S.  E.  Rep.,  148. 

Louisiana.  State  v.  Judge  8th 
Jud.  Dist.,  48  La.  Ann.,  503;  19  So. 
Rep.,  475;  State  v.  Paine,  49  La. 
Ann.,  1092;  22  So.  Rep.  316;  In  re 
Chandler,  45  La.  Ann.,  696;  12  So. 
R.  884  (investigation  of  sanity  after 
verdict,  before  sentence). 

Massachusetts.  In  re  Le  Donne, 
173  Mass.,  550;  54  N.  E.  R.,  244 
(custody  of  insane  convict  after 
expiration  of  sentence). 

Mississippi.  Caffey  v.  State,  78 
Miss.,  645;  29  So.  Rep.,  396.  In 
Mississippi,  where  a  person  was 
acquitted  on  the  ground  of  insanity, 
and  the  jury  certified  that  he  was 
still  insane  and  dangerous,  he  was 
sentenced  under  the  law  (Code,  § 
1468)  to  be  confined  in  an  insane 
asylum,  notwithstanding  he  was  an 
epileptic  and  his  fits  and  insanity 
recurred  only  at  irregular  intervals, 
he  at  other  times  being  sane. 

Missouri.  State  v.  Pennington, 
146  Mo.,  27;  47  S.  W.  Rep.,  799; 
Shields  v.  Johnson,  47  S.  W.  Rep., 
107. 

Montana.  State  v.  Peterson,  60 
Pac.  Rep.,  809. 

Nebraska.  Walker  v.  State,  46 
Neb.,  25;  64  N.  W.  Rep.,  357. 

New  York.  People  v.  McElvaine, 
125  N.  Y.,  596;  26  N.  E.  R.,  929 
(discretionary  with  court  to  appoint 
commission  to  inquire  of  sanity  at 
time  of  commission  of  crime);  Re 
Isabella  Jenisch,  3  Abb.  N.  C.,  200; 
People  v.  Beno  Ville,  3  Abb.  N.  C., 
195  (examples  of  commissions  ap- 
pointed under  N.  Y.  law  to  inquire 
into  insanity  of  accused).  See  Code 
Cr.  Pro.,  §  196,  examination  of 
sanity  of  person  sentenced  to  death. 

Ohio.  State  v.  O'Grady,  3  Ohio 
N.  P.,  279;  Brock  v.  State,  22  Ohio 
Cir.  Ct.  R.,  364  (trial  after  restora- 
tion of  sound  mental  condition); 


Rosselot  v.  State,  23  Ohio  C.  C.,  370. 
In  Ohio  a  separate  trial  by  jury  of 
the  question  whether  one  put  on 
trial  is  sufficiently  sane  to  proceed 
is  accorded  (R.  S.,  §7240);  therefore, 
where  a  judge  determines  that 
defendant  is  sufficiently  sane  to 
proceed,  a  verdict  of  guilty  will  be 
reversed. 

Oklahoma.  Maass  v.  Phillips,  61 
Pac.  Rep.,  1057. 

Pennsylvania.  Baranoski's  case, 
9  Pa.  Co.  Ct.,  264  (inquiry  into 
insanity  of  convicts) ;  Com.  v. 
Schmous,  162  Pa.  St.,  326;  29  Atl. 
R.,  644  (disregard  of  plea  of  in- 
sanity when  convict  called  for 
sentence);  Com.  v.  Buccieri,  153 
Pa.  St.,  535;  32  W.  N.  C.,  113;  26 
Atl.  R.,  228  (ditto). 

Texas.  Chase  v.  State  (Tex.  Cr. 
App.),  55  S.  W.  Rep.,  833  (effect  of 
finding  of  insanity  at  preliminary 
inquiry  no  bar  to  subsequent  trial 
for  the  crime);  Lenno  v.  State 
(Tex.  Cr.  App.),  68  S.  W.  Rep.,  684 
(trial  notwithstanding  suggestion  of 
insanity). 

United  States.  United  States  v. 
German,  115  Fed.  R.,  987  (Ky. 
Dist.)  (On  preliminary  finding  of 
insanity  jury  must  be  unanimous, 
to  require  action  of  court). 

Vermont.  State  v.  Kelley  (Vt.), 
52  Atl.  R.,  434  (insanity  suggested, 
but  no  preliminary  trial  of  that 
question  requested). 

Virginia.  Stover  v.  Common- 
wealth, 92  Va.,  780;  22  S.  E.  R.,  874. 

West  Virginia.  State  v.  Harrison, 
36  W.  Va.,  729;  15  S.  E.  R.,  982 
(within  court's  discretion  whether 
it  will  first  order  a  jury  to  inquire 
into  sanity). 

Wisconsin.  French  v.  State,  93 
Wis.  325;  67  N.  W.  Rep.  706;  French 
v.  State,  85  Wis.,  400;  55  N.  W.  R., 
566  (error  to  allow  plea  of  insanity 
and  not  guilty  to  proceed  before  same 
jury  under  law  for  trial  of  special  issue 
of  insanity). 

See  this  work,  vol.  iii.,  p.  579,  for 
a  discussion  of  the  laws  regulating 
the  Care  and  Custody  of  Incompetent 
Persons. 


INSANITY   AS   A    DEFENCE   TO   CRIMINAL   PROSECUTION.      431 

INSANITY   AS  A  DEFENCE  TO    CRIMINAL   PROSECU- 
TION. 

Introductory  Outline  of  the  Law.1— The  prevailing  the- 
ory of  the  law  in  this  country  and  in  England  is  that  capacity  to 
know  the  nature,  quality,  and  right  and  wrong  of  the  act  com- 
mitted is  the  only  test  as  to  responsibility  for  crime.2  The  com- 
mon law  holds  every  man  as  sane  until  proof  to  the  contrary 
is  shown  by  the  party  pleading  insanity  as  a  defence.3 

The  above  rule  holds  good  whether  there  is  total  or  partial 
impairment  of  the  intellect,4  and  though  the  accused  may  have 
been  sane  on  other  subjects  than  that  of  the  criminal  act  he  com- 
mitted;5 it  holds  good  to  the  extent  of  making  him  responsible 
if  he  falls  within  it,  even  though  he  may  be  insane  according  to 
medical  science  on  other  subjects  and  in  other  respects.8 

The  doctrine  that  a  reasonable  doubt  in  the  minds  of  the 
j  ury  of  the  sanity  of  the  accused  requires  an  acquittal  is  accepted 
in  various  States.7  But  evidence  of  loss  of  control  of  the  will, 
or  of  morbid  impulse,  does  not  constitute  a  defence  except  when 
it  demonstrates  mental  uusoundness  of  such  a  character  as  to 
destroy  the  power  of  distinguishing  between  right  and  wrong  as 
to  the  particular  act.8  The  theory  that  loss  of  will  power,  or 
morbid  impulse,  is  an  excuse  for  crime,  though  generally  repu- 
diated by  our  decisions9  and  never  recognized  by  our  statutes,  in 
practice  often  dominates  juries  in  rendering  their  verdicts.  For 

1  See   introductory   exposition    of  N.  J.  Law,  482;    see  infra,  p.   SCO, 

the  reasons  for  the  difference  between  Satisfaction  of  the  Jury, 

medical  and  legal  views  of  mental  4  Carr  v.   State,  96  Ga.,  284;    22 

responsibility,    supra,   p.      349.   See  S.  E.  R.,  570;    State  v.  Palmer,  161 

supra,   p.   427,   for  responsibility  in  Mo.,  152;   61  S.  W.  R.,  651.^ 

tort  of  conspirators  for  acts  of  insane  "Ford  v.  State,  73  Miss.,^734;    19 

conspirator.  So.  R.,  665. 

8  McNaghten's    case,    10   Clark    &  •  State  v.  Kalb,  7  Ohio  X.  P.,  547; 

F.,  H.  L.  Cas.,  200;  1  Car.  &  K.,  130;  5  Ohio  S.  &  C.  P.  Dec.,  738;  State  v. 

Flanagan  v.  People,  52  N.  Y.,  467;  Tyler,  7  Ohio  N.  P.,  443;  5  Ohio  S.  & 

10  Am.  R.,  731;    Lee  v.  State    (Ga.),  C.  P.  Dec.,  588.    Therefore,  it  is  not 

42  S.  E.  R.,  759.     Note  that  even  error  to  refuse  to  charge  a  jury  that 

incapacity  may  be  no  excuse  if  caused  if  a  man  is  insane  he  is  irresponsible 

by  drunkenness,   drugs,  etc.    (infra,  and  should  be  acquitted   of  crime, 

page    481    ff.),  and   not   by   mental  People   v.  Beverly  (Mich.),  66  N.  W. 

disease.  R.,  379;     People  v.   Silverman,    181 

1  But  the  insanity  is  at  most  to  be  N.  Y.,  235. 

proved  only  to  the  satisfaction  of  the  T  See  infra,  p.  559. 

jury,  and  a  charge  to  the  jury  which  8  By  the  weight  of  authority.     But 

leaves  this  element  out  is  erroneous.  see  infra,  p.  455. 

Genz  v.  State,  34  Atl.   R.,  816;  58  "But  see  infra,  p.  455,  and  su/wa, 

p.  350. 


432  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

in  countries  where  English  law  obtains  the  jury  may  acquit  the 
prisoner,  in  disregard,  if  it  pleases,  of  all  instructions  of  the  pre- 
siding justice  and  contrary  to  all  established  or  enaetcd  law; 
and  the  prosecution  has  no  appeal.  Thus,  the  system  of  trial  by 
jury  operates  as  a  modification  or  restraint  upon  the  absolutism 
of  general  law.  However  deplorable  certain  instances  may  be 
where  verdicts  have  gone  upon  "the  unwritten  law,"  or  like 
extra-legal  superstition,  the  "quality  of  mercy  "  which  character- 
izes the  jury  is  its  chief  merit  and  the  strongest  argument  for  its 
continuance,  in  criminal  cases.  Of  late,  courts  and  statutes  have 
conceded  that  intoxication  may  affect  the  element  of  premedita- 
tion or  intent  in  homicide  cases,1  and  may,  therefore,  be  consid- 
ered in  fixing  the  degree  of  crime,  and  hence  the  amount  of 
punishment  to  be  inflicted,  in  all  cases  requiring  proof  of  crim- 
inal intent.  This  principle  of  partial  responsibility  regulating 
the  grade  of  punishment  has  been  thoroughly  discussed  by  Casper- 
Limau 2  and  other  text-book  writers.  Many  years  ago,  in  Dr.  E.  J. 
Muuro's  testimony  in  the  classical  McNaghten  case,3 the  opinion 
was  expressed  that  monomania  may  coexist  with  general 
sanity,  or  even  with  a  high  degree  of  intellect,  or  with  a  nor- 
mal perception  of  right  and  wrong,  and  with  knowledge  of  mur- 
der to  be  a  crime.  The  doctor  testified  that  "he  had  not  the 
slightest  doubt  that  the  prisoner's  usual  perception  was  impaired 
in  consequence  of  his  delusion,  and  that  his  mind  was  so  ab- 
sorbed by  the  contemplation  of  his  fancied  wrongs  that  he  did 
not  distinguish  between  right  and  wrong."  This  seems  to  be 
the  present  status  of  medical  opinion  on  this  subject,  but  an  im- 
portant distinction  must  be  drawn  between  the  fact  of  insanity 
and  the  question  of  legal  responsibility.  Moved  by  the  desire 
of  protecting  society,  the  courts  almost  invariably  hold  that 
unless  the  mental  uusoundness  is  of  such  character  or  degree 
as  to  deprive  the  mind  of  the  ability  of  knowing  the  quality 
and  consequences  of  the  act  done  and  that  it  was  wrong,  there 
shall  be  legal  responsibility.  This  rule  is  the  legal  essence  of  the 
whole  matter,  and  it  avoids  much  of  the  confusion  which  the  Ger- 
man jurists  and  metaphysicians  have  infused  into  this  subject.4 

1  See  infra,  p.  488.  200;  1  Car.  &  K,  130.     See  infra,  p. 

*  Casper-Liman,  "  Handh.  d.    ger.      467. 

Med."  (9th  ed.),  vol.  3,  p.  \\etseq.  *Cf.  Dr.  Mittermaier's   discussion 

s  10  Clark  and  Finnelly,H.  L.  Cases,      of  the  subject,  translated  in  22  Am. 

Jur.,  311,  317. 


INSANITY  AS  A   DEFENCE  TO  CRIMINAL  PROSECUTION.      433 


The  Practice  in  Such  Cases.— While  it  is  not  within  the 
scope  of  this  article  to  treat  in  detail  of  mere  matters  of  practice 
with  respect  to  mental  unsoundness,  it  is  deemed  proper  to  refer 
in  the  subjoined  note  to  a  few  cases  which  illustrate  the  practice 
with  respect  to  the  defence  of  insanity  in  some  substantial  par- 
ticulars.1 


1  JURY  TRIAL. — The  right  to  trial 
by  an  impartial  jury  is  illustrated  by 
French  v.  State,  55  N.  W.  566;  85  Wis., 
400,  where  it  was  held  a  denial  of 
lawful  rights  of  the  accused  to  try 
him  on  the  plea  of  not  guilty  be- 
fore a  jury  which  had  already  dis- 
agreed on  his  special  plea  of  in- 
sanity. See  State  v.  Judge  8th  Jud. 
Dist.,  48  La.  Ann.,  503;  19  So.  Rep., 
475. 

PLEA  OP  INSANITY. — In  some  juris- 
dictions insanity  as  a  defence  must 
be  specially  pleaded;  in  such  juris- 
dictions, in  the  absence  of  the  special 
plea,  evidence  of  insanity  will  be  ex- 
cluded. See  Walker  v.  State,  36 
N.  E.  Rep.,  356;  136  Ind.,  663; 
People  v.  Davis  (Cal.),  36  Pac.  Rep., 
96;  Ward  v.  State,  96  Ala.,  100; 
11  So.  Rep.,  217.  See  as  to  issue  of 
insanity  at  time  of  trial,  People  v. 
McCarthy,  115  Cal.,  255;  46  Pac. 
Rep.,  1073.  In  Texas,  the  penal 
code  (Art.  518)  provides  that  a  plea 
of  guilty  shall  not  be  received  unless 
defendant  is  sane;  where  a  defendant 
pleaded  guilty  and  his  counsel  moved 
for  a  new  trial  on  the  ground  of  his 
insanity,  the  new  trial  was  refused, 
because  his  counsel  were  aware  at 
the  time  of  his  trial  of  the  testimony 
upon  which  they  relied  on  their 
motion.  Burton  v.  State,  25  S.  W. 
Rep.,  782;  33  Tex.  Cr.,  138. 

INSANITY  AFFER  CONVICTION. — 
Though  a  person  may  not  have  been 
insane  at  the  time  of  the  commission 
of  a  crime,  if  he  becomes  insane  after 
conviction  and  before  sentence,  it  is 
contrary  to  the  policy  of  the  law  to 
inflict  the  penalty  of  his  crime  while 
he  remains  insane. 

But  the  examination  into  his  sanity 
at  such  time  is  no  longer  regarded  or 
treated  as  a  right,  but  rather  as  a 
matter  of  indulgence,  in  which  the 
action  of  the  court  is  final  and  not 
subject  to  review.  See  Common- 
wealth v.  Schmous,  162  Pa.  St.,  326; 
III.— 28 


29  Atl.  Rep.,  644;  and  in  such  case,  in 
the  exercise  of  its  discretion,  another 
court  to  which  application  is  made 
for  a  commission  of  lunacy  will  de- 
cline to  issue  it— so  held  where  the 
alleged  lunatic  had  no  estate  and  was 
incarcerated  under  conviction  of 
murder,  punishable  with  death.  In 
re  Clifford  (N.  J.  Ch.),  41  Atl.  Rep., 
356;  57  N.  J.  Eq.,  14. 

PROCUREMENT  OF  EVIDENCE  AS  TO 
INSANITY  OF  ACCUSED.— In  State  v. 
Crisp  (Mo.),  29  S.  W.  Rep.,  699,  the 
court,  after  a  trial  had  been  delayed 
for  three  years,  was  held  justified  in 
refusing  to  adjourn  the  trial  to  enable 
defendant's  physicians  to  examine 
him  so  as  to  express  an  opinion  as 
to  his  sanity;  while  in  Claxon  v. 
Commonwealth,  30  S.  W.  Rep.,  998, 
17  Ky.  Law  R.,  284,  it  was  held  error 
to  refuse  a  continuance  to  obtain 
evidence  of  the  insanity  of  the  ac- 
cused where  his  counsel  was  ap- 
pointed during  the  trial. 

ABUSE  OF  DEFENCE  OF  INSANITY. 
— In  California  it  was  held  proper  to 
refuse  an  instruction  that  the  plea  of 
insanity  has  led  to  abuse  in  tne  ad- 
ministration of  justice,  and  which 
advised  the  jury  that  it  must  be 
examined  with  care.  Marceau  r. 
Travellers  Ins.,  35  Pac.  Rep.,  856. 
On  the  other  hand,  where  the  follow- 
ing instruction  was  given  it  was  held 
not  improper,  viz.:  that  the  defence 
of  insanity  is  often  resorted  to  when 
other  means  of  escaping  punishment 
is  hopeless,  and.  though  when  satis- 
factorily established  it  must  com- 
mend itself  to  the  justice  of  the  jury, 
they  must  examine  it  with  care  lest 
a  mere  counterfeit  of  mental  in- 
firmity furnish  immunity  from  guilt. 
People  r.  Larrabee,  115  Cal..  158;  4«> 
Pac.  Rep.,  922.  See  also  People  r. 
McCarthy,  115  Cal.,  255;  4i\  Pac. 
Rep.,  1073;  People  «>.  Kloss,  llo 
Caf,  567;  47  Pac.  Hep.,  459;  People 
v.  Allender,  48  IV.  Rep.,  1014; 


434  MENTAL.  UNSOUNDNESS—  BECKER   AND   BOSTON. 

A  Statement  of  the  Leading  Authorities  and  Cases. 
— Insanity  as  a  defence  to  a  criminal  prosecution  implies  such  a 
defective  mental  condition  that  the  defendant  did  not  know  the 
act  he  was  committing  to  be  unlawful  and  morally  wrong,  and 
had  not  reason  sufficient  to  apply  such  knowledge  and  to  be  con- 
trolled by  it.1 

The  Penal  Code  of  the  State  of  New  York  (section  20)  pro- 
vides that :  "  An  act  done  by  a  person  who  is  an  idiot,  lunatic, 
or  insane,  is  not  a  crime."  And  in  section  21:  "A  person  is 
not  excused  from  criminal  liability  as  an  idiot,  imbecile,  luna- 
tic, or  insane  person,  except  upon  proof  that  at  the  time  of  com- 
mitting the  alleged  criminal  act  he  was  laboring  under  such  a 
defect  of  reason  as  either  (1)  not  to  know  the  nature  and  quality 
of  the  act  he  was  doing;  or  (2)  not  to  know  that  the  act  was 
wrong. " 2  This  statute  preserves  essentially  the  rule  of  the  com- 
mon law.3 

Unless  a  defendant,  however  insane  he  may  be,  can  be 
brought  within  the  rule,  he  is  treated  the  same  as  a  sane  person. 
Therefore,  insanity  as  a  defence  is  not  inconsistent  with  self-de- 
fence,4 and  the  law  of  self-defence  is  applicable  alike  to  insane 
and  sane.  Nor  is  it  inconsistent  with  deliberation.5 

Such  being  the  measure  of  responsibility,  there  are  with  re- 
spect to  the  rule  no  degrees  of  insanity ;  insanity  which  brings 
its  victim  within  the  exception  to  the  rule  of  responsibility,  en- 
titles him  to  an  acquittal ;  mental  unsoundness  which  does  not  so 
afflict  the  sufferer  as  to  deprive  him  of  the  capacity  indicated, 

People  v.  Hettick,  126  Cal.,  425;   58  People  v.  Holmes  (Mich.),  69  N.  W. 

Pac.  R.,  918.  R.,  501. 

But  insanity  is  a  proper  and  '  McFarland's  Trial,  8  Abb.  Pr. 
legitimate  defence  when  the  act  is  N.  S.,  57;  Revoir  v.  State,  82  Wis., 
the  direct  result  of  the  insanity.  295;  Smith  v.  Com.,  93  Ky.,  318. 
State  v.  Miller,  7  Ohio  N.  P.,  458;  2  People  v.  Silverman,  181  N.  Y., 
5  Ohio  S.  &C.  P.  Dec.,  703;  and  it  is  235,  240:  "Whatever  may  be  the 
error  to  charge  that  the  defence  of  opinion  of  physicians  or  medical  ex- 
insanity  is  viewed  with  disfavor.  perts  on  the  subject,  there  is  but  one 
State  v.  Barry  (N.  D.),  92  N.  W.  R.,  test  of  responsibility  known  to  the 
809.  law  [in  New  York  State]:  that  found 

FUNCTION    OF   COURT. — It  is  the  in  section  21  of  the  Penal  Code,  which 

province  of  the    court  to  define  to  is  but  a  statutory  declaration  of  the 

the  jury  what  in  law  constitutes  such  law,  as  it  had  long  prevailed." 
insanity  as  amounts  to  a  defence;   in          3  But  cf.  Commonwealth  v.  Earner, 

acting  within  this  province  it  should  199  Pa.  St.,  335;   49  Atl.  R.,  60. 
avoid  such  an  argumentative  state-          4  State  v.  Wade,  161  Mo.,  441;    61 

ment    as    to    prejudice    the    jury.  S.  W.  Rep.,  800. 

5  People  v.  Wood,  126  N.  Y.,  249. 


INSANITY   AS   A   DEFENCE   TO   CRIMINAL   PROSECUTION.      435 

does  not  excuse  him  or  lower  the  grade  of  the  crime.1  With 
respect  to  this  rule,  if  the  accused  lias  the  requisite  mental  capac- 
ity, he  is  guilty  of  the  crime  charged  and  is  punished  accord- 
ingly ;  if  he  lacks  the  mental  capacity,  he  is  not  guilty.  The 
only  apparent  exception  is  in  those  cases  where  a  specific  intent 
is  an  element  of  the  crime,  or  where  the  law  reduces  the  grade 
of  the  crime  in  case  the  accused  is  incapable  of  entertaining  a 
specific  intent. 

Some  of  the  decisions,  showing  different  methods  of  stating 
the  proposition,  are  here  collated. 

A  man  is  not  criminally  responsible  for  an  act  when,  by  rea- 
son of  involuntary  insanity  or  delusion,  he  is  at  the  time  incapa- 
ble of  perceiving  that  the  act  is  either  wrong  or  unlawful.2 
To  establish  the  defence  of  insanity  in  a  criminal  case,  it  must 
be  shown  that  the  insanity  was  such  as  to  destroy,  for  the  time 
at  least,  the  consciousness  of  the  distinction  between  right  and 
wrong  in  reference  to  the  act  charged.3  There  must,  to  raise 
the  defence  of  insanity,  be  a  defect  of  reason  from  disease  of  the 
mind,  so  that  the  person  did  not  know  the  nature  and  quality  of 
the  act  he  committed,  or  did  not  know  whether  it  was  right  or 
wrong.4 

Where  the  defendant  was  capable  of  understanding  the 
nature  of  the  act  at  the  time  of  its  commission,  but  incapable  of 
distinguishing  whether  right  or  wrong,  then  he  is  not  responsi- 
ble. The  two  tests  are  in  the  alternative.5  But,  it  is  said, 
the  ability  to  distinguish  right  and  wrong  must  be  wholly  de- 
stroyed.8 

Where  a  person  at  the  time  of  the  commission 7  of  an  alleged 
crime  has  sufficient  mental  capacity  to  understand  the  nature  and 
quality  of  the  acts  constituting  the  crime,  and  the  mental  capac- 
ity to  know  whether  they  are  morally  or  legally  right  or  wrong, 
he  is  generally  responsible  if  he  commits  such  acts,  whatever 

1  Commonwealth  v.  Hollinger  (Pa.  772,    citing    MeNaghten's    case,    10 

O.  &  T.),  2  Dauph.  Co.  Rep.,  13.  Clark  &  F.,  200;  1  Car.  &  K.,  130; 

4  People    v.    Pine,    2    Barb.,    566;  Knights  v.  State  (Xek),  78  N.  W. 

People  v.  Sprague,  2  Park.  Cr.,  43.  Rep.,  508;  58  Neb.,  225. 

'People  v.  Montgomery,  13  Abb.  'Commonwealth?'.  Hollinger  (Pa. 

Pr.    N.    S.,   207,    citing   4    Den.,   9;  O.  &  T.),  2  Dauph.  Co.  Rep.,  13. 

People  v.   O'Connell,   62  How.    Pr.,  « Commonwealth    v.    Barner,    199 

436;    abstr.  s.  c.,   13  N.  Y.  Weekly  Pa.  St.,  335;    49  Atl.  R.,  60. 

Dig.,  95,  affirmed  in  id.,  536.  T  See  People  r.  Burgle,  55  Pac.  R.. 

4  Regina  v.   Burton,   3  F.   &   F.,  998 ;  123  Cal.,  303. 


436  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

may  be  his  capacity  in  other  particulars ;  but  if  he  does  not  pos- 
sess this  degree  of  capacity,  then  he  is  not  so  responsible.1 

If  the  accused  knows  that  the  act  is  wrong,  mere  insane  belief 
that  it  is  justifiable  is  no  excuse.2 

A  conviction  of  murder  may  be  had  if  the  accused  at  the 
time  of  the  killing  had  sufficient  power  of  mind  to  distinguish 
between  the  right  and  wrong  of  the  act,  although  he  suffered 
from  mental  aberration  as  to  other  matters.3 

While  it  is  true  that  discrimination  between  right  and  wrong 
is  not  required  in  general,  but  only  in  regard  to  the  act  in  ques- 
tion, it  is  on  the  other  hand  not  sufficient  for  the  defence  in  a 
given  case  to  rely  simply  on  a  general  state  of  uusoundness  of 
mind.  The  mere  fact  that  a  person  is  insane  does  not  relieve 
him  from,  criminal  responsibility.  The  insanity  must  have  been 
such  as  to  prevent  the  accused  from  distinguishing  between  right 
and  wrong  in  the  particular  act.4 

Temporary  or  Sudden  Insanity.  — The  law  does  not  reject  such 
a  mental  condition  as  a  defence  merely  because  it  is  transitory  or 
temporary,5  or  sudden.6 

Higher  Test  in  Pennsylvania  and  Illinois. — In  Pennsylvania,  in 
a  homicide  case,  it  was  said  that  not  only  must  the  ability 
to  distinguish  right  and  wrong  be  totally  destroyed,  but  the 
insanity  must  amount  to  delusion  controlling  the  will,  ar.d 
make  the  commission  of  the  act  an  overwhelming  necessity. 
This  decision  fixes  a  higher  standard  of  responsibility,  requiring 
the  concurrence  of  more  elements  of  mental  impairment  than 

1  Flanagan  v.   People,   52  N.   Y.,  (Or.),  56  Pac.  R.,  267;   State  v.  Cole 

467;    11  Am.   R.,  731;    Kearney  v.  (Del.),  2  Penne.,  344;  45  Atl.  R.,  391 ; 

State,    68   Miss.,    233;     8   So.,    292;  Maas  v.  Territory,  10  Okl.,  714;  63 

State  v.   O'Neil,  51   Kan.,  651;    33  Pac.  R.,  960. 

Pac.,  287;    Boiling  v.  State,  54  Ark.,  2  Commonwealth  v.  Wireback,  190 

588;     16    S.    W.,    658;     Hornish    v.  Pa.  St.,  138;   42  Atl.  R.,  542;   43  W. 

People,  142  111.,  620;    18  L.  R.  A.,  N.  C.,  506-     Cf.,  however,  Delusions, 

237;  32  N.  E.,677;  State  v.  Mclntosh,  infra,  p.  462. 

40  S.  C.,  349;    17  S.  E.,  446;   State  v.  3  State  v.  Maier,  36  W.  Va.,  757; 

Davis,  109  N.  C.,  780;    14  S.  E.,  55;  15  S.  E.,  991. 

Revoir  v.  State,  82  Wis.,  295;    52  N.  4  Johnson  v.  State,  45  S.  W.  Rep., 

W.,  84;    Smith  v.  Com.,  93  Ky.,  318;  436;  100  Tenn.,  254;  People  v.  Bev- 

17  S.  W.,  868;    Com.  v.  Gerade,  145  erly    (Mich.),    66   N.    W.    R.,     379; 

Pa.  St.,  289;   22  Atl.,  464;    People  v.  Mackin  v.  State,  59  N.  J.  Law,  495; 

Clendennin,  91  CaL,  35;  27  Pac.,  418;  36  Atl.  Rep.,  1040. 

State  v.  Schafer,  116  Mo.,  96;    22  S.  5  People  v.   Ford    (CaL),   70  Pac. 

W.,  447;   State  v.  Zorn,  22  Ore.,  591;  R.,  1075. 

30  Pac.,  317;   Lovegrove  v.  State,  31  6  Massengale  v.  State  (Tex.),  6  S. 

Tex.  Cr.  R.,  491;    State  v.  Branton,  W.  R.,  35. 


GENERAL   RULES   IN   FIXED    OR   COMPLETE    INSANITY.       437 

any  other  case  cited.1  A  similar  combination  of  the  two  testa 
has  been  adopted  in  Illinois.1 

General  Rules  in  Cases  of  Fixed  or  Complete  In- 
sanity.— Having  referred  to  the  leading  cases,  it  now  remains 
for  us  to  point  out  the  following  general  rules  as  to  irresponsi- 
bility in  cases  of  fixed  or  complete  insanity. 

Mental  States  of  Absolute  Irresponsibility. — These  states  are 
called  complete  idiocy,  general  mania,  general,  permanent,  and 
fixed  insanity.  The  first  attempt  to  point  out  precisely  three 
conditions  of  insanity  in  which  the  civil  and  criminal  responsi- 
bilities are  unequally  affected  was  made  by  Lord  Hale.  He 
divided  insanity  into  partial  insanity  as  to  certain  subjects, 
partial  as  to  degree,  and  total  insanity.  The  latter,  he  held,  ex- 
cused crime,  partial  insanity  did  not.2 

1.  Complete  idiocy  creates  exemption  from  crime  and  crimi- 
nal responsibility  under  all  circumstances.     For  "an  idiot  is  a 
person  without  understanding,  and  who  is  legally  presumed 
never  likely  to  have  any";3  and  where  there  is  no  reasoning 
power  at  all  there  cannot  be  capacity  for  responsible  discrim- 
ination in  any  particular  case.     Therefore  idiots — in  the  proper 
meaning  of  this  term — have  always  been  considered  at  law  in- 
capable of  crime. 

2.  A  similar  conclusion  may  be  drawn  as  to  general  or  fixed 
insanity.     A  person  cannot  be  lawfully  punished  for  an  act 
which  was  committed  by  him  while  in  such  a  state  of  insanity.4 

The  causes  producing  unsoundness  of  mind  are  irrelevant  to 
the  question  of  irresponsibility.  Whenever  general  or  fixed  in- 
sanity is  proved,  the  cause  by  which  it  has  been  produced  in  a 
given  case  is  wholly  irrelevant  as  to  the  question  of  irresponsi- 
bility. This  rule  goes  so  far  that  "where  a  person  is  insane  at 
the  time  he  commits  the  crime  he  is  not  punishable,  although 
such  insanity  be  remotely  occasioned  by  undue  indulgence  in 
spirituous  liquors,  or  from  what,  in  a  moral  sense,  is  a  criminal 
neglect  of  duty."* 

1  Commonwealth    v.    Earner,    199  v.  Coleman,  1  X.  Y.  O.  R.,  2;  Autro- 

Pa.   St.,   335;   49  Atl.    R.,  60;    cf.  mont ».  Fire  Aasn.,  48  N.  Y.  St.  Rep., 

Hopps  v.  People,  31  111.,  385;  83  Am.  43;  65  Hun,  477:  20  N.  Y.  Supp.,  345. 

Dec.,  231;  Lilly  v.  People,  148  111.,  467.  But  see  as  to  the  meaning  of  "in- 

*  Pleas  of  the  Crown,  30.  sanity''  in  this  connection  su//ra,  p. 

3  Supra,  p  351.  350.  " 

4  People  r.  McKlvnine,  125  N.  Y.,  •  "Am.  and  Enp.  Kncy.  of  Law, 
600;  36  N.  Y.  St.  Rep.,  181;    People  1st  ed.,  vol.  iv.,  p.  694. 


438  MENTAL  UNSOUNDNESS — BECKER  AND    BOSTON. 

States  of  Mental  Insufficiency  or  Abnormality 
Consistent  with  Criminal  Responsibility. — General 
Views. — Leaving  these  last-mentioned  states  of  palpable  irre- 
sponsibility as  indicated  by  complete  idiocy  or  fixed  and 
complete  mania,  we  may  conclude  that  each  case,  to  be  one 
of  irresponsibility,  must  contain  in  itself  the  following  elements: 
(1)  The  mental  defect — insufficiency  or  abnormality — of  the 
individual  who  committed  the  act  in  question  must  appertain, 
at  the  time  of  its  commission,  to  the  proper  categories  of  idiocy, 
imbecility,  lunacy,  or  insanity;  and  (2)  it  must,  at  the  same 
time,  causatively  refer  to  the  act  itself — that  is,  be  such  as  to  de- 
prive him  of  the  capacity  of  knowing  either  its  nature  and  qual- 
ity or  that  it  was  wrong  and  unlawful.  These  elements  are 
strictly  indispensable;  for,  "no  person  shall  be  excused  from 
punishment  unless  he  be  expressly  defined  and  exempted  by  the 
law  itself. " 1  The  inference  from  this  is  that  irreponsibility  as 
recognized  by  law  is  limited  so  that  not  every  kind  and  degree, 
be  it  even  morbid,  of  mental  infirmity  or  abnormality,  whether 
congenital  or  acquired,  permanent  or  temporary,  renders  the 
individual  irresponsible  in  a  given  case,  even  though  it  (1)  in- 
fluences actually  and  seriously  his  judgment  in  regard  to  right 
and  wrong,  or  (2)  affects  his  power  of  will.2 

Weak-  Mindedness. — If  one  is  of  sound  mind  he  is  responsible 
for  his  criminal  act,  even  though  his  mental  capacity  be  weak 
or  his  intellect  of  inferior  order ;  the  law  recognizes  no  exemp- 
tion from  crime  less  than  some  degree  of  insanity  or  mental  un- 
soundness.3 

1  "Am.  and  Eng.  Ency.  of  Law,"  3  Where  the  accused  was  a  man, 
1st  ed.,  vol.  iv.,  p.  693.  the  fact  that  his  intelligence  was  no 

2  Under  the  New  York  Penal  Code  greater  than  that  of  a  boy  thirteen  or 
(§§  17,21),  partial  or  incipient  insan-  fourteen  years  of  age   does  not  show 
ity  is  not  a  defence,  if  there  is  still  abil-  that  he  was  an  imbecile.    Rodgers  v. 
ity  to  form  a  correct  perception  of  the  State  (Tex.  Cr.  App.),  28  S.  W.  Rep., 
legal  quality  of  the  act  and  to  know  948.    Where  the  accused  was  eighteen 
that  it  is  wrong;    and  if  the  specific  years  old,  had  about  as  much  discre- 
act  is  contemplated  and  the  accused  tionasa  child  of  thirteen,  chose  the 
has  the  power  to  know  whether  it  is  company  of  children,  and  could  not  re- 
wrong  to  do  it,  the  law  presumes  that  member,  if  given  more  than  one  task 
he  has  the  power  to  choose  the  right,  at  a  time,  held  that  this  justified  no 
and  will  not  permit  court  or  jury  to  more  favorable  instruction  than  that 
speculate   as   to  its  possible  non-ex-  if  the  jury  should  find  accused  of  weak 
istence.    People  v.  Taylor,  34  N.  E.  mind,  they  should  consider  that  fact 
Rep.,    275;    138    N.    Y.,    398.     See  in    determining    the    degree    of    his 
infra,  p.  446,  "  Partial  Insanity  "  ;  in-  guilt  and  the  measure  of  his  punish- 
fra,  p.  448,  "Moral  Insanity";  infra.  ment.     Mangrum  v.  Commonwealth, 
p.  457.  "Morbid  Propensity."  39  S.  W.  Rep.,  703;  19  Ky.  Law  R., 


MENTAL   INSUFFICIENCY   OR   ABNORMALITY.  439 

Weakness  of  mind,  falling  short  of  incapacity  to  distinguish 
the  nature  of  the  act,  or  else  between  right  and  wrong,  with  re- 
spect to  the  particular  act,  is  insufficient  to  justify  a  verdict  of 
insanity  of  a  person  under  indictment.1  But  where  the  mental 
weakness  is  of  such  character  as  to  deprive  the  accused  of  the 
power  to  judge  between  right  and  wrong  he  is  not  responsible.2 
The  jury  must  be  satisfied  that  the  prisoner's  mind  is  in  such  a 
state  of  unsoundness  or  disease  as  to  exempt  him  from  responsi- 
bility ;  and  not  merely  that  it  is  so  infirm  as  to  render  him  in- 
capable of  managing  his  own  affairs.3 

The  law  requires  something  more  than  occasional  oddity  or 
hypochondria  to  exempt  the  perpetrator  of  an  offence  from  pun- 
ishment.4 The  theory  that  eccentricities  of  character  and  inor- 
dinate passion  can  render  a  sane  man  incapable  of  committing 
any  offence  which  involves  deliberation  is  wholly  untenable.5 
Where  the  acts  of  the  accused  were  such  as  to  satisfy  the  jury 
that  the  killing  was  the  result  of  premeditation  and  deliberation, 
his  bad  temper  and  eccentricities  of  character,  not  amounting  to 
insanity,  cannot  detract  from  the  effect  of  his  acts  or  shield  him 
from  responsibility  therefor.8 

Neither  melancholia  nor  uncontrollable  passion  excuses  the  pris- 
oner, if  notwithstanding  such  state  of  mind,  he  had  sufficient 
comprehension  of  the  nature  of  the  act  in  which  he  was  engaged 
to  understand  whether  it  was  right  or  wrong.7 

A  desire  for  self-destruction,  and  the  adoption  of  means  to 
secure  it,  do  not  of  themselves  indicate  a  mental  impairment, 
which  has  advanced  to  the  stage  of  irresponsibility.8 

An  irritable  temper  and  an  excitable  disposition  of  mind  do  not 
constitute  insanity;  a  person  possessing  such  mental  peculiarities 

94.     Cf.  Taylor  v.  Com.,  90  Va.,  109;  People  v.  Silverman,  181  N.  Y.,  235; 

19  S.  E.  R.,  739.  Reg.  v.  Burton    (Eng.),  3  F.  &  F., 

'State  v.  Tyler,  7  Ohio  N.  P.,  443;  772. 

5  Ohio  S.  &  C.  P.  Dec.,  588;   State  v.  8  Sindram  v.  People,  1  N.  Y.  Crim. 

Palmer,  161  Mo.,  152:  61  S.  W.  Rep.,  Rep.,  448,  affirmed  88  N.  Y.,  196. 

651;     Commonwealth    v.    Lutz,    10  6  Ibid.    Cf.   People    v.   Leary,   105 

Kulp    (Pa.),    234;     Nelson   v.    State  Cal.,  486;   39  Pac.  U.,  24. 

(Tex.  Cr.  App.),  67  S.  W.  R.,  320.  '  Cole's  Trial,   7  Abb.   Pr.   N.  S., 

*  Hays   v.    Commonwealth    (Ky.),  321.     Compare  People  v.  Montgom- 

33  S.  W.  Rep.,  1104;  17  Ky.  Law  R.,  ery,  13  Abb.  Pr.  N.  S.,  207  (N.  Y.). 

1147  «  People  v.  Taylor,  138  N.  Y.,  408: 

3  People  v.  Kleim,  1  Edm.  (N.  Y.),  see  1  N.  Y.  St.   Repr.,  648;  People 

13.  v.  Carpenter,  102  N.  Y.,  250;  4  N.  \ . 

4Hawe  v.  State,  11  Neb.,  537;  38  Cr.    R.,    187;     People   v.    Haight,   3 

Am.   Rep.,  375;  Anderson  v.  State,  id.,  61:  13  Abb.  N.  C.,  198;  People  v. 

43  Conn.,   514;  21  Am.   Rep.,  669;  Rhinelander,  2  N.  Y.  Cr.  R.,  340. 


440          MENTAL  UNSODNDNESS — BECKER  AND   BOSTON. 

is  more  predisposed  to  an  attack  of  insanity  than  men  in  gen 
eral,  but  is  not  on  that  account  actually  insane ;  such  peculiari- 
ties are  not  of  themselves  evidences  of  insanity ;  and  the  greater 
liability  of  such  a  person  to  give  way  to  passion  cannot  be  con- 
sidered in  determining  his  responsibility,  if  he  is  capable  of  dis- 
tinguishing the  right  or  wrong  of  his  act.1  If  the  prisoner, 
when  he  killed  the  deceased,  was  in  such  a  state  of  mind  as  to 
know  that  the  deed  was  unlawful  and  morally  wrong,  he  was 
responsible,  and  otherwise  he  was  not.2 

Belief  in  spirits  in  itself  is  no  defence,  provided  the  accused 
knew  and  realized  that  the  act  was  wrong.3 

Temporary  Excitement  or  Passion. — The  heat  of 
passion  or  feeling  produced  by  anger,  hatred,  jealousy,  or  re- 
venge is  not  insanity.  The  law  holds  the  doer  of  the  act  under 
such  conditions  responsible  for  the  crime.4 

Jealousy. — In  People  v.  Foy 5  the  defendant  murdered  Henri- 
etta Wilson  in  one  of  the  streets  of  Saratoga  on  the  13th  of  May, 
1892.  He  had  known  her  for  some  time.  A  short  time  before 
the  murder,  he  had  said  to  her  in  a  conversation  in  Saratoga  that 
he  intended  to  go  away.  She  remonstrated,  saying,  as  long  as 
she  had  a  dollar  he  could  have  it,  but  he  replied  that  she  had 
ruined  him,  that  he  was  broke  and  she  was  throwing  him  out, 
that  she  had  another  mash,  and  that  he  was  going  away.  He 
then  went  to  New  York,  where  he  pawned  his  overcoat  to  get  a 
pistol,  returned  soon  after  and  shot  her.  He  said  that  he  had 
had  the  intent  to  kill  himself  also.  On  the  trial  temporary  in- 
sanity was  pleaded  as  a  defence.  It  was  proved  that  he  was 
laboring  under  the  passion  of  jealousy  and  was  very  angry  with 
the  woman.  The  trial  court,  on  being  requested  to  charge  the 
jury  that  insanity  produced  by  anger  or  jealousy,  if  it  incapaci- 
tated the  subject  from  knowing  right  from  wrong,  would  be  a 
defence,  instructed  the  jury  that  "if  there  is  such  a  thing  as 

1  State  v.  Brooks,  57  Pac.  R.,  1038;  respect  to  competency  of  a  testator 

23  Mont.,  146;    People  v.  Leary,  105  to  muke  a  will. 

Cal.,  486;  39  Pac.  11.,  24.  4  People  v.   Foy,  138  N.  Y.,  664; 

*  Willis  v.  People,  32  N.  Y.,  715,  53  N.   Y.  St.   Repr.,  265;  34  N.  E. 

affirming  5  Park.  Cr.,  621.     Compare  Rep.,  396;    People  v.  Nolan,  7  N.  Y. 

Colo's  Trial,  7  Abb.  Pr.  N.  S.,  321;  Cr.  R.,  134. 

Flanagan  v.  People,  supra.  5  138  N.  Y.,  664.     Though  it  may 

3  People   v.   Waltz,   50  How.   Pr.,  reduce  the  degree,  for  instance  from 

214.     See  supra,  p.  399.  for  effect  of  murder  in  the  first,  to  murder  in  the 

belief  in    spirits  on  competency  in  second  degree.     State  v.  Gosnell,  74 

Fed.  Rep.,  734. 


TEMPORARY   EXCITEMENT  OR   PASSION.  441 

genuine  insanity  produced  by  jealousy,  or  revenge,  or  wrath — I 
do  not  mean  turbulence  of  passion  produced  by  a  desire  for 
revenge — but  if  there  is  any  genuine  insanity  produced  by  any 
cause,  then  so  far  as  affecting  the  prisoner,  it  is  the  same  as  any 
other  kind  of  insanity.  The  heat  of  passion  and  feeling  pro- 
duced by  motives  of  anger,  hatred,  or  revenge  is  not  insanity. 
The  law  holds  the  doer  of  the  act  under  such  conditions  respon- 
sible for  the  crime."  The  prisoner  was  convicted  of  murder  in 
the  first  degree  and  sentenced  to  death.  On  appeal  the  charge 
was  held  proper  and  the  judgment  was  affirmed. 

In  People  v.  Nolan 1  the  defendant  was  indicted  for  murder 
in  the  first  degree.  He  had  been  living  with  a  prostitute  who 
supported  him  to  a  certain  extent.  One  day  she  refused  to  do 
so  any  longer.  A  short  time  before  the  crime  he  found  another 
man  in  her  room,  went  away,  purchased  a  pistol,  returned  to  the 
house,  called  her  to  come  down  stairs,  and,  when  she  came,  shot 
her  five  times,  from  which  she  died.  He  fled,  and, « when  subse- 
quently arrested,  stated  that  he  had  shot  the  deceased  because 
"she  had  shook"  him;  he  was  angry  and  did  not  know  what  he 
did.  The  defence  was  insanity.  On  the  trial  it  appeared  that 
when  a  small  boy  he  fell  from  a  banister  and  hit  his  head,  re- 
maining unconscious  a  couple  of  hours;  that  shortly  after  his 
mother's  death,  he  then  being  twelve  years  of  age,  he  woke  up 
in  the  night  and  told  his  brother  that  he  had  seen  his  mother ; 
and  this  occurred  somewhat  frequently  since,  especially  two 
weeks  before  the  shooting ;  that  when  he  was  seventeen  years  old 
he  was  overcome  by  the  heat ;  whether  he  became  unconscious 
or  not  could  not  be  remembered  by  his  brother,  who  gave  these 
statements  as  witness,  but  he  remembered  that  defendant  was 
then  sick  about  a  week.  The  defendant,  at  the  time  of  the  trial, 
was  about  twenty-three  years  of  age,  and  had  been  a  hard  drinker. 
Defendant  was  convicted  of  murder  in  the  first  degree.  On  ap- 
peal it  was  held  that  the  evidence  in  chief  was  sufficient  to  jus- 
tify the  verdict,  and  that  the  evidence  above  quoted  was  entirely 
insufficient  to  prove  insanity,  and  the  judgment  was  affirmed.1 

Frenzy,  induced  by  violent  pawtion,  unless  settled  down  into  a 
state  of  total  derangement,  will  not  excuse  the  commission  of  an 
offence.3  Uncontrollable  frenzy  does  not  excuse,  unless  it  l>e 

1  7  N.  Y.  Cr.  R.,  134.  *  Pienovi's  Case,  3  City  H.   Roc. 

*  115  N.  Y.,  660.  (N.  Y.),  123.     But  it  may  reduce  the 


442  MENTAL  UNSOUNDNESS— BECKER  AND   BOSTON. 

that  of  madness  or  mental  alienation.1    Passion  and  malice  do 
not  show  insanity.2 

Adultery  will  not  justify  a  homicide,  though  it  is  a  provocation 
of  the  gravest  character.  Whether  it  is  murder  or  manslaughter 
for  a  husband  to  kill  his  wife,  when  taken  in  the  act  of  adultery, 
depends  on  whether  the  act  was  done  with  intent  to  kill  or  in  the 
heat  of  passion  engendered  by  the  sudden  discovery,  and  with- 
out intent  to  kill.3  The  overwhelming  conviction  of  domestic 
dishonor,  although  not  such  as  to  prevent  him  from  discriminat- 
ing between  right  and  wrong,  may  nevertheless  deprive  the 
slayer's  act  of  premeditation  and  thus  reduce  the  crime  to  man- 
slaughter.4 

In  People  v.  Osmond 5  the  defendant  was  indicted  for  the 
murder  of  his  wife.  The  defence  was  insanity.  His  wife  had 
entertained  for  a  long  time  improper  relations  with  one  Bur- 
chell.  After  defendant  discovered  these  relations,  he  failed  for 
months  to  make  even  an  attempt  to  punish  Burchell  or  his  wife, 
but  continued  his  intimate  and  daily  association  with  both,  al- 
though constantly  complaining  of  this  discovery.  The  rooms 
where  he  lived  were  a  part  of  the  house  occupied  and  owned  by 
Burchell.  The  defendant,  his  wife,  and  Burchell  went  together 
on  excursions,  and  Burchell  paid  the  expenses  with  defendant's 
acquiescence.  One  day  he  shot  and  killed  his  wife  and  Bur- 
chell, who  was  with  her.  Defendant  testified  that  he  remem- 
bered with  distinctness  all  that  took  place  at  the  interview  in 
which  the  killing  occurred  up  to  the  moment  when  he  saw  Bur- 
chell "nudge  his  wife's  knee,"  but  that  from  that  time  during 
several  hours  and  at  intervals  his  mind  was  a  blank,  except  that 
he  heard  a  shot  before  Burchell  struck  him,  and  that  the  pistol 
went  off  toward  the  corner  where  the  latter  was  shot.  Defend- 
ant's father,  stepmother,  and  brother  testified  that  he  was  some- 
degree  of  the  crime,  for  instance  from  4  Cole's  Trial,  7  Abb.  Pr.  N.  S., 
murder  in  the  first  to  murder  in  the  321.  But  it  is  not  any  previous 
second  degree.  State  v.  Gosnell,  74  conduct  of  the  deceased  which  will 
Fed.  Rep.,  734.  have  this  effect,  at  least  where  the 

'Coles   Trial,  7  Abb.  Pr.    N.   S.       wife  is  the  victim;  it  is  only  when  she 
(N.  Y.),  321.  is  taken  in  adultery  or  immediately 

4  Deas  v.  Wandell,  3  Supm.  Ct.  (T.      afterward  that  the  passion  will  re- 
and  C.),  128  (N.  Y.).  duce  the  degree  of  the  crime.     State 

3Shtifflin  v.  People,  62  N.  Y.,  229;      v.  Callaway,  154  Mo.,  91;  55  S.  W. 
20  Am.   R.,   483,    affirming  4  Hun,       Rep.,    444.     See   Attaway   v.    State 
16;    6    Supm.  Ct.  (T.   and   C.),  215.       (Tex.  Cr.  App.),  55  S.  W.  Rep.,  45. 
See  also  3  Hun,  515;    5  Supm.  Ct.          5  138  N.  Y..  80. 
(T.  and  C.),  572. 


INTERMEDIATE   STEPS   BETWEEN  SANITY   AND   INSANITY.     443 

what  nervous,  irritable,  and  excited  over  the  behavior  of  his 
wife. 

The  defence  set  up  was  the  insanity  of  the  defendant  at  the 
very  moment  of  the  killing,  or,  if  not  insane,  that  his  mind  was 
then  in  such  a  weak  condition  as  to  have  been  overcome,  and 
that  he  was  incapable  of  forming  an  intent  to  commit  murder, 
and  therefore  his  crime,  if  anything,  was  a  lesser  offence. 

The  district  attorney  asked  a  medical  witness  called  by  him 
whether  there  was  any  form  of  insanity  known  to  the  medical 
profession  where  the  mind  temporarily  comes  and  goes,  leaving 
in  the  middle  a  blank.  The  question  was  objected  to  and  ad- 
mitted on  the  ground  that  it  was  a  hypothetical  question.  The 
answer  was  given  in  the  negative.  The  defendant  was  convicted 
of  murder  in  the  first  degree. 

On  appeal  the  judgment  was  affirmed.  Judge  Peckham, 
writing  the  opinion  for  the  court,  stated  that  here  was  no  such 
case  as  a  husband  suddenly  confronted  with  proofs  of  his  wife's 
infidelity,  but  a  full  and  clear  knowledge  of  it  for  months  before 
the  killing  and  an  intimate  and  daily  association  with  both  the 
guilty  parties. 

The  court  also  held  that  when  the  defence  is  temporary  in- 
sanity, or,  if  not  insane,  that  defendant's  mind  was  so  weak  that 
he  was  incapable  of  forming  an  intent  to  commit  murder,  evi- 
dence on  cross-examination  of  defendant's  brother  as  to  whether 
he  would  regard  defendant's  actions  as  irrational  if  he  were 
nervous  or  irritable  after  divorce  papers  had  been  served  on 
him,  was  proper  though  unimportant;  and  also  that  evidence  of 
acts  of  infidelity  on  the  part  of  the  wife  were  not  admissible  to 
show  the  state  of  defendant's  mind  unless  such  acts  were  known 
to  him. 

Intermediate  Steps  Bet-ween  Sanity  and  Insanity.— 
Judge  Cox,  in  charging  the  jury  in  the  celebrated  trial  of  Gui- 
teau  for  murdering  President  Garfield,  said  that  there  is  a  de- 
batable border-line  between  the  sane  and  the  insane,  and  there 
is  often  great  difficulty  in  determining  on  which  side  of  it  a  party 
is  to  be  placed.  It  is  in  these  cases  that  the  difficulty  arises  of 
determining  whether  the  patient  has  passed  the  line  of  moral  or 
legal  accountability  for  his  actions.1 

Illustrative  Cases. — Some  cases  on  this  point  may  here  be  given. 
1  10  Fed.  Rep.,  1C1. 


444  MENTAL   UNSOUNDNBSS — BECKER   AND    BOSTON. 

The  Court  of  Appeals  of  New  York  has  held  that  incipient  in- 
sanity is  not  a  sufficient  excuse  from  criminal  liability  under 
the  New  York  Penal  Code,  section  21,  if  the  accused  has  still 
the  ability  to  form  a  correct  perception  of  the  legal  quality  of 
his  act  and  to  know  that  it  is  wrong.1 

In  an  interesting  case  one  Brush  was  indicted  upon  the  charge 
of  attempted  murder.  On  the  trial,  evidence  was  given  that  he 
imagined  that  some  waiters  in  a  restaurant  in  New  York  City, 
which  he  frequented,  had  drugged  his  food.  He  therefore  com- 
plained to  the  proprietor,  who  remonstrated,  and  he  then  became 
violent  and  aggressive.  On  being  removed  by  force  from  the 
premises  he  drew  a  pistol  and  attempted  to  shoot  those  about 
him.  Examined  by  the  physicians  of  the  Tombs,  he  was  pro- 
nounced insane  and  sent  to  the  State  Homoeopathic  Asylum  for 
the  Insane.  After  a  detention  of  a  few  weeks  he  petitioned  for 
his  release  on  the  ground  of  recovery  of  sanity.  The  Commis- 
sioners of  Lunacy,  by  Hon.  John  Ordronaux,  expressed  the 
opinion  that  his  case  belonged  to  the  borderland  of  insanity, 
that  his  condition  showed  physical  paradoxes  which  indicated 
weakness  and  instability  of  the  brain.  He  had  led  a  roving  life, 
exhibiting  unsteadiness  of  purpose.  An  uncle  an  I  an  aunt  were 
insane.  He  was  oscillating  between  insanity  and  imperfect 
soundness ;  any  disturbance  of  health  might  cause  him  to  cross 
the  boundary.  Nevertheless,  in  a  quiet,  disciplined  mode  of 
life,  he  would  undoubtedly  possess  the  legal  competency  neces- 
sary for  the  exercise  of  all  his  civil  rights.  The  petitioner  had 
been  not,  properly  speaking,  so  much  insane,  as  laboring  under  a 
chronic  irritation  of  brain  which  led  him  to  irrepressible  violence 
when  excited,  because  of  the  existing  state  of  mental  weakness 
which  such  a  brain  always  produces.  No  other  symptoms  had 
exhibited  themselves  in  the  asylum  and  his  natural  condition  had 
been  restored  there.  The  commissioners  recommended  that  he 
should  be  further  observed  during  a  few  weeks,  and  then  dis- 
missed. He  was  accordingly  Inter  discharged,  1877. 2 

It  has  been  held  in  Connecticut  that  a  person  may  be  re- 
sponsible, although  he  is  mentally  incapable  "of  a  careful  weigh- 
ing of  reasons  in  order  to  reach  a  decision."  3 

1  People  v.  Taylor,  138  N.  Y.,  398;          3  State    v.   Swift,   57  Conn.,   496; 
52  N.  Y.  St.  R.,  914.  18  Atl.  Rep.,  664, 

-  Case  of  Rodman  A.  Brush,  3  Abb. 
N.  C.,  225. 


INTERMEDIATE   STEPS     BETWEEN   SANITY    AND    INSANITY.    445 


Aiid  it  was  held  in  Illinois  that  evidence  that  defendant,  in- 
dicted for  shooting  his  wife,  was  in  trouble  with  his  family  and 
was  disturbed  in  mind  and  perhaps  somewhat  excited,  is  not 
sufficient  to  raise  a  reasonable  doubt  as  to  his  sanity.1 

In  Missouri,  a  man  was  accused  of  the  murder  of  his  wife; 
evidence  that  his  wife  had  left  him,  and  he  then  acted  strangely 
for  several  weeks,  talked  disconnectedly,  refused  to  eat,  and 
became  moody  and  melancholy,  was  insufficient  to  establish  in- 
sanity.1 

Epilepsy  and  Kindred  Diseases. — It  has  frequently  been  held 
that  epilepsy  alone  does  not  establish  insanity  which  will  excuse 
from  crime.2  But  evidence  of  epilepsy  may  be  such  as  to  estab- 


1  Montag  v.  People,  141  111.,  75; 
and  cf.  State  v.  Clark,  47  S.  W. 
Rep.,  886;  147  Mo.,  20. 

s  Lovegrove  v.  State,  31  Tex.  Crim. 
Rep.,  491;  21  S.  W.  Rep.,  191.  Com- 
pare Walsh  v.  People,  88  N.  Y.,  458; 
Hall  v.  Com.  (Pa.),  12  Atl.  Rep., 
163;  Fogarty  v.  State,  80  Ga.,  450; 
5  S.  E.  Rep.,  782;  Com.  v.  Buc- 
cieri,  153  Pa.  St.,  535;  32  W.  N.  C., 
113;  26  Atl.  Rep.,  228;  State  v. 
Alexander,  30  S.  C.,  74.  The  follow- 
ing case,  though  not  establishing  any 
legal  principle  with  respect  to  epi- 
lepsy as  a  defence,  is  an  illustration 
of  the  attempted  defence  of  epileptic 
insanity.  In  Commonwealth  v.  Buc- 
cieri  (153  Pa.  St.,  535;  26  Atl.  Rep., 
•  228)  the  defendant  was  indicted 
upon  a  charge  of  murder.  The 
defence  was  epileptic  insanity.  He 
had  been  injured  by  an  explosion 
and  taken  to  a  hospital.  He  asked 
there  a  fellow-patient  to  lend  him 
his  knife,  and  requested  him  to  open 
it  as  his  left  hand  was  disabled. 
About  this  time  a  sister  of  charity 
who  had  been  nursing  him  came  in 
with  a  glass  of  milk  which  she  left 
by  his  bedside  and  went  out  again. 
Defendant  got  up,  followed  her  into 
an  adjoining  room,  and  stabbed  her. 
She  attempted  to  escape  and  ran 
into  the  sick-ward.  He  pursued  her 
and  stabbed  her  again,  causing  her 
death.  The  patient  who  lent  him 
the  knife  raised  a  chair  to  strike  him; 
then  he  stopped  and  gave  the  knife 
back. 

It  was  proved  that  defendant  was 
an  epileptic,  and  it  was  pointed  out 


that  the  tendency  of  the  disease  was 
to  weaken  the  intellect.  The  evi- 
dence, however,  did  not  show  that 
his  intellect  had  been  impaired  or 
that  he  had  been  affected  on  the  day 
of  the  murder.  He  had  had  one 
attack  of  epilepsy  it  the  hospital 
five  weeks  before.  A  witness  who 
knew  the  prisoner  intimately  for  five 
years  had  only  on  two  occasions 
seen  him  act  irrationally  and  had 
never  seen  him  have  an  epileptic 
attack.  No  motive  for  the  crime  was 
shown  except  that  two  or  three  days 
before  the  occurrence  defendant  had 
stated  he  did  not  like  the  sister. 

Defendant  having  offered  evidence 
that  he  was  subject  to  epileptic  fits, 
from  which  he  frequently  fell  and 
lay  in  a  stupor,  and  that  on  recovery 
his  mind  was  disordered,  it  was  held 
proper  for  the  Commonwealth  to 
call  witnesses  who  lived  near  and  saw 
him  often,  to  prove  that  they  never 
saw  him  have  an  epileptic  attack, 
but  often  saw  him  drunk  and  in  a 
drunken  stupor,  and  that  it  was  for 
the  jury  to  determine  whether  or 
not  the  alleged  symptoms  of  epileptic 
insanity  were  only  drunken  prostra- 
tion. The  court  further  held  that 
the  general  charge  was  not  unfair  to 
defendant,  when  his  defence,  insanity, 
as  well  as  the  alleged  cause  of  it, 
epilepsy,  were  prominently  brought 
to  the  attention  of  the  jury,  though 
it  was  assumed  that  the  evidence  did 
not  show  a  motive  for  the  crime: 
but  the  jury  were  told  that  in  con- 
sidering the  other  evidence  of  insanity 
they  might  consider  the  enormity  of 


446  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

lish  irresponsibility  for  crime  on  the  recognized  theory  of  in- 
ability to  know  the  quality  of  the  act,  or  whether  it  was  right  or 
wrong,  if  the  evidence  shows  that  defendant  was  unconscious 
from  epilepsy  and  acted  automatically,  without  design,  purpose, 
or  memory.1 

Partial  Insanity  and  Paranoia.— "There  are  cases  in 
which  a  man's  mental  faculties  generally  seem  to  be  in  full  vigor, 
but  on  some  one  subject  he  seems  to  be  deranged.  He  is  pos- 
sessed perhaps,  with  a  belief  which  every  one  recognizes  as  absurd 
which  he  has  reasoned  himself  into,  and  cannot  be  reasoned  out 
of,  which  we  call  an  insane  delusion ;  or  he  has,  in  addition,  some 
morbid  propensity,  seemingly  in  harsh  discord  with  the  rest  of 
his  intellectual  and  moral  nature.  This  class  of  cases,  for  want 
of  a  better  term,  is  called  'partial  insanity. '  " 2 

By  the  earlier  English  law,  such  insanity  was  not  a  defence 
to  criminal  prosecution. 

The  following  extract  is  from  Dr.  Bay's  "Medical  Jurispru- 
dence " : 

"  Until  quite  recently,  the  course  of  practice  in  the  English 
criminal  courts  has  been  in  strict  conformity  to  the  doctrines  laid 
down  by  Lord  Hale,  that  partial  insanity  is  no  excuse  for  the  com- 
mission of  illegal  acts.  For  instance,  in  the  trial  of  Arnold,  in 
1723,  for  shooting  at  Lord  Onslow,  Mr.  Justice  Tracey  observed 
'that  it  is  not  every  kind  of  a  frantic  humor,  or  something  uncon- 
trollable in  a  man's  actions,  that  points  him  out  to  be  such  a 
madman  as  is  exempted  from  punishment ;  it  must  be  a  man  that 

the  crime  and  the  absence  of  motive,  (judgment  reversed   for    refusal    to 

and    this,    though    the    trial    court  charge  "if  no  motive  had  been  es- 

charged   that   the   enormity   of   the  tablished  for  the  crime  it  should  be 

crime  was  of  itself  not  evidence  of  regarded  as  important  on  the  question 

insanity.  of  epilepsy  "). 

The  defence  being  epileptic  insanity,  1  People  v.  Barberi,  47  N.  Y.  Supp., 
a  combination  of  physical  and  mental  168;  2  N.  Y.  Crim.  R  89. 
infirmities,  and  defendant  having  *  Judge  Cox  in  Guiteau's  case,.  10 
been  on  the  stand  to  testify  to  his  Fed.  Rep.,  161.  See  supra,  article: 
own  insanity,  the  court  said  it  was  Insanity,  vol.  III.,  p.  262,  title 
proper,  in  referring  to  the  evidence  "Paranoia,"  for  the  medical  con- 
on  this  question,  to  direct  the  jury  to  ception  of  partial  insanity.  Where 
consider  the  appearance  and  con-  the  court  properly  states  the  rules 
duct  of  defendant  along  with  the  respecting  criminal  responsibility  of 
other  evidence.  The  conviction  was  persons  of  impaired  mental  capacity, 
affirmed.  See  also  Commonwealth  it  is  not  necessary  that  it  should  use 
v.  Hillman,  189  Pa.  St.,  548;  42  Atl.  the  term  paranoia,  or  delusional 
Rep.  196;  43  W.  N.  C.,  356;  29  Pitts.  insanity.  Muider  v.  State,  113  Ga., 
L.  J.,  268;  People  v.  Barber,  115  772;  39  S.  E.  Rep.,  284. 
N.  Y.,  475;  26  N.  Y.  St.  R.,  184 


PARTIAL     INSANITY    AND    PARANOIA.  447 

is  totally  deprived  of  his  understanding  and  memory,  and  doth 
not  know  what  he  is  doing,  no  more  than  an  infant,  than  a 
brute  or  a  wild  beast,  such  a  one  is  never  the  object  of  punish- 
ment.'"1 

Dr.  Eay  then  proceeds :  "  It  appears,  then,  that  the  law  at 
that  time  did  not  consider  an  insane  person  irresponsible  for 
crime  in  whom  there  remained  the  slightest  vestige  of  rational- 
ity, though  it  did  then,  and  has  ever  since,  deprived  him  of  the 
management  of  himself  and  his  affairs,  and  vitiates  his  civil  acts 
even  when  they  have  no  relation  to  the  delusions  that  spring 
from  his  madness.  That  the  progress  of  science  and  general  en- 
lightenment has  produced  no  improvement  of  the  law  oil  this 
subject  is  abundantly  shown  in  the  strong  declarations  of  Sir 
Vicary  Gibbs,  when  Attorney-General  of  England,  in  the  trial  of 
Bollingham,  in  1812.  'A  man, '  says  he,  'may  be  deranged  in  his 
mind ;  his  intellect  may  be  insufficient  for  enabling  him  to  conduct 
the  common  affairs  of  life,  such  as  disposing  of  his.property,  or 
judging  of  the  claims  which  his  respective  relations  have  upon 
him ;  and  if  he  be  so,  the  administration  of  the  country  will  take 
his  affairs  into  their  management,  and  appoint  to  him  trustees; 
but,  at  the  same  time,  such  a  man  is  not  discharged  from  re- 
sponsibility for  criminal  acts '  (Collinson  on  Lunacy,  657). 
Lord  Erskine  had  previously  given  the  same  doctrine  the  sanction 
of  his  authority,  in  his  celebrated  speech  in  defence  of  Hatfield. 
'I  am  bound,'  he  says,  'to  admit  that  there  is  a  wide  distinction 
between  civil  and  criminal  cases.  If,  in  the  former,  a  man  ap- 
pears upon  the  evidence  to  be  non  compos  mentis,  the  law  avoids 
his  act,  though  it  cannot  be  traced  or  connected  with  the  morbid 
imagination  which  constitutes  his  disease,  and  which  may  be 
extremely  partial  in  its  influence  upon  his  conduct;  but  to  de- 
liver a  man  from  responsibility  for  crime,  above  all  for  crimes 
of  great  atrocity  and  wickedness,  I  am  by  no  means  prepared  to 
apply  this  rule,  however  well  established  where  property  only 
is  concerned. '  " 2 

Some  of  the  more  recent  authorities  on  this  subject  hold- 
ing that  partial  insanity  or  paranoia  is  not  necessarily  sufficient 
to  exempt  a  person  from  criminal  responsibility  are:  People  v. 

1  8  Harprave's State  Trials,  sec.  322,          *  Ray,  "Med.  Jur.,"  voL  i.,  p.  16. 
quoted  in  Ray's  "Med.  Jur.,"  v.  i., 
p.  14 


448  MENTAL   UNSOUNDNESS — BECKER  AND    BOSTON. 

Taylor,1  State  v.  Sckaefer,2  State  v. Harrison,3  State  v.  Maier,4  and 
Eiley  v.  State.5 

MOEAL    INSANITY   AXD   IRRESISTIBLE   IMPULSE. 

Certain  forms  of  partial  insanity  are  also  sometimes  denomi- 
nated "moral  insanity."8  There  are,  however,  diverse  under- 
standings of  the  meaning  of  the  term  "  moral  insanity, "  and  by 
some  it  has  been  used  to  describe  a  degenerate  moral  state  with- 
out any  mental  disease.7 

The  plea  of  moral  insanity,  in  the  phases  of  alleged  "irresist- 
ible impulse"  to  commit  crime;  "emotional  insanity";  deca- 
dence of  will  power,  depriving  the  defendant  of  the  ability  to 
refrain  from  crime ;  so-called  kleptomania,  etc.,  has  had  an  in- 
teresting history  in  the  law  of  insanity.  By  the  prevailing 
American  rule,  the  accused  may  be  responsible  even  though  some 
controlling  mental  disease  was,  in  truth,  the  acting  power  within 
him;  even  though  passion,  which  he  had  not  through  disease 
sufficient  will  power  to  control,  prompted  the  act.  He  is  re- 
sponsible provided  he  knew  the  quality  of  the  act  and  was  able 
to  distinguish  between  right  and  wrong  with  respect  to  it.8 

Although  some  courts  have  expressed  doubts,  alienists  agree 
that  veritable  cases  of  insanity  have  existed  where  some  mental 

1  138  N.  Y.,  398;   52  N.  Y.  St.  R.,  11  Am.  Rep.,  731.     Compare  13  Alb. 
919.  L.  J.,  210,  225;    63  Alb.  L.  J.,  429, 

2  116  Mo.,  96;   22  S.  W.  R.,  447.  459;  People  v.  Wood,  126  N.  Y.,  269; 

3  36  W.  Va.,  729;   18  L.  R.  A.,  224;  36  N.  Y.  St.  R.,  963. 

15  S.  E.  R.,  982.  7In  New  Jersey  emotional  insanity 

4  36  W.  Va.,  757;  15  S.  E.  Rep.,  was  ironically  defined  as  depending 
991;   it  was  held  that  it  was  no  error  "upon  the  mere  emotions  of  the  time 
to  charge  that  if  the  jury  believed  arising  from  some  defective  or  per- 
that    the    accused    did    the    act    as  verted  moral    sense,     which    begins 
charged  in  the  indictment  and  had  on   the   eve  of   the  crime  and  ends 
sufficient   power   to   distinguish   be-  when  it  is  finished."     Genz  v.  State, 
tween  the  right  and  wrong  of  such  34  Atl.  Rep.,  816;  58  N.  J.  Law,  482. 
act,  the  verdict  ought  to  be  guilty,  "The  doctrine  of  moral    insanity 
though  they  believed  he  suffered  from  consisting  of  irresistible  impulse  co- 
mental  aberration  as  to  other  matters.  existent  with  mental  sanity   has    no 

8  44  S.  W.   R.,  498   (Texas),  held,  support     in     psychology     or     law." 

that    a    person    partially   insane     is  State  v.  Lyons,  113  La.,  959;  37  So. 

not  exempt  from  the  consequences  R.,  890.     Cf.  Cawley  v.  State  (Ala.), 

of  his  act,  if,  at  the  time  of  its  com-  32  So.  R.,  327. 

mission,  he  knew  it  to  be  wrong  and  8  People  v.  Carpenter,   102  N.  Y., 

criminal  and  could  apply  that  knowl-  250;  1  N.  Y.  St.  R.,  648;  4  N.  Y.  Cr. 

edge  to  his  own  case.  R.,  178;  People  v.  Walworth,  4  id., 

•See   medical  view  of  Moral  In-  395;   Willis  v.  People,  32  N.  Y.,  717; 

sanity,  vol.  III.,  p.  243,  title  "Moral  State  v.  Knight,  95  Me.,  467;  50  Ati. 

Insanity."   See  N.  Y.  Penal  Code,  sec.  R.,  276;  55  L.  R.  A.,  373;  and  cases 

20;  Flanagan  v.  People,  52  N.  Y.,467;  cited  in  the  last  note  and  infra. 


MORAL,   INSANITY.  449 

disease  or  lesion  destroyed  the  will,  subjecting  it  to  the  whim  of 
every  flaming  passion,1  without  also  destroying  the  rational 
power  of  discriminating  between  right  and  wrong. 

The  learned  but  dogmatic  Baron  Eolfe  said,  in  the  English 
case  of  Eegina  v.  Allunt,2  where,  on  the  trial  of  an  indictment 
for  poisoning,  the  defendant  was  alleged  to  have  acted  under 
some  moral  influence  which  he  could  not  resist,  that  "every 
crime  was  committed  under  an  influence  of  such  a  description ; 
and  the  object  of  the  law  was  to  compel  people  to  control  these 
influences."  Yet  there  would  seem  to  be  a  distinction  between 
an  emotional  impulse  which  a  person  cannot  control,  perhaps  by 
reason  of  a  brain  lesion,  and  one  which  he  does  not  control  be- 
cause he  is  a  criminal. 

"Without  doubt  the  main  reason  which  has  impelled  the  courts 
and  legislatures  to  adhere  to  the  common-law  rule  in  Mc- 
Naghteu'scase,3  that  ability  to  distinguish  between  the  right  and 
wrong  of  it  is  substantially  the  only  test  of  responsibility  for  a 
criminal  act,  and  to  refuse  to  adopt  the  inability  to  choose  be- 
tween right  and  wrong  as  an  additional  test,  is  the  protection  of 
the  public.  "Emotional  insanity"  and  "irresistible  impulse" 
would  offer  a  dangerous  facility  of  escape  from  just  punishment 
and  salutary  separation  from  society,  to  the  depraved  and  vicious. 
For  the  margin  between  disease  of  the  brain  causing  such  pro- 
pensity to  unlawful  acts,  and  mere  depravity,  moral  turpitude,  or 
criminality,  is  slender.  More  than  now  even,  and  more  justly,  the 
criticism  of  the  administration  of  criminal  justice  would  be  made 
that  almost  any  homicidal  degenerate  who  is  rich  enough  to  hire 
experts  can  raise  a  reasonable  doubt  of  his  sanity  and  escape 
punishment.  It  will  be  long  before  in  every  court  the  defend- 
ant who,  knowing  that  what  he  did  was  wrong,  nevertheless  did 
the  act  because  he  had  so  weak  and  diseased  a  will  that  he  could 
not  resist  the  impulse,  will  be  held  any  less  a  criminal  than  he 
is  a  menace  to  society. 

Able  courts  which,  in  the  light  of  the  most  recent  studies  of 
learned  alienists,  have  decided  for  the  first  time  or  re-examined 

1  "A  helpless  puppet  in  the  hands  People,  52  N.  Y.,  467,  as  Rogers  v. 

of  Briarean  passions,"  Robertson,  J.,  Allunt.     Quoted    also   in    People   v. 

in  Smith  v.  Com.,  1  Duv.  (Ky.),  224.  Waltz,  50  How.  Pr.  (N.  Y.),  204. 

Cf.  Professor  Fisher's   article  on  In-  3 10  Clark  &  F.,  200;  1  Car.  &  K. 

sanity,  supra,  p.  273.  130. 

8  Erroneously  cited  in  Flanagan  v. 
III.— 29 


450  MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 

this  question,  adhere  to  the  traditional  view.  In  a  Maine  case  the 
trial  judge  was  asked  to  instruct  the  jury  that  the  right-aud- 
wroug  test  has  proved  to  be  insufficient  and  unsatisfactory. 
The  defendant  sought  to  rely  upon  a  plea  of  uncontrollable 
insane  impulse.  The  court  refused  the  instruction  asked.  On 
appeal  the  Supreme  Court  declared  that  the  test  of  responsibility 
consisting  of  capacity  to  understand  the  nature  and  quality  of 
the  act  and  distinguish  between  the  right  and  wrong  of  it  is  the 
only  proper  legal  criterion,  and  when  fully  explained  to  the  jury 
in  its  application  to  special  facts  and  circumstances  will  always 
be  found  adequate  to  meet  the  demands  of  justice  and  humanity 
to  the  accused  as  well  as  to  insure  the  protection  and  safety  of 
the  public.1 

IMPULSIVE   INSANITY   OE  INSANE  IEEESISTIBLE 
IMPULSE. 

STATES  EEJECTING  THE  THEORY. 

Following  the  rules  announced  by  Tindal,  C.  J.,  andMaule,  J., 
in  McNagh ten's  case,2  the  courts  of  California,3  Kansas,4  Maine,5 
Maryland,8  Michigan,7  Minnesota,8  Mississippi,9  Missouri,10 
Nebraska,11  Nevada,12  New  Jersey,13  New  York,14  Oklahoma,15 
Oregon,16  South  Carolina,17  South  Dakota,18  Tennessee,19  Texas,20 

1  State  v.  Knight,  95  Me.,  467;  50          9  Cunningham  v.   State,   56  Miss., 
Atl.  R.,  276;  55  L.  R.  A.,  373;   Maas      269;  31  Am.  R.,  360. 

v.  Territory,   10  Okl.,  714;  63  Pac.  10  State   v.   Soper,    148    Mo.,    217 

R.,  960;  53  L.  R.  A.,  814.     See  also  49  S.  W.  R.,  1007. 

cases  cited  infra,  p.  455,  and  an  able  u  Hawe  v.  State,  11  Neb.,  537;  38; 

and    exhaustive    argument    for    the  Am.  R.,  375. 

irresistible-impulse  test  by  Professor  12  State  v.  Lewis,  20  Nev.,  333. 

W.  H.  Parry  in  63  Alb.  Law  Jour.,  13  Genz  v.  State,  59  N.  J.  Law,  488; 

429,  459.  37  Atl.  R.,  69. 

2  10  Clark  &  F.,  200;  1  Car.  &  K.,  >4  Flanagan   v.  People,    52   N.    Y., 
130;    applied  in  Reg.  v.  Haynes,   1  467;  11  Am.  R.,  731. 

Fost.  &  F.,  666.  15  Maas  v.  Ty.,  10  Okl.,714;  63  Pac. 

'People  v.  Hubert,  119  Cal.,  216;  R.,  960;  53  L.  R.A.,  814;   Turner  v. 

51   Pac.   R.,   329;    People  v.  Trebil-  Ty.,  82  Pac.  R.,  650. 

cox,  86  Pac.  R.,  684.  '6  People  v.  Owens,  56  Pac.  R.,  251. 

4  State  v.  Mowry,  15  Pac.  R.,  282.  »  State  v.  Levelle,  34  S.  C.,    126; 

5  State  v.  Knight,  95  Me.,  467;  50  13  S.  E.  R.,  319. 

Atl.  R.,  276;  55  L.  R.  A.,  373.  18  State  v.  Leehman,  2  S.  D.,  171; 

6  Spencer  v.  State,  69  Md.,  28.  49  N.  W.  R.,  3. 

1  People  v.  Finley,  38  Mich.,  482.  >9  Wilcox  v.  State,  94  Tenn.,   106; 

*  Minn.    Penal  Code,  sees.  19,  20;  28  S.  W.  R.,  312. 

State  v.  Scott,  41  Minn.,  365;  43  N.  20  Carter  v.  State,  12  Tex.  500;  62 

W.  R.,  62,  Am.  Dec.,  539;  but  otherwise  as  to 


IMPULSIVE  INSANITY.  451 

and  West  Virginia l  have  explicitly  rejected  insane  irresis- 
tible impulse  as  a  defence. 

In  some  of  these  courts  doubt  was  expressed  whether  there 
was  any  such  thing  as  insane  irresistible  impulse.  Others  admit 
the  possibility,  but  conclude  that  to  apply  it  as  a  test  of  capac- 
ity to  commit  crime  would  be  too  dangerous  and  difficult,  and 
that  in  any  event  an  impulse  sufficiently  strong  to  render  the 
insane  person  governed  by  it  irresponsible  must  generally  l>e 
characterized  by  an  inability  to  distinguish  as  well  as  choose  be- 
tween right  and  wrong.2  In  Pennsylvania  and  Illinois,  decisions 
appear  to  require  that  in  order  to  be  irresponsible  a  lunatic  must 
be  subject  to  both  irresistible  impulse  and  inability  to  distinguish 
between  right  and  wrong.3  In  Florida  the  statute  provides  that 
the  common  law  of  England  shall  be  in  force,  and  probably  the 
irresistible-influence  doctrine  is  rejected.4 

Illustrative  Cases  Rejecting  the  Theory. — In  the  New  York 
case  of  Flanagan  v.  People*  the  defendant  was  convicted  of 
murder  in  the  first  degree  for  killing  his  wife.  The  defence 
was  insanity.  In  the  Court  of  Appeals,  Judge  Andrews,  in 
delivering  the  opinion  of  the  court  affirming  the  conviction, 
said :  "  We  are  asked  in  this  case  to  introduce  a  new  element 
into  the  rule  of  criminal  responsibility  in  cases  of  alleged 
insanity,  and  to  hold  that  the  power  of  choosing  right  from  wrong 
is  as  essential  to  legal  responsibility  as  the  capacity  of  distin- 
guishing between  them ;  and  that  the  absence  of  the  former  is  con- 
sistent with  the  presence  of  the  latter.  The  argument  proceeds 
upon  the  theory  that  there  is  a  form  of  insanity  in  which  the 
faculties  are  so  disordered  and  deranged  that  a  man,  though  lie 
perceives  the  moral  quality  of  his  acts,  is  unable  to  control 
them,  and  is  urged  by  some  mysterious  pressure  to  the  com- 
mission of  acts  the  consequences  of  which  he  anticipates  but 
cannot  avoid.  Whatever  medical  or  scientific  authority  there 

"kleptomania,"  Harris  v.  State,   18  'Commonwealth    r.    Barner,    199 

Tex.  App.,  287.  Pa.  St.,  335,  supra,  p.  437  ;  r/.  Com. 

1  State   v.   Harrison,    36    W.    Va.,  v.   Hillman,  18!)   Pa.  St.,  f>48:  42  All. 

729;  15  S.  E.  R.,  982;    18  L.  R.  A.,  R.,  196;  43  W.  X.  C.,  3-><>;  29  Pitts. 

224.     See    valuable    note    appended  L.  J.,  268;   Hopps  r.  People,  31  111., 

to  this  case  in  18  L.  R.  A.  385;     83    Am.    l)<>c.,    231;     Lilly   v. 

a  Brannon,  J.,  in  State  v.  Harrison,  People,  148  111.,  467. 

36  W.  Va.,  729,  quoted  infra,  p.  453.  *  Cf.  Davis  r.  State,  32  So.  R.,  822 

Cf.  Com.  v.  Rogers,  7  Mete.  (Mass.),  See  also  U.  S.  v.   Faulkner,  35  Fed. 

500;     Bovard     v.    State,    30    Miss.,  R.,  730. 

600;  Brown  v.  Com.,  78  Pa.  St.,  122.  'See  note  1,  p.  452. 


452  MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 

may  be  for  this  view,  it  has  not  been  accepted,  by  courts  of 
law."1 

In  People  v.  Wai  worth,2  the  defendant  was  indicted  for  the 
killing  of  his  father,  the  well-known  novelist  Mansfield  Tracy 
Walworth.  The  latter  had  been  estranged  from  the  defendant, 
as  well  as  all  his  family,  for  a  series  of  years.  He  had  shown  a 
bad  and  violent  conduct  toward  them,  and,  living  separated  from 
his  family,  used  to  write  outrageous  letters  and  to  utter  violent 
threats  to  them.  In  the  last  week  of  May,  1873,  the  defendant 
was  invited  by  his  uncle  to  accompany  him  to  Europe.  On  the 
31st  of  the  same  month  he  learned  by  a  letter  written  to  his 
mother  by  the  deceased  that  the  latter  interposed  an  obstacle  to 
the  visit  to  Europe  then  contemplated  by  him.  He  then  decided 
to  see  his  father  personally,  for  the  purpose  of  removing  the 
obstacle  and  at  the  same  time  to  relieve,  if  possible,  himself  and 
his  mother  from  the  danger  which  he  feared  from  his  father, 
especially  as  to  her  safety  during  his  absence.  On  Monday,  the 
3d  of  June,  1873,  he  went  from  Saratoga,  where  he  lived  with 
his  mother,  to  New  York.  Here  he  had  an  interview  with  his 
father  at  the  Sturtevant  House,  being  then  alone  with  him  in  a 
room,  and,  when  he  felt  the  result  not  a  satisfactory  one,  killed 
him,  firing  four  shots  at  him.  After  the  deed  he  told  the  hotel 
clerk  that  he  had  killed  his  father  by  four  shots,  and  asked  him 
to  send  for  the  police.  Then  he  dictated  to  the  officer  who  ar- 
rested him  a  telegram  to  his  uncle :  "  I  have  shot  father.  Look 
after  mother. " 

The  defendant  asserted  on  the  trial  that  he  had  had  no  inten- 
tion of  killing  the  deceased.  At  the  hotel,  he  said,  he  requested 
his  father  to  promise  that  he  would  neither  shoot  his  mother,  nor 
insult  her  or  any  of  the  family  any  further.  The  father  an- 
swered, "I  promise,"  but  with  a  look  which  implied  contempt  and 
the  reverse  of  intent  to  keep  the  promise,  after  having  just  put 

1  52 N.  Y., 467;  Peoples.  Walworth,  other   grounds   in    96    N.    Y.,    115; 

4   N.    Y.   Cr.    Rep.,   355;   People  v.  People  v.  Taylor,  138  N.  Y.,  398. 

C'oleman,  1  N.  Y.  Cr.  R.,  1;  People  v.  2  4  N.  Y.  Cr.  Rep.,  355.     The  jury 

Waltz,  50  How.  Pr.,  214;    People  v.  found    the    defendant  guilty  of  mur- 

Carpenter,  1  N.  Y.  St.  R.,  648;  102  N.  der  in    the    second   degree,  and    he 

Y.,  250;  4  N.  Y.  Cr.  R.,  187;  Willis  v.  was  sentenced  to    imprisonment  in 

People,    32   N.   Y.,   715;     People   v.  the  State  prison  at  hard  labor  for  the 

Otto,  38  Hun,  99;  4  N.  Y.  Cr.  R.,  154;  term  of  his  natural  life.     His   sen- 

Moett  v.  People,  85  N.  Y.,  379;  People  tence  was  after  several  years'    im- 

v.  Casey,  31  Hun,  158;  reversed  on  prisonment  commuted  by  the  gover- 
nor, and  he  was  discharged. 


IMPULSIVE  INSANITY.  453 

his  hand  up  to  his  breast  as  if  to  pull  out  a  pistol.  Then  the 
defendant  fired.  He  said  he  remembered  only  that  he  fired  three 
times.  The  question  of  insanity  was  raised  by  the  claim  that 
he  acted  under  an  uncontrollable  impulse,  and  especially  by 
pointing  out  that  he  did  not  recollect  the  number  of  his  shots. 
The  charge  delivered  by  Justice  Davis  to  the  jury  contained  the 
following:  "If  it  be  satisfactorily  shown  that  the  accused  at  the 
time  of  committing  the  act  had  not  the  capacity  to  understand 
what  he  was  doing,  and  to  know  the  consequences  of  his  act, 
and  to  know  that  it  was  wrong,  then  he  is  excused.  But  if  he 
had  capacity  sufficient  to  know  the  legal  and  moral  character  of 
the  act  he  was  doing,  the  fact  that  he  alleges  that  he  had  not  the 
control  of  his  will  in  respect  to  it,  but  that  his  will  was  con- 
trolled by  irresistible  impulse,  is  no  defence." l 

In  Maryland,  in  Spencer  v.  State,2  Spencer  was  indicted  for 
the  crime  of  murder.  The  defence  was  emotional  insanity.  De- 
ceased had  assaulted  the  prisoner's  wife  before  her  marriage. 
After  her  death  the  defendant  called  upon  him,  induced  him  to 
take  a  walk  with  him,  accused  him  then  of  the  assault,  and  shot 
him.  Evidence  was  offered  on  behalf  of  the  defence  to  show 
that  the  prisoner's  wife  attributed  her  illness  to  the  assault ;  that 
her  dead  body  with  scars  inflicted  by  the  deceased  would  appear 
to  the  prisoner  in  his  dreams ;  that  he  was  haunted  with  the  idea 
that  he  would  have  no  peace  of  mind  until  he  had  killed  her 
assailant,  the  deceased ;  and  that  since  the  killing  he  had  found 
rest  and  quiet.  The  court  refused  to  admit  this  evidence,  and 
the  prisoner  was  found  guilty  and  sentenced.  On  appeal  it  was 
held  no  error  to  exclude  such  evidence  without  other  proof  of 
insanity,  and  the  judgment  was  sustained. 

In  Thomas  v.  State 3  it  was  held  that  though  defendant,  ap- 
parently without  motive  and  without  provocation,  shot  deceased 
while  the  latter  was  disputing  with  a  third  person,  the  fact  that 
he  was  subject  to  temporary,  uncontrollable  impulses  to  injure 
any  one  in  front  of  him  is  not  available  as  a  defence,  his  condi- 
tion at  the  time  not  being  shown. 

In  State  v.  Harrison 4  the  defendant  was  indicted  for  murder. 
The  defence  was  insanity,  viz.,  irresistible  impulse.  He  was  a 
homeless  wanderer,  and  was  taken  in  by  a  family  to  do  odd  jobs. 

'  See  note  2,  p.  452.  •  71  Miss.,  345. 

8  69  Md.f  469.  4  36  W.  Va.,  729. 


454  MENTAL,   UNSOUNDNESS — BECKER   AND   BOSTON. 

He  fell  in  love  with  his  employer's  daughter,  a  child  of  the  age 
of  fifteen.  She  refused  to  have  anything  to  do  with  him,  and  he 
became  very  jealous  of  her  other  male  acquaintances.  He  secretly 
procured  a  pistol,  went  to  a  shop  and  purchased  cartridges  and 
laudanum,  and  then  returned  to  the  house  of  his  employer  and 
shot  the  girl.  He  was  subsequently  found  in  the  woods  suffer- 
iug  from  the  effects  of  laudanum.  On  being  questioned  he 
claimed  that  he  did  not  know  why  he  did  the  act.  Convicted 
and  sentenced,  he  appealed.  On  the  appeal,  Justice  Brannou, 
in  sustaining  the  conviction,  expressed  the  following  opinion: 
"This  irresistible-impulse  theory  test  has  been  only  recently  pre- 
sented, and  while  it  is  supported  by  plausible  arguments,  it  is 
rather  refined,  and  introduces  what  seems  to  me  a  useless  element 
of  distinction  for  a  test,  and  is  misleading  to  juries,  and  fraught 
with  great  danger  to  human  life,  so  much  so  that  even  its  advo- 
cates have  warningly  said  it  should  be  very  cautiously  applied 
and  only  in  the  clearest  cases.  What  is  this  irresistible  impulse? 
How  shall  we  of  the  courts  and  juries  know  it?  Does  it  exist 
when  manifested  in  one  single  instance,  as  in  the  present  case, 
or  must  it  be  shown  to  be  habitual,  or  at  least  to  have  evinced 
itself  in  more  than  a  single  instance?  ...  I  admit  the  existence 
of  irresistible  impulse  and  its  efficacy  to  exonerate  from  respon- 
sibility, but  not  as  consistent  with  an  adequate  realization  of  the 
wrong  of  the  act.  It  is  that  uncontrollable  impulse  produced  by 
the  disease  of  the  mind,  when  that  disease  is  sufficient  to  over- 
ride judgment  and  obliterate  the  sense  of  right  as  to  the  acts  done, 
and  deprives  the  accused  of  power  to  choose  between  them. " 

In  South  Carolina,1  on  a  trial  for  murder  where  the  defence 
was  irresistible  impulse,  it  was  shown  that  the  defendant  suf- 
fered from  St.  Vitus's  dtmce  (chronic  chorea),  which  affected  his 
physical  condition ;  how  far  it  affected  his  mind  the  witnesses 
were  not  agreed.  The  defence  requested  the  court  to  charge  the 
jury  that,  if  by  reason  of  mental  derangement  the  prisoner  had 
not  power  to  control  the  disposition  or  impulse  to  commit  the 
deed,  he  should  be  acquitted.  The  court  refusing  to  do  so, 
charged  that  mere  mental  weakness  was  not  sufficient  to  exempt  one 
from  responsibility;  that  it  required  insanity,  and  insanity  to 
the  extent  of  destroying  a  knowledge  of  the  moral  and  legal 
wrongfulness  of  the  act,  to  have  that  effect.  The  prisoner  was 
1  State  v.  Alexander,  30  S.  C.,  74. 


IMPULSIVE   INSANITY.  455 

found  guilty,  and  on  appeal  the  charge  was  approved  and  the 
judgment  was  affirmed. 

STATES  ACCEPTING  THE  THEORY. 

Insaiie  irresistible  impulse,  notwithstanding  capacity  to  dis- 
tinguish between  right  and  wrong,  has  been  accepted  as  a  de- 
fence in  Alabama,1  Arkansas,2  Delaware,3  Georgia,4  Indiana,5 
Iowa,6 Kentucky,7  New  Hampshire,8  Ohio,9  Virginia,10  and  Wis- 
consin.11 In  Vermont12  and  Montana  13  the  theory  has  been  in- 
timated, but  not  actually  so  held." 

Illustrative  Cases  Accepting  the  Irresistible- Impulse  Test. — In  the 
leading  cases  adopting  as  an  innovation  the  irresistible- impulse 
theory,  attempts  have  been  made  to  reconstruct  the  law  of  crim- 
inal insanity  in  accordance  with  the  new  test.  Thus,  in  Ala- 
bama, the  court  said : 15  "  We  think  that  the  inquiries  to  be  sub- 
mitted to  the  jury,  in  every  criminal  trial  where  the  defence  of 
insanity  is  interposed,  are  these: 

"  First :  Was  the  defendant,  at  the  time  of  the  alleged  crime, 
as  a  matter  of  fact,  afflicted  with  a  disease  of  the  mind,  so  as  to 
be  either  idiotic  or  otherwise  insane? 

"Second:  If  such  be  the  case,  did  he  know  right  from  wrong, 
as  applied  to  the  particular  act  in  question  !  If  he  did  not  have 
such  knowledge,  he  is  not  legally  responsible. 

1  Parsons  v.  State,  81  Ala.,  577;  60          "  Butler  v.  State,    102  Wis.,  364; 

Am.  R.,  193.  78  N.  W.  R.,  590. 

*  Green  v.  State,  64  Ark.,  523;  43          J3  State  v.  Kelley,  32  Atl.  R.,  434. 
S.  W.  R.,  973.  13  State  v.  Peel,  23  Mont.,  358;  59 

3  State  v.  Jack,  58  Atl.  R.,  833.  Pac.  R,,  169. 

4  Flanagan  v.  State,  103  CJa.,  619;  u  In    England  (Lord    Denman    in 
30  S.  E.  R.,  550;  where  exercise  of  Reg.  v    Oxford,  9  Car.  &    P.,  525) 
the   will  necessary  to  formation  of  and  New  York  (People  r.  Kleim,  1 
specific  intent  essential.  Edm.,  13,  26),  this  rule  at  one  time 

5  Plake   v.    State,    121    Ind.,    433;  gained  some  authority.     In  Germany 
23  N.  E.  R.,  273;  16  Am.  St.  R.,  408.  and  Austria,  the  "free-will"  test  of 

*  State  v.  Felter,  25  Iowa,  67.  criminal  responsibility  has  complete 

7  Karris  v.  Com.,  1  S.  W.  R.,  729;  acceptance  in  the  codes;    "Deutachea 
Shannahan  v.  Com.,  8  Bush  (Ky.),  Strafgesetzbueh,"  g  51   (translated): 
463;  8  Am.  R.,  465.  "It  is  not  a  punishable  act,  when  the 

8  State  v.  Pike,  49  N.    H.,  399;    6  doer  at  the  time  of  the  commission 
Am.    R.,    533,    professing   to    reject  of  the  act  was  in  a  condition  of  unron- 
evenj    so-called     test     of     criminal  sciousness  or  diseased  derangement 
capacity,  but     really    accepting    the  of  mind,  through  which  the  free  exer- 
irresistible-impulsc    theory;  exhibit-  cie^  of  his  will   was  precluded."    Cf^ 
inn  more  common-sense  than  scien-  "Oesterreichisches  Strafgesetzbuch," 
tific  knowledge.  §  2;  Casper-Liman,  "  Handb.  der  ger. 

9  Blackburn  v.  State,  23  Ohio  St.,  Med.,"  9th  ed.,  vol.  3,  pp.  2, 3,  7-1 1. 
146.  '»  Parsons  v.  State,  81  Ala.,  577;  60 

10  Dejarnette  v.  Com.,75  Va.,  867.       Am.  R.,  193. 


456  MENTAL  UNSOUNDNESS — BECKER  AND  BOSTON. 

"Third:  If  he  did  have  such  knowledge,  he  may  nevertheless 
not  be  legally  responsible  if  the  two  following  conditions  concur : 
(1)  If,  by  reason  of  the  duress  of  such  mental  disease,  he  had  so 
far  lost  the  power  to  choose  between  the  right  and  the  wrong, 
and  to  avoid  doing  the  act  in  question,  as  that  his  free  agency 
was  at  the  time  destroyed;  (2)  and  if,  at  the  same  time,  the 
alleged  crime  was  so  connected  with  such  mental  disease,  in  the 
relation  of  cause  and  effect,  as  to  have  been  the  product  or  off- 
spring of  it  solely." 

In  Indiana,  the  court  said:1  " Though  accused  had  sufficient 
mental  capacity  to  know  right  and  wrong  and  to  comprehend 
the  nature  and  consequence  of  his  acts,  he  is  not  criminally  re- 
sponsible, if  in  consequence  of  the  diseased  state  of  his  mind  he 
lacked  the  will  power  to  resist  an  impulse  to  commit  crime." 

And  in  Georgia,  the  rule  has  been  formulated  as  follows: 
"If  a  man  has  reason  sufficient  to  distinguish  between  right  and 
wrong  in  relation  to  a  particular  act  about  to  be  committed,  he 
is  criminally  responsible.  An  exception  to  this  rule  is,  where  a 
man  has  reason  sufficient  to  distinguish  between  right  and  wrong 
as  to  a  particular  act  about  to  be  committed,  yet,  in  consequence 
of  some  delusion,  his  will  is  overmastered,  and  there  is  no  crimi- 
nal intent;  provided,  that  the  act  itself  is  connected  with  the 
peculiar  delusion  under  which  the  prisoner  is  laboring."2 

Limitations  of  this  Defence. — In  jurisdictions  where  insane 
irresistible  impulse  is  a  defence,  it  of  course  becomes  necessary 
to  determine  whether  morbid  propensity  to  crime  rises  to  the 
point  of  insanity.  And  the  courts  have  been  led  to  declare 
frequently  that  the  defence  must  be  guarded  by  clear  and  strict 
instructions  to  the  jury,  warning  them  of  its  uncertainties  and 
narrow  limits.3 

Kleptomania,  Pyromania,  etc. — Most  or  all  of  the  decisions 
cited  above  have  been  in  homicide  cases.  When  kleptomania 
has  been  alleged,  the  courts  have  sometimes  failed  to  recognize 
it  as  a  mere  variant  of  the  irresistible-impulse  doctrine.  ~~ 

In  a  Pennsylvania  case  it  was  held  that  the  court  will  not 

1  Plake  v.  State,  121  Ind.,  433;  23  (Ala.),  32  So.  R.,  227;  Boiling  v. 

N.  E.  R.,  273;  16  Am.  St.  R.,  408.  State,  54  Ark.,  588;  Choice  v.  State, 

1  Taylor  v.  State,  105  Ga.,  746;  31  Ga.,  424,  473;  Guetig  v.  State,  66 

Adams  v.  State,  123  Ga.,  500.  Ind.,  94;  32  Am.  R.,  99;  State  v. 

*  Parsons  v.  State,  81  Ala.,  567;  Mewherter,  46  Iowa,  88;  State  v. 

60  Am.  R.,  193;  Cawley  v.  State  Lyons,  113  La.,  959;  37  So.  R.,  870. 


UNCONTROLLABLE   PROPENSITY   TO   CRIME.  457 

disturb  a  verdict,  rejecting  the  defeuce  of  kleptomania  in  a  trial 
for  larceny,  as  contrary  to  the  weight  of  evidence,  unless  the 
defeuce  is  overwhelmingly  sustained  by  the  quantity  and  quality 
of  the  evidence.1  By  implication,  this  decision  recognizes  klep- 
tomania as  a  defence.  And  in  Texas,  where  the  irresistible-im- 
pulse doctrine  has  been  clearly  repudiated,2  kleptomania,  defined 
as  "  an  uncontrollable  propensity  to  steal, "  has  been  allowed  as 
a  defence.3 

MORBID,  UNCONTROLLABLE  PROPENSITY  TO  CRIME. 

The  defence  of  partial  insanity  has  often  been  based  upon 
an  asserted  chronic  propensity  to  commit  crime,  or  a  particular 
class  of  criminal  acts.  As  we  have  stated,  the  rule  is  that 
moral  insanity,  so  called,  as  distinguished  from  mental  de- 
rangement, can  never  be  a  defence  to  a  criminal  prosecution. 
Because  a  person  is  degraded,  erotic,  bestial,  degenerate,  un- 
governably passionate,  a  criminal,  in  short,  he  must  not  therefore 
be  unpunished  for  his  crimes.4  Physiologists  have  insisted  that 
such  degeneracy  usually  involved  a  mental  disease  or  abnor- 
mality. But  as  Chief  Justice  Gibson  of  Pennsylvania  remarked,5 
"There  may  be  an  unseen  ligament  pressing  on  the  mind,  draw- 
ing it  to  consequences  which  it  sees,  but  cannot  avoid,  and 
placing  it  under  coercion,  which,  while  its  results  are  clearly 
perceived,  is  incapable  of  resistance.  The  doctrine  which  ac- 
knowledges this  mania  is  dangerous  in  its  relations,  and  can  be 
recognized  only  in  the  clearest  cases." 

Illustrative  Cases. — In  Walker  v.  People9  Walker  was  indicted 
for  the  crime  of  abduction  of  Katie  Hennessy.  The  defence  was 
insanity.  The  defendant  had  enticed  the  girl,  aged  about  eight 
years,  from  the  street  in  front  of  her  parents'  house  in  New 
York,  and  had  taken  her  to  the  upper  part  of  the  city.  The 
attention  of  a  passer-by  having  been  attracted  to  Walker  and  the 
girl,  he  questioned  the  child,  who  said  the  man  was  not  her 
father,  that  he  was  taking  her  away,  and  that  she  wanted  to  go 
home.  Walker  was  then  arrested.  Katie  Hennessy  testified 

1  Com.  v.  Fritsch  (Pa.  O.  and  T.),          8  Harris  v.  State,  18  Tex.  Cr.  Apn., 

9  Pa.  Co.  Ct.  R.,  164.  287;    Looncy  v.   State,    10  Tex.  Cr. 

"  Leache    v.    State,    22    Tex.    Cr.  App.,  520;  38  Am.  R.,  646. 
App.,  279;  58  Am.  R.,  638;    Carter          4  People  r.  Foy,  138  N.  Y.,  664. 
v.  State,  12  Tex.,  500;  62  Am.  Dec.,          'Com.  r.  Mosler,  4  Pa.  St..  264. 
539.  "26  Hun,  67;  1  N.  Y.  Cr.  R.,  7. 


458  MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 

that  while  she  and  the  prisoner  were  together  on  the  street  rail- 
road, he  had  put  his  hands  under  her  clothes.  The  prison  phy- 
sicians Hardy  and  Jackson  testified  that  they  believed  from  ex- 
aminations of,  and  conversations  with,  the  prisoner,  that  he  was 
insane ;  that  he  did  not  recognize  the  gravity  of  his  offence,  was 
afraid  of  the  people  in  the  prison,  was  wandering  and  discon- 
nected in  his  conversation,  was  subject  to  delusions  as  to  an 
imaginary  conspiracy  of  chemists  against  him,  on  account  of 
valuable  discoveries  he  had  made ;  that  his  manner  was  nervous 
and  uneasy,  and  that  he  was  suffering  from  chronic  mania.  Dr. 
Spitzka,  as  witness,  declared  that  the  prisoner  was  perfectly  sane 
and  was  shamming  insanity.  Defendant  had  been  previously 
sentenced  for  rape  to  a  term  of  ten  years  in  the  State  prison  at 
Trenton,  N.  J.,  where  it  was  thought  he  feigned  insanity;  and 
had  also  been  confined  in  the  New  York  City  prison  on  a  charge 
of  assault  on  a  young  woman. 

In  the  abduction  case,  the  prisoner  was  convicted  and  sen- 
tenced to  the  State  prison  for  the  term  of  ten  years.  On  appeal 
to  the  New  York  General  Term,  Justice  Davis  expressed  the  fol- 
lowing opinion:  "Where  the  defence  of  insanity  is  interposed  to 
au  indictment,  the  true  test  of  criminal  responsibility  is  whether 
the  accused  had  sufficient  reason  to  know  right  from  wrong.  If 
he  had  sufficient  intelligence  to  know  it,  whether  he  had  suffi- 
cient power  to  control  or  govern  his  actions  is  a  matter  of  no 
moment  whatever." 

In  the  Court  of  Appeals,  the  opinion  of  Justice  Davis  was 
approved  and  the  judgment  of  conviction  was  again  affirmed.1 

In  United  States  v.  Faulkner 2  the  defendant  was  indicted  for 
mailing  obscene  matter.  Insanity  was  interposed  as  a  defence, 
and  it  was  claimed  that  by  reason  of  masturbation  he  had  be- 
come mentally  irresponsible.  The  court  charged  the  jury  to  the 
effect  that  the  unsoundness,  to  relieve  from  crime,  must  refer 
positively  to  the  offence  charged  and  deprive  the  accused  of  the 
capacity  of  discerning  that  the  act  committed  was  wrong. 

In  England,  Christina  Edmunds,  aged  forty-three,  was  charged  with  the 
wilful  murder  of  a  little  boy  named  Barker.  The  boy  ate  some  chocolate- 
creams,  which  were  bought  at  a  respectable  confectioner's  shop;  half  an 
hour  after,  he  died  with  the  symptoms  of  poisoning  with  strychnine.  The 
presence  of  the  alkaloid  was  subsequently  detected  in  the  contents  of  his 
stomach.  It  was  proved  that  the  prisoner  had  obtained  a  considerable 
amount  of  strychnine  under  false  pretences,  had  got  possession  of  the  drug- 

1  88  N.  Y.,  81.  2  35  Fed.  Rep.,  730. 


UNCONTROLLABLE   PROPENSITY    TO   CRIME.  459 

gist's  poison-book,  and  had  torn  out  leaves  which  recorded  the  purchase. 
It  appeared  that  she  incorporated  part  of  the  poison  with  some  chocolate- 
creams,  and  then  asked  a  small  boy  to  purchase  some  more  creams  for  her; 
when  he  brought  them  she  said  they  were  too  large,  and  sent  them  back  to 
be  changed.  Unknown  to  the  boy  she  substituted  poison  creams,  which 
when  returned  to  the  confectioner,  were  placed  with  his  ordinary  stock  to 
be  sold  in  due  course.  One  or  more  of  these  poisoned  sweets  caused  the  death 
of  the  boy  Barker,  who  was  totally  unknown  to  the  prisoner.  She  also  dis- 
tributed poisoned  sweets  to  many  children  who  became  ill.  At  the  inquest, 
which  was  held  on  the  body  of  the  deceased  (before  being  suspected  of  the 
crime),  she  volunteered  evidence  in  order  to  implicate  the  confectioner  who 
had  sold  the  sweets;  she  also  wrote  anonymous  letters  to  the  father  of  the 
deceased,  inciting  him  to  take  legal  proceedings  against  the  confectioner. 
This  was  not  done  through  malice  toward  the  man,  but  to  divert  suspicion 
from  herself.  She  had  previously  been  accused  of  endeavoring  to  poison  a 
lady,  for  whose  husband  she  had  conceived  a  regard,  and  the  whole  of  this 
elaborately  carried  out  public  poisoning  was  apparently  the  result  of  a  scheme 
to  make  it  evident  that  the  lady's  indisposition  was  also  due  to  poisoned 
sweets,  owing  to  carelessness  of  the  confectioner.  It  was  proved  in  evidence 
that  the  prisoner's  father  on  two  occasions  had  been  under  restraint  and  that 
he  died  in  an  asylum;  that  one  brother  had  epilepsy  and  died  in  Earlswood 
Asylum;  that  a  sister  was  hysterical  and  had  tried  to  throw  herself  out  of  a 
window,  and  that  other  members  of  the  family  had  suffered  from  various 
psychoses.  Expert  physicians  were  called  to  prove  that  the  prisoner  was 
morally  insane:  she  was  -without  intellectual  defect  and  was  free  from  de- 
lusions, but  she  was  indifferent  to  her  position  and  to  the  enormity  of  her 
crime.  She  was  found  guilty  and  was  sentenced  to  death,  but  the  sentence 
was  subsequently  changed  to  detention  in  Broadmoor  Asylum  (Regina  v. 
Edmunds,  C.  C.  C.  1872,  quoted  in  J.  Dixon  Mann,  "Forensic  Medicine,"  etc., 
Philadelphia,  1893.) 

Another  case  quoted  in  Mann's  "  Forensic  Medicine,"  is  the  following:  A 
man,  who  in  his  youth  was  sullen,  uncommunicative,  idle,  sly,  and  treacherous, 
at  an  early  age  evinced  a  disposition  to  torture  domestic  animals  and  to  treat 
cruelly  younger  members  of  the  family.  On  one  occasion  he  took  a  younger 
brother  into  the  fields,  undressed  him,  beat  him  with  long  lithe  willows,  and 
bit  and  scratched  him  about  the  arms  and  upper  part  of  the  body,  threatening 
to  kill  him  with  a  table  knife  if  he  cried  out.  Shortly  after  he  was  apprehended 
for  cutting  the  throat  of  a  horse  belonging  to  a  neighbor,  and  confessed  that 
he  had  maimed  several  other  animals,  and  had  twisted  the  necks  of  fowls  and 
then  concealed  them  in  wood  piles;  he  was  sentenced  to  twelve  months'  im- 

Erisonment.  On  his  discharge  from  prison  he  attempted  to  suffocate  a 
ttle  child  by  piling  clothing,  etc.,  on  the  top  of  it;  he  then  stole  some  money 
from  his  father's  desk,  for  which  act  he  was  sentenced  to  seven  years  in  a 
penitentiary.  After  his  liberation,  being  again  at  home,  he  saw  his  father 
accidentally  cut  his  hand  so  that  it  bled  profusely;  this  seemed  to  excite  him, 
and  he  went  to  a  neighboring  farm-yard  and  cut  the  throat  of  a  horse,  killing 
it.  He  escaped,  and,  whilst  hiding  in  a  wood,  saw  a,  young  girl,  seized  her 
and  committed  a  criminal  assault  on  her.  After  being  about  ten  years  in 
prison  for  this  offence  he  was  set  free,  and  on  his  way  home  from  prison  he 
caught  a  horse,  tied  it  to  a  telegraph  pole  and  mutilated  it  in  a  shocking 
manner,  cutting  a  terrible  gash  in  the  neck,  another  in  the  abdomen,  and 
taking  a  piece  off  the  end  of  its  tongue.  For  this  he  was  tried  and  acquitted  on 
the  ground  of  insanity,  and  was  transferred  to  an  asylum.  After  being  there 
for  five  years  he  made  his  escape,  and  was  only  absent  from  the  asylum  about 
an  hour  when  he  overtook  and  attempted  to  outrage  a  young  girl  almost  in 
sight  of  the  pursuing  attendants.  Besides  all  this  he  was  guilty  of  innumer- 
able acts  of  cruelty  to  fellow-patients  in  the  asylum,  and  also  to  dogs,  cats, 
fowls,  etc.  He  was  a  great  coward  and  was  never  known  to  attack  any  person 
that  would  be  likely  to  offer  resistance..  The  sight  of  blood  had  a  strange 
effect  on  this  man;  his  face  grew  pallid,  he  become  nervous  and  restless,  and, 


4GO  MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON. 

unless  watched,  lost  control  over  himself  and  indulged  in  the  proclivities  for 
which  he  was  notorious.  If  so  situated  that  he  could  not  indulge  his  evil 
propensities  he  was  quiet  and  a  usef  il  man;  he  had  had  a  fair  education  and 
enjoyed  reading  the  newspapers  ani  letters  sent  to  him.  (Hack  Tuke,  Journal 
of  Mental  Science,  1886;  J.  Dixon  Mann,  "Forensic  Medicine,"  Phila.,  1893.) 

Effect  of  Moral  Insanity  on  Degree  of  Crime.  — The  crime  of 
murder  requires  a  specific  intent  to  kill.  Where  degrees  of 
murder  have  been  established,  murder  in  the  first  degree  re- 
quires premeditation.  Insanity  not  destroying  the  capacity  to 
distinguish  between  right  and  wrong  may  nevertheless  lower  the 
crime  of  homicide  from  murder  to  manslaughter  *  or  affect  the 
degree2  by  proving  the  accused  deprived  of  the  capacity  to  pre- 
meditate murder,  or  form  an  intent  to  kill.3 

Melancholia  and  Mania.  — The  general  principle  above 
stated  and  illustrated  was  that  partial  insanity,  as  such,  will  not 
afford  a  legal  excuse  for  crime  unless  the  intellect  of  the  accused 
is  at  the  same  time  deprived  of  the  knowledge  of  right  and 
wrong  in  regard  to  the  act  in  question.  This  principle  applies 
equally  to  all  varieties  of  incomplete  insanity,  and  thus  shows  how 
far  mania  and  melancholia  are  considered  at  law  as  causes  of  irre- 
sponsibility. In  other  words,  their  existence  is  generally  by  itself 
without  any  importance  as  to  the  question  of  guilt  or  innocence. 

With  Respect  to  Melancholia,  we  may  be  allowed  instead  of 
further  explanation  to  refer  to  the  most  significant  case  of  Peo- 
ple v.  Taylor.4  The  defendant  was  convicted  and  sentenced,  be- 
cause he  knew  that  his  deed  was  contrary  to  social  or  legal  com- 
mands. In  the  face  of  this  fact,  his  being  melancholic  could  not 
save  him  from  the  ordinary  consequences  which  the  law  applies 
to  the  crime  of  murder.  Besides  being  melancholic,  he  was  sub- 
ject to  impulses  manifesting  themselves  in  morbid  tendencies,  to 
both  homicide  and  suicide.  When  he  killed  his  fellow-prisoner, 
he  adopted  this  way  of  action  as  a  certain  though  indirect  way 
of  getting  rid  of  his  own  life.  Yet  the  fact  that  his  melancholia 
resulted  in  such  powerful  impulses  could  not  add  any  strength 
to  the  arguments  of  the  defence,  as  we  have  just  seen.5  Besides 
we  may  refer  to  the  English  case  of  Burton,  where  melancholia 
was  also  presented  with  unquestionable  distinctness.6  In  this  case 

1  State  v.  Potts,  100  N.  C.,  457;  6  *  People  v.  Taylor,  138  N.  Y.,  398. 
S.  E.  R.,  657.  'Supra,  p.  444. 

2  Andersen  v .  State,  43  Conn.,  514;  6  Regina  v.  Burton,  3  F.   and   F., 
21  Am.  R.,  669.  772 ;  see  infra,  p.  463. 

*  CJ.  Intoxication,  infra,  p.  488. 


MELANCHOLIA   AND    MANIA.  461 

the  defendant  also  chose  murder  as  the  means  of  causing  his  own 
death,  which  he  had  not  the  personal  courage  to  accomplish 
himself. 

The  case  of  Reidell  in  Delaware  is  interesting  on  account  of 
the  conviction  found  by  the  jury,  although  the  court  was  seem- 
ingly inclined  to  appreciate  more  fully  the  plea  of  melancholia 
made  by  the  prisoner  and  testified  to  by  the  medical  experts. 
One  Eeidell  was  indicted  for  the  murder  of  his  wife.  The  de- 
fence of  insanity  was  sustained  by  expert  opinion  as  melancholia. 
The  court  charged  to  the  effect  that  the  jury  should  acquit  if 
they  believed  the  testimony  as  to  the  harmonious  relations  exist- 
ing previously  between  the  prisoner  and  his  wife,  together  with 
the  testimony  of  experts  that  the  prisoner  had  at  the  time  of  the 
homicide  the  disease  of  melancholia  that  impaired  his  will  power 
and  rendered  him  likely  at  any  time  to  commit  such  an  act  as 
he  was  charged  with.  The  fact  that  he  exhibited  no  remorse, 
but  rather  calm  satisfaction  following  its  commission,  raised  a 
reasonable  doubt  of  the  prisoner's  sanity,  which  the  testimony 
of  witnesses  as  to  his  appearance  and  conduct  did  not  remove. 
The  jury,  however,  found  him  guilty.1 

In  regard  to  mania  the  law  requires,  as  before  stated, 
that  the  same  rule  be  applied  as  to  melancholia:  that  to  be  ex- 
cused from  crime  the  accused  must  be  unconscious  of  the  wrong- 
fulness  of  his  act.  The  question  of  mania  often  arises  in  the 
courts  in  connection  with  temporary  insanity,  either  as  a  single 
and  isolated  phenomenon  or  in  the  form  of  recurrent  insanity. 
Again,  in  such  cases,  mania  frequently  presents  the  type  of  irre- 
sistible impulse.  In  this  regard  we  have  nothing  further  to  note 
in  addition  to  former  statements  of  the  law,  except  that  it  will 
easily  be  understood  that  transitory  mania  generally  meets  with 
no  favorable  consideration  on  the  part  of  the  courts.  For  it 
presents  special  difficulties  even  to  medical  science,  and  the  dan- 
ger of  the  abuse  of  such  a  plea  is  obvious.  Of  course,  speaking 
of  transitory  mania,  we  do  so  in  its  proper  sense,2  leaving  apart 
those  cases  where  any  doubt  could  exist  as  to  whether  the  abnor- 
mal state  of  mind  might  not  be  rather  an  excessive  heat  of  pas- 
sion or  anger.  Thus  limited,  such  mania,  as  a  defence,  when 

1  State  v.   Reidell,  9   Del.,  470;   14      article   on   "  Medical  Aspects  of  In- 
Atl.  Rep.,  550.  sanity,"    vol.   III.,    p.  261,    of   this 

2  See  on  "Mania  Transitoria"  the      work. 


462  MENTAL   UNSOUNDNESS— BECKER   AND   BOSTON. 

occurring  as  a  solitary  phenomenon,  will  be  much  more  difficult 
to  establish  in  our  courts  than  when  a  series  of  previous  mani- 
acal attacks  can  be  shown.  Yet  it  is  a  fact  that  transitory  mania 
is  acknowledged  in  principle  as  a  full  excuse  for  crime,  though 
this  has  not  always  been  the  case.  The  practical  difficulties  of 
proof  in  a  concrete  case  often  paralyze  the  practical  value  of 
that  principle.  On  the  other  hand,  the  existence  of  such  a  form 
of  insanity  was  looked  upon  with  great  suspicion  in  the  case  of 
People  v.  Osmond.1 

Delusional  Insanity. — We  have  seen  that  partial  insanity 
constitutes  an  excuse  from  criminal  responsibility  only  when  it 
obliterates  the  capacity  to  discriminate  between  right  and  wrong. 
The  same  rule  applies  to  delusions.  Delusions  occur  in  all  forms 
of  insanity,  general  as  well  as  partial.  They  are,  as  matter  of 
fact,  mere  symptoms  of  the  illness  itself,  but  they  are  in  a 
medical  sense  not  essential  elements  of  unsoundness.  "Yet  it  is 
a  fact,"  says  a  recent  medical  writer,  "that  delusional  insanity 
appeals  more  cogently  to  the  legal  mind  than  other  varieties. 
Lawyers  attach  much  importance  to  the  presence  of  delusions 
as  a  sign  of  insanity,  and  admit  that  they  may  be  so  dominant  as 
to  disturb  the  judgment  to  a  degree  inconsistent  with  sane  con- 
duct."2 

"  The  test  of  responsibility  where  insanity  is  asserted,  is  the 
capacity  to  distinguish  between  right  and  wrong  with  respect  to 
the  act,  and  the  absence  of  insane  delusions  respecting  the 
same."3 

The  existence  of  delusions  in  any  single  case,  whenever 
proved,  strengthens  the  evidence  of  insanity  otherwise  estab- 
lished, and  alone  it  often  affords  in  trials  the  possibility  of  sus- 
taining the  plea  of  uusoundness ;  and  while  this  is  so  in  re- 
gard to  general  as  well  as  partial  insanity,  its  importance  is  most 
obvious  when  the  latter  comes  in  question,  for  we  have  seen  how 
careful  courts  generally  are  in  dealing  with  such  a  plea. 

Insane  Delusion  Defined.* — In  considering  the  part  which  de- 
lusions take  in  irresponsibility,  being  aware  that  many  different 

1  People  v.  Osmond,  138  N.  Y.,  80;  4  See  Insane  Delusions  in  Relation 
33  X.  E.  Rep.,  739.  And  see  also  to  Contracts,  supra,  p.  357;  in  re- 
People  v.  Casey,  2  N.  Y.  Cr.  R.,  187.  gard  to  wills,  supra,  p.  394,  where 

2J.    Dixon    Mann,    "For.    Med.,"  also  the  legal  concept  of  what  consti- 

P-  3.56.  tutes  an  insane  delusion  is  discussed, 

'  "Am.  and  Eng.  Ency.  of  Law,"  at  some  length. 
1st  ed.,  vol.  iv.,  p.  696. 


DELUSIONAL   INSANITY.  463 

meanings  of  this  term  are  used  in  common  life  and  in  diffeient 
branches  of  science,  we  have  first  to  define  delusions.  Using  the 
term  "insane  delusions "  will  iiot  avail  us  essentially.  Jn  an 
English  case  already  referred  to,  Justice  Wightman  said:  "De- 
lusion means  the  belief  iu  what  did  not  exist." '  This  statement 
is  apparently  not  a  sufficient  definition,  as  it  comprehends  only 
one  logical  element  of  the  term  to  be  defined. 

In  the  Guiteau  case,  Judge  Cox  charged  the  jury  as  follows 
on  this  subject:  "An  insane  delusion  is  never  the  result  of  rea- 
soning and  reflection.  It  is  not  generated  by  them  and  it  cannot 
be  dispelled  by  them.  .  .  .  Whenever  convictions  are  founded 
on  evidence,  on  comparison  of  facts  and  opinions  and  arguments, 
they  are  not  insane  delusions.  The  insane  delusion  does  not  re- 
late to  mere  sentiments  or  theories,  or  abstract  questions  of  law, 
politics,  or  religion.  All  these  are  the  subject  of  opinions, 
which  are  beliefs  founded  on  reasoning  and  reflection.  These 
opinions  are  often  absurd  in  the  extreme,  and  result  from  natu- 
rally weak  or  ill-trained  reasoning  powers,  hasty  conclusions 
from  insufficient  data,  ignorance  of  men  and  things,  credulous 
dispositions,  fraudulent  imposture,  and  often  from  j>erverted 
moral  sentiments.  But  still,  they  are  opinions,  founded  upon 
some  kind  of  evidence,  and  liable  to  be  changed  by  better  exter- 
nal evidence  or  sounder  reasoning.  But  they  are  not  insane 
delusions. " 2 

Citing  and  approving  the  last-mentioned  opinion,  it  was  said 
by  a  Nevada  judge  that  "an  insane  delusion  is  an  incorrigible 
belief,  not  the  result  of  reasoning,  in  the  existence  of  facts  which 
are  either  impossible  absolutely,  or  are  impossible  under  the  cir- 
cumstances of  the  individual."3  And  essentially  to  the  same 
effect  is  the  following  definition:  "The  delusions  which  indicate 
a  defect  of  sanity,  such  as  will  relieve  a  person  from  criminal 
responsibility,  are  delusions  of  the  senses,  or  such  as  relate  to 
facts  or  objects,  not  mere  wrong  notions  or  impressions,  or  of  a 
moral  nature ;  and  the  aberration  must  be  mental,  not  moral,  to 
affect  the  intellect  of  the  individual."4 

1  Regina  v.  Burton,  3  F.  and  F.,  Lewis,  20  Nov.,  333:  22  Pac.  R.,  241; 

772  People  v.  Taylor,  34  N.  E.  Rep.,  275; 

•  10  Fed.  Rep.,  161.  138  N.  Y.,  398;  52  N.  Y.  St.  R.,  91 1; 

'State  v.  Lewis,  20Nev.,333;  22  Thurman  v.  State,  32  \eb.,  224;  4 

Pac    R     241.  N.  W.  R.,  338;    Rolling  ?•.  State,  54 

4  "Am.  and  Eng.  Ency.  of  Law,"  Ark.,  588;  16  S.  W.,  658;    Smith  r. 

1st  ed.,  vol.  iv.,  p.  695.     State  v.  State,  55  Ark.,  259;  18  S.  W.,  237. 


464  MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON. 

By  adopting  this  definition,  we  may  reach  the  conclusion  that 
no  other  delusions  than  those  thus  defined  will  afford  sufficient 
ground  on  which  a  crime  may  be  excused  because  of  the  in- 
sane delusions  of  the  alleged  criminal.  Within  such  limits  the 
law  attaches  especial  importance  to  delusions,  without  having 
much  regard  to  what  particular  psychosis  may  have  produced 
them. 

But  whether  an  insane  delusion  exists  is  a  question  of  fact, 
and  not  of  law,  therefore,  a  court  should  not  instruct  that  a  cer- 
tain belief  constitutes  an  insane  delusion,  but  should  merely  give 
a  correct  definition,  and  leave  it  to  the  jury  to  apply.1 

The  view  held  by  the  New  York  courts  under  the  Penal 
Code,  and  by  the  courts  of  most  of  the  other  States,  as  well  as 
those  of  England,  as  to  what  is  required  to  create  irresponsibility, 
is  that  the  person  in  question,  idiot,  imbecile,  lunatic  or  insane 
person,  be  laboring  under  such  a  defect  of  reason  as  either  not  to 
know  the  nature  and  quality,  or  the  wrongfulness  of  the  act.2 
Applying  this  rule  to  cases  of  delusions,  there  is  but  one  con- 
clusion to  be  reached,  which  is :  That  to  constitute  a  legal  ex- 
cuse from  crime,  the  delusion  must  result  from  a  morbid  state  of 
mind,  and  coincidentally  be  such  as  to  deprive  the  person  of  the 
knowledge  of  the  nature  and  quality  or  wrongfulness  of  the 
act.  Such  are  the  limits  within  which  the  law  recognizes  delu- 
sional insanity.3 

1  People  v.  Hubert,  119  Cal.,  216;  the   case   on   which   to   found   such 
51  Pac.  Rep.,  329;    Merritt  v.  State,  instruction,   it  was  held   on  appeal 
39  Tex.  Cr.  App.,  70;  45  S.  W.  Rep.,  that  the  refusal  to  give  it  was  error, 
21.  and  that  it  was  not   cured  by  an 

2  See  supra,  p.  434.  instruction    that     "an    insane    de- 

3  In  Arkansas,  on  a  trial  for  murder,  lusion    relieves    a   person    from  re- 
where   the    defence    was   temporary  sponsibility    when,   and  only  when, 
insanity,    the    defendant    asked    for  the  facts  or  state  of  facts  believed 
the   following  instruction:     "If  the  in,  under  the  insane  delusion,  would, 
jury  find  from  the  evidence  that  the  if  actually  existing,  have  justified  the 
defendant,  at  the  time  he  fired  the  act."      Smiths.  State,  55  Ark.,  259; 
fatal  shot,  was  acting  under  a  de-  18  S.  W.  R.,  237. 

lusion,  although  able  to  distinguish  In  Nebraska,  on  the  trial  of  an 

right  from  wrong,  and  believed  that  indictment  for  shooting  with  intent 

the  deceased  and  others  had  formed  to  kill,   where  the  defence  was  in- 

a  plot  to  take  away  his  life  or  do  him  sanity,  it  was  held  that  an  instruction 

some  great  bodily  injury,  and  that  that  a  delusion  must  be  of  such  a 

the    deceased    had    an    immediate  character  that  if  things  were  as  the 

design   to   do  so,   and   that   it   was  defendant  imagined  them  to  be  they 

necessary  for  him  to  fire  the  shot  to  would  justify  the  act  springing  from 

protect  his  life  or  prevent  his  receiv-  the  delusion,  is  not  erroneous.    Thur- 

mg  great  bodily  injury,  they  must  man    v.   State,    32    Neb.,    224;     49 

acquit."     There    being   evidence    in  N.  W.,  338.       The   court  closed  its 


DELUSIONAL   INSANITY.  465 

The  legal  consequence  of  this  abstract  principle,  when  it  is 
applied  to  concrete  cases,  is  that  an  insane  delusion  is  not  a  de- 
fence unless  it  would  excuse  the  crime,  if  the  facts  about  which 
it  exists  were  true.1 

Illustrative  Cases. — The  delusion  must  have  a  bearing  on  the 
act  committed ;  it  must  also  be  of  such  a  character  that  the  per- 
son cannot  be  reasoned  out  of  it.  In  a  Nebraska  case  the  de- 
fendant, one  Thurrnau,  was  indicted  for  shooting  with  intent  to 
kill.  Insanity  was  pleaded  as  a  defence.  The  court  charged  the 
jury:  "It  is  not  every  delusion  that  can  be  considered  an  insane 
delusion.  The  delusion  must  be  of  such  a  character  that  if 
things  were  as  the  delusion  pictured  them  to  be,  they  would  jus- 
tify the  act  springing  from  the  delusion.  To  illustrate:  If  a 
person  be  under  the  insane  delusion  that  he  is  the  Almighty 
Himself,  or  is  directly  commissioned  or  commanded  by  the  Al- 
mighty Himself  to  shoot  a  particular  person  that  the  Almighty 
has  decided  must  be  shot,  and  is  moved  by  such  delusion  alone 
to  do  the  shooting,  that  would  be  an  insane  delusion,  because  if 
true  it  would  justify  the  shooting.  But  if  a  person  is  under  a 
delusion  that  a  man  has  done  him  a  mean  trick  and  that  he 
ought  to  be  shot  for  it,  and  the  delusion  moves  the  person  to 
shoot  the  man,  that  is  no  excuse  on  the  ground  of  insane  delu- 
sion ;  because  if  the  person  had  really  done  the  man  a  mean  trick, 
and  he  had  not  just  imagined  it,  it  would  not  have  justified  the 
shooting.  An  insane  delusion  is  like  a  waking  dream:  the  sub- 
ject can  neither  be  reasoned  into  nor  out  of  it.  It  may  throw 
some  light  on  the  application  of  the  subject  to  this  case  to  con- 
sider whether  a  conviction  in  this  case  would  have  a  tendency  to 

instruction    by    saying:      "It    may  lusion  would  only  absolve  from  guilt 

throw  some  light  on  the  application  where  the  facts,  if  real,  would  excuse 

of  the  subject  to  this  case  to  con-  it,  is  incomplete,  in  that  it  fails  to 

sider  whether  a  conviction  in   this  state  what  facts  would  excuse  homi- 

case  would  have  a  tendency  to  pre-  cide;   and  it  was  held  that,  while  the 

vent  a  repetition  of  such  acts."  court     should     have     supplied     the 

In  another  case,  in  Arkansas,  it  was  omission    and    given    the    charge,  a 

held  that  an  instruction  that  "de-  failure  to  do  so  was  not  reversible 

fendant  would  not  be  responsible  if  error.      Boiling   v.    State,    54    Ark., 

he  killed  deceased  under  an  insane  588;  16  S.  W.  Rep.,  658. 

delusion  that  deceased  was    trying  It  would  seem  that  the  last  men- 

to   marry  defendant's  mother,   ana  tioned    legal    test    refers   to  partial, 

that  this  delusion  caused  the  killing,"  rather  than  to  general  insanity, 

was   properly   refused,    as  such   de-  '  Commonwealth  i>.  Wireback,  190 

lusions,  if  true,  would  not  excuse  the  Pa.  St.,  138;  42  Atl.  K.,  542;  43  W.  N. 

act;    and    also    that    an   instruction  C.,  506;   McNaghten's  case,  10  Clark 

asked  by  the  defendant  that  a  de-  &  F.,  200;  1  Car.  &  K.,  130. 
Ill  —30 


466  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

prevent  a  repetition  of  such  acts."  The  verdict  was  guilty.  On 
appeal  the  charge  was  held  correct  and  the  conviction  was 
affirmed. l 

Where  the  accused  had  a  delusion  that  his  wife  was  putting 
poison  in  his  food,  and  murdered  her,  it  was  held  that  as  he 
knew  the  homicide  was  wrong  nevertheless,  his  conviction 
should  be  affirmed.2  And  it  has  been  held  that  an  insane  belief 
that  the  act  was  justified  is  no  excuse,  when  the  accused  knew 
nevertheless  that  it  was  unlawful ;  but  this  last  case  is  close  to 
the  border  line.3  Where  delusions  so  took  possession  of  the  mind 
that  the  defendant  labored  under  the  belief  that  the  community 
and  his  Creator  were  against  him  and  his  soul  was  lost,  and  from 
these  insane  notions  the  act  resulted,  it  was  held  no  crime.  The 
court  said  that  it  makes  no  difference  whether  the  act  was  the 
result  of  general  insanity  or  of  an  insane  delusion  regarding  some 
person  or  subject,  if  at  the  time  of  committing  the  act,  the  ac- 
cused was  laboring  under  the  delusion,  and  the  act  was  the  prod- 
uct of  the  delusion  and  the  accused  did  not  realize  that  he  was 
committing  a  crime,  though  he  may  have  known  right  from 
wrong  in  the  abstract.4 

In  Texas,  one  who  killed  another,  did  so  under  the  insane 
delusion  that  deceased  was  leader  of  a  mob  that  sought  the  slay- 
er's life,  and  by  killing  the  leader,  accused  was  preserving  his 
life  from  the  mob;  held  that  he  was  not  criminally  liable,  as  the 
delusion  if  true  would  have  rendered  the  act  lawful.  The  ac- 
cused was  unable  by  reason  of  his  delusions  to  know  the  nature 
and  quality  of  his  act.5 

Judge  Maynard,  in  delivering  an  opinion  for  the  New  York 
Court  of  Appeals  affirming  a  judgment  of  conviction,  said: 
"Proof  on  the  trial  of  an  indictment  for  murder  that  there  ex- 
isted in  the  mind  of  the  defendant  an  insane  delusion  with  refer- 
ence to  the  conduct  and  attitude  of  the  deceased  will  not  excuse 
the  homicide,  unless  the  delusion  was  of  such  a  character  that 
if  it  had  been  true  it  would  have  rendered  the  act  excusable  or 
justifiable."  Accordingly  it  was  held  that  proof  on  the  trial  of 

1  Thurman  v.  State,  32  Neb.,  224;          'Commonwealth  v.  Wireback,  190 
49     N.     W.    Rep.,    338.      See    also      Pa.  St.,  138;  42  Atl.  R.,  542;  43  W. 
People  v    Ferraro,   161  N.  Y.,  365;      N    C     506 

14  N.  Y.  Cr.  R.,  266;  55  N.  E.  Rep.,          *  State  v.  Miller,  7  Ohio  N.  P.,  458; 

5  Ohio  S.  &  C.  P.  Dec.,  703. 

2  People  v.  Hubert,  119  Cal.,  216;          5  Merritt  v.  State,  39  Tex.  Cr..  70; 
51  Pac.  R.,  329.  45  S.  W.  Rep.,  21. 


THE   M'NAGHTEN   CASE.  46? 

such  au  indictment  of  the  existence  of  a  delusion  in  the  mind  of 
the  defendant  that  the  deceased  was  acting  as  a  spy  upon  the 
defendant  and  had  betrayed  a  plan  of  escape,  did  not  affect  the 
criminal  nature  of  the  act.  Under  the  provision  of  the  Penal 
Code  (section  21)  proof  of  partial  or  incipient  insanity  is  not 
sufficient  to  require  an  acquittal,  if  there  is  still  the  ability  to 
form  a  correct  perception  of  the  quality  of  the  act,  and  to  know 
that  it  was  wrong.1 

The  McNaghten  Cane,  Historically  a  Leading  Case  on  Delusional 
Insanity. — This  delusional  test2  was  formally  and  expressly  recog- 
nized in  the  often  quoted  English  McNaghteu  case.  Daniel 
McNaghten  was  tried  at  the  Central  Criminal  Court,  London,  in 
March,  1843,  for  the  murder  of  Mr.  Edward  Drummond,  the 
private  secretary  of  Sir  Eobert  Peel.  The  judges  sitting  were 
Lord  Chief- Justice  Tindal,  Justices  Williams  and  Coleridge.  Sir 
William  Follett,  the  solicitor-general,  represented  the  prosecu- 
tion, Mr.  Cockburn  (afterward  Lord  Chief -Just  ice)  was  leading 
counsel  for  the  defendant.  The  evidence  established  that  the 
premeditated  intention  of  the  prisoner  had  been  to  shoot  Sir 
Eobert  Peel.  On  the  20th  of  January,  1843,  he  watched  his 
house  with  that  intention,  and  seeing  Mr.  Drummond  come  out 
from  the  house,  he  followed  him  and  shot  him  without  any  pre- 
vious altercation  or  provocation,  in  the  mistaken  belief  that  he 
was  shooting  Sir  Eobert  Peel. 

The  defence  was  insanity.  The  counsel  for  the  defendant 
stated  expressly  that  he  did  not  bring  forward  this  as  a  case  of 
complete,  but  of  partial  insanity. 

The  Lord  Chief -Justice,  as  quoted  by  Lord  Lyndhurst  in  his 
speech,  summed  up  the  case  as  follows  in  his  address  to  the 
jury:3  "The  point  which  at  last  will  be  submitted  to  you  will  be, 
whether  or  not  on  the  whole  of  the  evidence  you  have  heard, 
you  are  satisfied  that  at  the  time  the  act  was  committed,  for  the 
commission  of  which  the  prisoner  stands  charged,  he  had  not 
that  competent  use  of  his  understanding  as  not  to  know  what  he 
was  doing  with  respect  to  the  act  itself— a  wicked  and  a  wrong 
thing;  whether  he  knew  it  was  a  wicked  or  a  wrong  thing  he  had 
done,  or  that  he  was  sensible  at  the  time  he  committed  this  act 
that  it  was  contrary  to  the  laws  of  God  and  man.  Undoubtedly 

1  People  v.  Taylor,  138  N.  Y.,  398;          '  Supra,  p.  462-4. 
ntjn-a,  p.  400.  *  Hansard,  vol.  67,  p.  724. 


468  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

if  lie  was  not  so  sensible,  he  is  not  a  person  so  responsible.  If 
upon  balancing  the  evidence  in  your  minds  you  should  think  the 
prisoner  capable  of  distinguishing  right  from  wrong  with  respect 
to  the  act  with  which  he  stands  charged,  he  is  then  a  responsible 
agent,  and  liable  to  the  penalties  imposed  upon  those  who  com- 
mit the  crime  of  which  he  is  accused. " 

Clark  and  Finnelly,  Vol.  X.,  page  202,  give  a  report  of  the 
summing  up,  in  which  in  one  passage  a  very  material  difference 
occurs.  "The  question,"  said  Lord  Chief- Justice  Tindal,  in 
charging  the  jury,  "to  be  determined  is  whether  at  the  time  the 
act  in  question  was  committed  the  prisoner  had  or  had  not  the 
use  of  his  understanding  so  as  to  know  that  he  wras  doing  a 
wrong  or  wicked  act.  If  the  jurors  should  be  of  the  opinion 
that  the  prisoner  was  not  sensible,  at  the  time  he  committed  it, 
that  he  was  violating  the  laws  both  of  God  and  man,  then  he 
would  be  entitled  to  a  verdict  in  his  favor;  but  if  they  are  of 
the  opinion  that  when  he  committed  the  act  he  was  in  a  sound 
state  of  mind,  then  their  verdict  must  be  against  him. "  Verdict, 
not  guilty  on  the  ground  of  insanity.1 

This  verdict  and  the  question  of  the  nature  and  extent  of  the 
unsoundness  of  mind  which  would  excuse  the  commission  of  a 
felony  of  this  sort  having  been  made  the  subject  of  debate  in  the 
House  of  Lords,2  it  was  determined  to  take  the  opinion  of  the 

1  Hack      Tuke,      "Dictionary     of  to  be  submitted  to  the  jury,  when  a 
Psychological      Medicine,"      Phila.,  person  alleged  to  be  afflicted   with 
1892,  vol.  i.,  p.  304;  C.  Clark  and  W.  insane    delusion    respecting    one    or 
Finnelly,  "Reports  of  Cases  decided  more  particular  subjects  or  persons, 
in   the    House   of   Lords,"    London,  is  charged  with  the  commission  of 
1845,  vol.  x.,  p.  200.  a  crime  (murder,  for  example),  and 

2  See    Hansard's    "Debates,"    vol.  insanity  is  set  up  as  a  defence? 

67,  pp.  228,  714.  (3)  In  what  terms  ought  the  ques- 

The  following    are    the    questions  tion  to  be  left  to  the  jury,  as  to  the 

submitted  to  the  judges:  prisoner's  state  of  mind  at  the  time 

(1)  What    is    the    law    respecting  when  the  act  was  committed? 
alleged  crimes  committed  by  persons          (4)    If  a  person  under  an  insane 
afflicted    with    insane    delusion,    in  delusion   as  to  existing  facts   corn- 
respect   of   one   or   more   particular  mits     an     offence     in     consequence 
subjects  or  persons;   as,  for  instance,  thereof,  is  he  thereby  excused? 
where  at  the  time  of  the  commission          (5)    Can  a  medical   man   conver- 
of    the    alleged    crime    the    accused  sant    with   the   disease    of   insanity, 
knew  he  was  acting  contrary  to  the  who  never  saw  the  prisoner  previ- 
law,  but  did  the  act  complained  of  ously  to  the  trial,  but  who  was  pres- 
with  a  view,  under  the  influence  of  ent  during  the  whole  trial  and  the 
insane  delusion,  of  redressing  or  re-  examination  of  all  the  witnesses,  be 
yenging  some  supposed  grievance  or  asked  his  opinion  as  to  the  state  of 
injury   or   of    producing  some   sup-  the  prisoner's  mind  at  the  time  of 
posed  public  benefit?  the  commission  of  the  alleged  crime, 

(2)  What  are  the  proper  questions  or  his  opinion  whether  the  prisoner 


THE  M'NAGHTEN  CASE. 


4C9 


judges  on  the  law  governing  such  cases.     Several  questions  were 
propounded  without  arguments  to  the  judges;  among  others  the 


was  conscious  at  the  time  of  doing 
the  act,  that  he  was  acting  contrary 
to  law,  or  whether  he  was  laboring 
under  any  and  what  delusion  at  the 
time? 

On  June  19,  the  following  answers 
were  returned  by  the  judges  (with 
exception  of  Justice  Maule,  who 
stated  his  opinion  separately): 

(1)  Assuming  that  your  lord- 
ships' inquiries  are  confined  to  those 
persons  who  labor  under  such  par- 
tial delusions  only,  and  are  not  in 
other  respects  insane,  we  are  of 
opinion  tnat,  notwithstanding  the 
party  accused  did  the  act  complained 
of  with  a  view,  under  the  influence 
of  insane  delusion,  of  redressing  or 
revenging  some  supposed  grievance 
or  injury,  or  of  producing  some 
public  benefit,  he  is  nevertheless 
punishable,  according  to  the  nature 
of  the  crime  committed,  if  he  knew 
at  the  time  of  committing  such 
crime  that  he  was  acting  contrary 
to  law,  by  which  expression  we 
understand  your  lordships  to  mean 
the  law  of  the  land. 

(2  and  3)  As  these  two  questions 
appear  to  us  to  be  more  conveniently 
answered  together,  we  have  to  sub- 
mit our  opinion  to  be  that  the  jurors 
ought  to  be  told,  in  all  cases,  that 
every  man  is  to  be  presumed  to  be 
sane,  and  to  possess  a  sufficient 
degree  of  reason  to  be  responsible 
for  his  crimes,  until  the  contrary  be 
proved  to  their  satisfaction;  and 
that  to  establish  a  defence  on  the 
ground  of  insanity  it  must  be 
clearly  proved  that  at  the  time  of 
the  committing  of  the  act  the  ac- 
cused party  was  laboring  under 
such  a  defect  of  reason,  from  dis- 
ease of  the  mind,  as  not  to  know 
the  nature  and  quality  of  the  act 
he  was  doing;  or,  if  he  did  know  it, 
that  he  did  not  know  he  was  doing 
what  was  wrong.  The  mode  of 
putting  the  latter  part  of  the  ques- 
tion to  the  jury  on  these  occasions 
has  generally  been  whether  the  ac- 
cused, at  the  time  of  doing  the  act, 
knew  the  difference  between  right 
and  wrong;  which  mode,  though 
rarely,  if  ever,  leading  to  any  mis- 


take with  the  jury,  is  not,  we  con- 
ceive, so  accurate  when  put  gener- 
ally anci  in  the  abstract,  as  when 
put  with  reference  to  the  party's 
knowledge  of  right  and  wrong  "in 
respect  to  the.  very  act  with  which 
he  is  charged.  If  the  question  were 
to  be  put  as  to  the  knowledge  of  the 
accused  solely  and  exclusively  with 
reference  to  the  law  of  the  land,  it 
might  tend  to  confound  the  jury  by 
inducing  them  to  believe  that  an 
actual  knowledge  of  the  law  of  the 
land  was  essential  in  order  to  lead 
to  a  conviction;  whereas  the  law  is 
administered  upon  the  principle  that 
every  one  must  be  taken  conclusively 
to  know  it,  without  proof  that  he 
does  not.  If  the  accused  was  con- 
scious that  the  act  was  one  which  he 
ought  not  to  do,  anil  if  that  act  was 
at  the  same  time  contrary  to  the 
law  of  the  land,  he  is  punishable; 
and  the  usual  course,  therefore,  has 
been  to  leave  the  question  to  the  jury 
whether  the  accused  had  a  sufficient 
degree  of  reason  to  know  he  was 
doing  an  act  that  was  wrong;  and 
this  course,  we  think,  is  correct, 
accompanied  with  such  observations 
and  explanations  as  the  circum- 
stances of  each  particular  case  may 
require. 

(4)  The  answer  must  of  course 
depend  on  the  nature  of  the  delusion; 
but,  making  the  same  assumption 
as  we  did  before — namely,  that  he 
labors  under  such  particular  de- 
lusion only,  and  is  not  in  other 
respects  insane — we  think  he  must 
be  considered  in  the  same  situation 
as  to  responsibility  as  if  the  facts 
with  respect  to  which  the  delusion 
exists  were  real.  For  example,  if 
under  the  influence  of  his  delusion 
he  supposes  another  man  to  be  in 
the  act  of  attempting  to  take  away 
his  life,  and  he  kills  that  man,  as 
he  supposes  in  self-defence,  he  would 
be  exempt  from  punishment.  If 
his  delusion  was  that  the  deceased 
had  inflicted  a  serious  injury-  to 
his  character  and  fortune,  and  he 
killed  him  in  revenge  for  such  sup- 
posed injury,  he  would  be  liable  to 
punishment. 


470 


MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 


question :  "  What  is  the  law  respecting  the  alleged  crime,  when, 
at  the  time  of  the  commission  of  it,  the  accused  knew  he  was 
acting  contrary  to  the  law,  but  did  the  act  with  a  view,  under 
the  influence  of  insane  delusion,  of  redressing  or  revenging  some 
supposed  grievance  or  injury,  or  of  producing  some  supposed 
public  benefit?  "  Mr.  Justice  Maule  and  Lord  Chief- Justice  Tin- 
dal  answered  this  question  that  there  was  no  law  that  makes 
persons  in  the  state  described  in  the  opinion  not  responsible  for 
their  criminal  acts.  Lord  Chief- Justice  Tindal  said :  "  He  is, 
nevertheless,  punishable  according  to  the  nature  of  the  crime 
committed,  if  he  knew  at  the  time  of  committing  such  crime  that 
he  was  acting  contrary  to  law. " 

The  Guiteau  Case. — The  celebrated  case  of  Charles  Julius 
Guiteau,  who  was  tried  at  Washington,  D.  C.,  under  an  indict- 
ment for  murder  for  shooting  President  Garfield  on  the  2d  of 
July,  1881,  will  help  to  illustrate  these  principles.  The  defence 
was  insanity  and  other  points  which  have  no  bearing  here.  The 
defendant  was  in  his  youth  a  bright  boy,  enjoyed  an  ordinary 
school  education,  and  worked  then  as  clerk  in  commercial  houses 


(5)  We  think  the  medical  man, 
under  the  circumstances  supposed, 
cannot  in  strictness  be  asked  his 
opinion  in  the  terms  stated,  because 
each  of  those  questions  involves 
the  determination  of  the  truth  of  the 
facts  deposed  to,  which  it  is  for 
the  jury  to  decide;  and  the  questions 
are  not  mere  questions  upon  a  mat- 
ter of  science,  in  which  case  such 
evidence  is  admissible.  But  where 
facts  are  admitted  or  not  disputed, 
and  the  question  becomes  substan- 
tially one  of  science  only,  it  may  be 
convenient  to  allow  the  question  to 
be  put  in  that  general  form,  though 
the  same  cannot  be  insisted  as  a 
matter  of  right. 

Justice  Maule  said  in  his  separate 
answers  that  he  would  have  been 
glad  if  his  brethren  had  joined  him 
in  praying  to  be  excused  from 
answering  these  questions,  and  he 
feared  that  the  answers  might  em- 
barrass the  administration  of  jus- 
tice when  they  were  cited  in  crimi- 
nal trials,  and  in  his  answer  to  the 
third  question  he  said:  "There  are 
no  terms  which  the  judge  is  by  law 
required  to  use." 


We  are  led  to  similar  conclusions 
by  the  following  English  case.  The 
prisoner,  Dodwell,  was  a  clergyman 
who  became  involved  in  legal  pro- 
ceedings, and,  after  quarrelling  with 
his  legal  adviser,  conducted  his 
own  case  in  such  an  irregular  manner 
that  he  did  not  obtain  what  he 
desired.  On  the  strength  of  this  he 
conceived  that  he  had  a  grievance 
against  the  Master  of  the  Rolls.  One 
morning  he  awaited  the  arrival  of 
his  Lordship  and  fired  a  pistol  at  him; 
no  injury  was  inflicted,  as  the  pistol 
was  only  loaded  with  powder  and 
wadding,  the  prisoner  declaring  that 
his  sole  object  was  to  direct  public 
attention  to  his  wrongs.  At  the 
trial  the  Master  of  the  Rolls  stated 
that  the  prisoner  was  incoherent  and 
irritable,  and  that  he  appeared  to 
be  under  a  delusion;  no  medical 
evidence  was  called  on  either  side, 
and  the  jury  returned  a  verdict  of 
"not  guilty  on  the  ground  of  in- 
sanity. (Regina  v.  Dodwell,  C.  C. 
C.,  1878,  as  unofficially  reported  in 
J.  Dixon  Mann,  "For.  Med.,"  etc., 
Phila.,  1893,  p.  357.) 


THE   GUITEAU   CASE. 


471 


iu  Freeport,  111.,  and  Chicago.1  His  real  name  was  Julius  Ccesar 
Guiteau,  which  he  changed  because,  he  said,  it  reminded  him  too 
much  of  negro  names.  When  twenty  years  of  age  he  joined  the 
so-called  Oneida  Community,  in  Oneida  County,  X.  Y.,  founded 
on  communistic  principles.  Entering  this  community  in  1860, 


1  Judge  Cox  in  his  admirable 
charge  to  the  jury  in  this  case  said: 

"In  order  to  constitute  the  crime 
of  murder  the  assassin  must  have  a 
responsibly  sane  mind.  The  tech- 
nical term,  'sound  memory  and  dis- 
cretion,' in  the  old  common-law 
definition  of  murder,  means  this. 
An  irresponsibly  insane  man  can  no 
more  commit  murder  than  a  sane 
man  can  do  so  without  killing. 
His  condition  of  mind  cannot  be 
separated  from  the  act.  If  he  is 
laboring  under  disease  of  the  mental 
faculties,  if  this  is  a  proper  expres- 
sion, to  such  an  extent  that  he  does 
not  know  what  he  is  doing  or  does 
not  know  that  it  is  wrong,  then  he 
is  wanting  in  that  sound  memory 
and  discretion  which  make  part  of 
the  definition  of  murder.  In  the 
next  place,  every  defendant  is  ^  pre- 
sumed innocent  until  the  accusa- 
tion against  him  is  established  by 
proof.  Again,  notwithstanding  this 
presumption  of  innocence,  it  is 
equally  true  that  the  defendant  is 
presumed  to  be  sane  and  to  have 
been  so  at  the  time  when  the  crime 
charged  against  him  was  committed; 
that  is  to  say,  the  Government  is  not 
bound  as  a  part  of  its  proofs  to  show 
affirmatively  that  the  defendant 
was  sane.  As  insanity  is  the  excep- 
tion, and  most  men  are  sane,  the  law 
presumes  the  latter  condition  to  be 
the  condition  of  everybody  until 
some  reason  is  shown  to  believe  the 
contrary.  The  burden  is,  therefore, 
on  the  defendant  who  sets  up  in- 
sanity as  an  excuse  for  crime,  to  bring 
forward  his  proofs,  in  the  first 
instance  to  show  that  the  presump- 
tion is  a  mistake  as  far  as  it  relates  to 
him.  But  after  all  the  evidence  is 
in,  if  the  jury,  while  bearing  in  mind 
both  these  presumptions  and  con- 
sidering the  whole  evidence  in  the 
case,  still  entertain  what  is  called 
'a  reasonable  doubt  on  any  ground, 
(either  as  to  the  killing  or  the 


responsible  condition  of  mind), 
whether  he  is  guilty  of  the  crime  of 
murder  as  it  has  been  explained  and 
defined,  then  the  rule  is  that  the 
defendant  is  entitled  to  the  benefit 
of  that  doubt  and  to  an  acquittal. 

"As  to  questions  relating  to  hu- 
man affairs,  a  knowledge  of  which 
is  derived  from  testimony,  it  is  im- 
possible to  have  the  same  kind  of 
certainty  which  is  created  by  scien- 
tific demonstration.  The  only  cer- 
tainty you  can  have  is  a  moral  one, 
which  depends  upon  the  confidence 
you  have  in  the  integrity  of  wit- 
nesses and  their  capacity  to  know 
the  truth.  If,  for  example,  facts 
not  improbable  are  attested  by  nu- 
merous witnesses  who  are  credible, 
and  sustained  and  uncontradicted, 
and  who  had  every  opportunity  of 
knowing  the  truth,  a  reasonable  or 
moral  certainty  would  be  inspired 
by  their  testimony.  In  such  a  case 
doubt  would  be  unreasonable;  and 
it  is  not  a  doubt  whether  the  party 
may  not  be  possibly  innocent  in  the 
face  of  strong  proof  of  his  guilt,  but 
a  sincere  doubt  as  to  whether  he  has 
been  proved  guilty  that  is  called 
reasonable;  and  even  where  the  tes- 
timony is  contradictory,  so  much 
more  credit  may  be  due  to  one  side 
or  the  other  that  the  same  result 
may  be  produced.  On  the  other 
hand,  the  opposing  proofs  may  be 
so  nearly  balanced  that  the  jury 
may  justly  doubt  on  which  side  lies 
the  truth,  and  in  such  a  case  the 
accused  party  is  entitled  to  the  bene- 
fit of  the  doubt,  All  that  a  jury 
can  be  expected  to  do  is  to  l>e 
reasonably  or  morally  certain  of  the 
fact  which  they  declare  by  their 
verdict.  As  Chief  Justice  Shaw  says, 
in  Com.  r.  Webster,  f>  dish.,  320. 
'For  it  is  not  sufficient  to  establish 
a  probability,  though  a  strong  one 
arising  from  the  doctrine  of  chances 
that  the  fact  charged  is  more  likely 
to  be  true  than  the  contrary,  but  the 


472 


MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 


he  gave  to  it,  according  to  its  rules,  bis  estate  ($900),  which  was 
left  him  by  his  mother.     In  April,  1865,  he  withdrew  from  this 


evidence  must  establish  the  truth  of 
the  fact  to  a  reasonable  and  a  moral 
certainty — a  certainty  that  convinces 
and  directs  the  understanding,  and 
satisfies  the  reason  and  judgment  of 
those  who  are  bound  to  act  con- 
scientiously upon  it.'  The  defence 
of  insanity  has  been  so  abused  as  to 
be  brought  into  great  discredit.  It 
has  been  a  last  resort  in  cases  of 
unquestionable  guilt,  and  has  been 
the  excuse  to  juries  for  acquittal 
when  their  own  and  the  public 
sympathy  have  been  with  the  ac- 
cused, and  especially  when  the  pro- 
vocation to  homicide  has  excused 
it  according  to  public  sentiment, 
but  not  according  to  lavy.  For 
these  reasons  it  is  viewed  with  sus- 
picion and  disfavor  whenever  pub- 
lic sentiment  is  hostile  to  the  ac- 
cused; nevertheless,  if  insanity  be 
established  to  the  degree  that  has 
been  already  in  part,  and  will  here- 
after further  be  explained,  it  is  a 
perfect  defence  to  an  indictment  for 
murder  and  must  be  allowed  full 
weight.  Now,  it  is  first  to  be  ob- 
served that  we  are  not  troubled  in 
this  case  with  any  question  about 
what  may  be  called  total  insanity, 
such  as  raving  mania  or  absolute 
imbecility,  in  which  all  exercise  of 
reason  is  wanting,  and  there  is  no 
recognition  of  persons  or  things  or 
their  relations;  but  there  is  a  de- 
batable border-line  between  the  sane 
and  the  insane,  and  there  is  often 
great  difficulty  in  determining  on 
which  side  of  it  the  party  is  to  be 
placed.  There  are  cases  in  which 
a  man's  mental  faculties  generally 
seem  to  be  in  full  vigor,  but  on  some 
one  subject  he  seems  to  be  deranged; 
he  is  possessed  perhaps  with  a  belief 
which  every  one  recognizes  as  ab- 
surd, which  he  has  not  reasoned 
himself  into,  and  cannot  be  reasoned 
out  of,  which  we  call  an  insane 
delusion ;  or  he  has  in  addition 
some  morbid  propensity  seemingly 
in  harsh  discord  with  the  rest  of 
his  intellectual  and  moral  nature. 
These  are  cases  of  what,  for  want  of 
a  better  term,  are  called  'partial 
insanity.'  Sometimes  its  existence, 


and  at  other  times  its  limits  are 
doubtful  and  undefinable,  and  it  is 
in  these  cases  that  the  difficulty 
arises  of  determining  whether  the 
patient  has  passed  the  line  of  moral 
or  legal  accountability  for  his  actions. 
A  man  does  not  become  irresponsible 
by  the  mere  fact  of  being  partially 
insane.  Such  a  man  does  not  take 
leave  of  his  passions  by  becoming 
insane,  and  he  retains  as  much 
control  over  them  as  in  health.  He 
may  commit  offences  too,  with 
which  his  infirmity  has  nothing  to 
do;  he  may  be  sane  as  to  his  crime, 
understand  its  nature,  and  be  gov- 
erned by  the  same  methods  in  re- 
gard to  it  as  other  people,  while  on 
some  other  subject  having  no  rela- 
tion to  it  whatever  he  may  be  sub- 
ject to  some  delusion.  In  a  reported 
case  a  defendant  was  convicted  of 
cheating  by  false  pretences,  but  was 
not  saved  from  punishment  by  his 
insane  delusion  that  he  was  the 
lawful  son  of  a  well-known  prince. 
The  first  thing,  therefore,  to  be  im- 
pressed upon  you  is,  that  whenever 
this  partial  insanity  is  relied  on  as 
a  defence  it  must  appear  that  the 
crime  charged  was  the  product  of 
the  delusion  or  other  morbid  condi- 
tion, and  connected  with  it  as  cause 
and  effect,  and  not  the  result  of  sane 
reasoning  or  natural  motives,  which 
the  party  may  be  capable  of  not- 
withstanding his  circumscribed  dis- 
order. But  assuming  that  the  in- 
firmity of  mind  has  had  a  direct 
influence  in  the  direction  of  the  crime, 
the  difficulty  is  to  fix  the  degree  and 
character  of  disorder  W7hich  in  such 
cases  will  correct  irresponsibility  in 
law.  The  outgivings  of  the  judicial 
mind  on  this  subject  have  not  always 
been  entirely  satisfactory  or  in  har- 
mony with  the  conclusions  of  medi- 
cal science.  Courts  have  in  former 
times  undertaken  to  lay  down  a  law 
of  insanity  without  reference  to, 
and  in  ignorance  of,  the  medical 
aspects  of  the  subject,  when  it  could 
only  properly  be  dealt  with  through 
a  concurrent  and  harmonious  treat- 
ment by  the  two  sciences  of  law  and 
medicine.  They  have,  therefore, 


THE   GCITEAU   CASE. 


473 


order,  because,  as  be  said,  he  did  not  agree  with  it  in  its  opin- 
ioiis  as  to  the  labor  question,  although  harmonizing  otherwise 


adopted,  and  again  discarded  one 
theory  after  another  in  the  effort  to 
find  some  common  ground  where 
the  due  regard  for  the  security  of 
society  and  humanity  for  the  afflicted 
may  meet.  The  mind  can  only  be 
known  by  its  outward  manifestations, 
and  they  are  found  in  the  language 
and  conduct  of  the  man.  For  this 
reason,  evidence  is  admissible  to  show- 
conduct  and  language  at  different 
times  and  on  different  occasions 
which  indicate  to  the  general  mind 
some  morbid  condition  of  the  intel- 
lectual powers,  and  the  more  extend- 
ed the  view  of  the  person's  life  the 
safer  is  the  judgment  formed  of  him. 
Everything  relating  to  his  physical 
and  mental  history  is  relevant,  be- 
cause "ny  conclusion  as  to  his  sanity 
must  often  rest  upon  a  large  number 
of  facts. 

"Evidence  as  to  insanity  in  the 
parents  and  immediate  relatives  is 
also  pertinent.  It  is  never  allowed 
to  infer  insanity  in  a  case  from  the 
mere  fact  of  its  existence  in  the 
ancestors,  but  when  testimony  is 
given  directly  tending  to  prove  in- 
sane conduct  on  the  part  of  the  ac- 
cused, this  kind  of  proof  is  admis- 
sible as  corroborative  of  the  other. 
The  reliance  of  the  defence  is  on 
the  existence  of  an  insane  delusion 
in  the  prisoner's  mind,  which  so  per- 
verted his  reason  as  to  incapacitate 
him  from  perceiving  the  difference 
between  right  and  wrong  as  to  this 
particular  act." 

As  a  part  of  the  history  of  judi- 
cial sentiment  on  this  subject,  and 
by  way  of  illustrating  the  relation 
between  insane  delusions  and  re- 
sponsibility, the  judge  referred  to 
the  McNaghten  case  in  England, 
and  the  rules  laid  down  by  the  judges 
of  the  Superior  Court  of  England, 
and  stated  that  these  rules,  with 
some  qualifications,  had  been  ap- 
proved in  the  United  States,  as  in 
the  case  of  Com.  v.  Rogers,  7  Mete., 
500,  where  Chief  Justice  Shaw,  of 
Massachusetts,  said:  "Monomania 
may  operate  as  an  excuse  for  a 
criminal  act  when  the  delusion  is 
such  that  the  person  under  its 


influence  has  a  real  and  firm  belief 
of  some  fact,  not  true  in  itself,  but 
which  if  it  were  true  would  excuse 
his  act — as  when  the  belief  is  that 
the  party  killed  had  an  immediate 
design  upon  his  life,  and  under  that 
belief  the  insane  man  kills  in  sup- 
posed self-defence.  A  common  in- 
stance is  where  he  believes  that  the 
act  he  is  doing  is  done  by  the  im- 
mediate command  of  God,  and  he 
acts  under  the  delusive  but  sincere 
belief  that  what  he  is  doing  is  by  the 
command  of  a  superior  power  which 
supersedes  all  human  laws  and  the 
laws  of  nature." 

Judge  Cox,  in  his  charge,  also 
explained  the  term  "  insane  delusion" 
as  follows:  "An  insane  delusion  is 
never  the  result  of  reasoning  and 
reflection.  It  is  not  generated  by 
them,  and  it  cannot  be  dispelled  by 
them.  Whenever  convictions  are 
founded  on  evidence,  on  comparison 
of  facts  and  opinions,  and  arguments, 
they  are  not  insane  delusions.  The 
insane  delusion  does  not  relate  to 
mere  sentiments  or  theories,  or  ab- 
stract questions  in  law,  politics,  or 
religion — all  these  are  the  subject 
of  opinions  which  are  beliefs  founded 
on  reasoning  and  reflection.  These 
opinions  are  often  absurd  in  the 
extreme,  and  result  from  naturally 
weak  or  ill-trained  reasoning  powers 
— hasty  conclusions  from  insufficient 
data,  ignorance  of  men  and  things, 
credulous  disposition,  fraudulent  im- 
posture, and  often  from  perverted 
moral  sentiments — but  still  they  air 
opinions  founded  on  some  kind  of 
evidence  and  liable  to  Ix?  changed 
by  other  external  evidence  or  sounder 
reasoning,  but  they  are  not  insane 
delusions.  The  M~onnon  prophets 
profess  to  l>e  inspired  and  to  believe 
in  the  duty  of  plural  marriages, 
although  it  was  forbidden  by  a  law 
of  the  United  States.  One  of  the 
sect  violated  the  law  and  was  in- 
dicted for  it.  Tho  judge  who  tried 
him  instructed  the  jury  as  follows. 
That  if  the  defendant,  under  the 
influence  of  a  religious  Ix'liof  that  it 
was  right  under  an  inspiration,  if 
he  believed  that  it  was  right,  de- 


474 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


with  its  principles  and  religious  theories.     The  money  he  re- 
ceived back  from  the  order.     He  then  went  to  New  York  to 


liberately  married  a  second  time, 
having  a  first  wife  living,  the  want 
of  consciousness  of  evil  intent,  the 
want  of  understanding  that  he  was 
committing  a  crime,  did  not  excuse 
him.  Approved  by  the  Supreme 
Court  of  the  United  States  (Reynolds 
?'.  U.  S.,  98  U.  S.,  145).  And  so  in 
like  manner  a  man  may  reason  him- 
self into  a  conviction  of  the  ex- 
pediency and  patriotic  character  of 
political  assassination,  but  to  allow 
him  to  find  shelter  from  punishment 
behind  that  belief  as  an  insane  de- 
lusion would  be  simply  monstrous. 
There  is  undoubtedly  a  form  of  in- 
sane delusion  consisting  of  the 
belief  by  a  person  that  he  is  inspired 
by  the  Almighty  to  do  something — 
to  kill  another,  for  example — and 
this  delusion  may  be  so  strong  as  to 
impel  him  to  the  commission  of  a 
crime.  The  defendant  in  this  case 
claims  that  he  labors  under  such  a 
delusion,  an  impulse,  or  'pressure,' 
as  he  called  it  at  the  time  of  the 
assassination.  The  prisoner's  i:n- 
sworn  declarations  since  the  assas- 
sination on  this  subject,  in  his  own 
favor,  are  of  course  not  evidence. 
A  man's  language,  when  sincere, 
may  be  evidence  of  the  condition  of 
his  mind  when  it  is  uttered,  but  it 
is  not  evidence  in  his  favor  of  the 
facts  declared  by  him,  or  as  to  his 
previous  acts  or  condition.*  It  is  true 
that  the  law  allows  a  prisoner  to 
testify  in  his  own  behalf,  and  thereby 
makes  his  sworn  testimony  on  the 
witness-stand  legal  evidence,  to  be 
received  and  considered  by  you,  but 
it  leaves  the  weight  of  that  evidence 
to  be  determined  by  you  also. 
Whether  it  is  true  or  not  that  insanity 
is  a  disease  of  the  physical  organ,  the 
brain,  it  is  clearly  in  one  sense  a  dis- 
ease when  it  attacks  a  man  in  his 
maturity.  It  involves  a  departure 
from  his  normal  and  natural  condi- 
tion, and  this  is  the  reason  why  the 
inquiry  into  the  man's  previous  con- 
dition is  so  pertinent,  because  it  tends 
to  show  whether  what  is  called  'an 
act  of  insanity'  is  a  natural  out- 
growth of  his  disposition,  or  is  utterly 
at  war  with  it,  and  therefore  indicates 


an  unnatural  change.  That  evidence 
on  this  subject  is  proper  was  held  by 
the  Supreme  Judicial  Court  of  New 
Hampshire  in  State  v.  Jones,  50  N. 
H.,  369,  Judge  Ladd. 

"From  the  materials  that  have 
been  presented  to  you,  two  pictures 
have  been  drawn  by  counsel — the 
one  represents  a  youth  of  more  than 
the  average  of  mental  endowments, 
s  irrounded  by  certain  demoralizing 
influences  at  a  time  when  his  char- 
acter was  being  developed;  starting 
in  life  without  resources,  but  de- 
veloping a  vicious  sharpness  and 
cunning,  conceiving  evidences  of 
great  pith  and  moment  that  indi- 
cated unusual  forecast,  though  be- 
yond his  resources;  consumed  all 
the  while  by  insatiate  vanity  and 
craving  for  notoriety;  violent  in  tem- 
per and  selfish  in  disposition;  im- 
moral and  dishonest  in  every  direc- 
tion; leading  a  life  for  years  of 
swindling  and  fraud,  and  finally, 
as  the  culmination  of  a  depraved 
career,  working  himself  up  to  the 
resolution  to  startle  the  country 
with  a  crime  which  would  secure 
for  him  a  bad  eminence,  and  perhaps 
a  future  reward.  The  other  repre- 
sents a  youth,  born,  as  it  were,  under 
malign  influences;  the  child  of  a 
diseased  mother,  and  a  father  sub- 
ject to  religious  delusions;  deprived 
of  his  mother  at  an  early  age;  reared 
in  retirement  and  under  the  influence 
of  fanatical  religious  views;  subse- 
quently this  man,  filled  with  fanatical 
theories,  launched  upon  the  world 
with  no  guidance  save  his  own  im- 
pulses, and  then  evincing  an  inca- 
pacity for  any  continuous  occupa- 
tion; changing  from  one  pursuit  to 
another — now  a  lawyer,  now  a 
religionist,  now  a  politician — un- 
successful in  law;  full  of  widely 
impracticable  schemes  for  which  he 
had  neither  resources  nor  ability; 
subject  to  delusions  about  his  abili- 
ties and  prospects  of  success,  and  his 
relations  to  others;  his  mind  incohe- 
rent and  incapable  of  reasoning  on 
any  subject,  withal  amiable,  gentle, 
and  not  aggressive,  but  the  victim 
of  surrounding  influences;  with  a 


THE   GUITEAU   CASE.  475 

round  a  religions  paper,  expecting  by  it  considerable  improve- 
ment for  religion  as  well  as  splendid  success  for  himself.     After 
a  few  months  his  means  being  reduced  to  a  small  sum,  he  re- 
entered  the  order,  but  left  it  again  in  November,  1866,  studied 
law  at  Chicago,  and  was  there  admitted  to  the  bar.     As  his  first 
case  he  brought  a  lawsuit  against  the  Oneida  Community  for 
$9,000  as  compensation  for  the  work  done  by  him  for  the  order, 
asking  $1,500  for  each  year  of  his  membership.     By  threatening 
that  he  would  bring  to  light  the  "free  love"  practised  by  the 
order,  he  tried  to  induce  the  latter  to  a  compromise ;  but  its 
chief,  Mr.  J.  H.  Noyes,  answered  by  publishing  in  its  official 
paper  that  Guiteau  had  confessed  to  them  to  having  stolen  large 
sums  from  his  former  employers  in  Freeport  and  Chicago  and 
to  have  visited  houses  of  prostitution.     On  the  trial  in  October 
29th,  1881,  Mr.  Noyes  said  that  he  did  not  remember  any  action 
or  other  symptom  on  the  part  of  the  murderer  indicating  insan- 
ity, but  that  he  had  been  born  with,  and  possessed  during  his 
whole  life,  a  special  inclination  to  evil.     The  evidence  showed 
that  sometimes  he  practised  as  a  lawyer,  defrauding  his  clients; 
again  he  wandered  about  as  a  political  agitator  or  religious  orator. 
Very  often  he  let  himself  be  served  in  hotels  as  a  grand  seigneur 
and  then  absconded  without  having  paid  his  bills.     In  his  law 
practice  he  used  to  undertake  the  collection  of  doubtful  claims 
tinder  the  stipulation  of  one-half  of  them  as  a  fee.     In  one  in- 
stance the  debt  being  $100,  and  $40  collected,  he  retained  this 
sum  as  payment  for  himself.     For  such  offences  he  was  repeat- 
edly sentenced  and  imprisoned  in  New  York  and  Chicago.     At 
one  time  when  the  New  York  Herald  published  an  account  of 
such  a  case,  he  sued  that  paper  for  $100,000  on  the  ground  of 
calumny,  but  afterward  withdrew  the  action.     He  intended  to 
reform  religion  and  to  become  an  apostle ;  when  he  failed  therein, 
he  tried  to  play  a  political  part.     So  he  concluded  to  buy  the 
Inter  Ocean,  a  leading  Chicago  paper,  and  worked  out,  in  fact,  a 
very  practical  plan,  which  he  submitted  to  a  rich  politician  of 
Chicago,  whom  he  knew  to  be  ambitious  and  liberal  for  political 
purposes.     He  asked  of  him  a  loan  of  $200,000,  promising  to 

mind  so  weak  and  a  temperament  so  mission    of    a    crime,    the    guilt    of 

impressible   that   under   the   excite-  which  he  could  not  at  the  moment 

merit  of  a  political  campaign  he  be-  understand."     This     case  ^  will     be 

came  frenzied  and  insanely  deluded,  found  fully  reported  in  10  ted.  Rep., 

and  thereby  impelled  to  the  com-  p.  161. 


476  MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

make  him  President  of  the  United  States  by  means  of  this  paper, 
but  he  failed  to  convince.  In  the  latter  part  of  the  summer  and 
in  the  fall  of  1880,  during  the  Presidential  election  struggle,  he 
was  employed  as  speaker  by  the  Eepublican  committees,  meeting 
at  that  time  in  New  York.  He  had  been  engaged  after  he  had 
shown  them  a  speech  he  had  made  and  had  had  printed,  entitled 
"Garfield  versus  Hancock,"  which  speech  he  was  afterward  per- 
mitted to  deliver  at  a  meeting.  He  became  then  personally  ac- 
quainted with  the  chiefs  of  the  Eepublican  party,  and  being 
courteously  treated  by  them,  he  imagined  himself  to  be  a  very 
important  political  personality.  He  belonged  to  that  class  of 
political  workers  whose  compensation  consisted,  in  case  of  vic- 
tory, in  the  expectation  of  a  public  office.  The  result  of  the 
election — James  A.  Garfield  as  President,  with  Vice-President 
Chester  A.  Arthur — was  claimed  by  many  to  be  due  to  a  com- 
promise arranged  between  the  two  Eepublican  factions  existing 
at  that  time,  the  "Half-Breeds"  and  the  "Stalwarts,"  the  Presi- 
dent belonging  to  the  former,  the  Vice-President  to  the  latter. 
After  the  election  the  "Stalwarts,"  according  to  the  public  re- 
ports, felt  disappointed  as  to  the  proportion  in  which  their 
members  were  bestowed  with  public  offices.  The  defendant  re- 
peatedly asked  "of  the  President  and  of  James  G.  Elaine,  Secre- 
tary of  State,  that  he  be  nominated  consul  to  Vienna  or  to  Paris, 
ostensibly  relying  on  his  supposed  political  merits  during  the 
campaign,  and  insisting  on  his  request  in  an  exceedingly  impor- 
tunate manner.  Upon  having  realized  that  he  never  would  be 
successful,  after  a  long  and  mature  premeditation  he  shot  the 
President.  When  arrested,  he  said  to  the  officer  escorting  him 
to  the  prison,  that  he  was  a  Stalwart,  and  Arthur  now  Presi- 
dent. In  the  following  night  he  told  James  J.  Brooks,  chief  of 
the  secret  service  of  the  Treasury,  that  he  had  prayed  to  God  for 
six  weeks  concerning  the  matter,  that  his  resolution  to  remove 
the  deceased  had  only  become  firmer  by  these  prayers,  and  that 
his  motive  was  patriotism.  In  prison  he  was  repeatedly  visited 
by  ex -Judge  Eeynolds,  of  Chicago,  to  whom  he  stated  that  he 
committed  the  murder  for  love  of  the  nation.  A  few  weeks 
after,  when  he  realized  that  his  deed  was  condemned  by  all  par- 
ties, he  began  in  conversation  with  Eeynolds  to  protest  against 
the  use  of  the  term  "murder"  or  "assassination"  in  reference  to 
his  act,  which  meant  only  to  "remove"  the  President,  and  he 


THE    GUITEAU   CASE.  477 

then  wrote  a  proclamation  to  the  people,  stating  that  his  action 
was  a  patriotic  one,  accomplished  for  the  interest  and  welfare  of 
the  nation,  and  inspired  of  God;  that  he  could  not  resist  the  im- 
pulse to  do  it  which  paralyzed  the  power  of  his  own  will ;  but 
that  immediately  after  he  had  yielded  to  the  inspiration  he  had 
regained  his  will  power  and  mental  health.  This  was  and  re- 
mained the  whole  of  his  defence.  In  the  court  he  again  and 
again  used  to  interrupt  judge,  counsel  for  the  prosecution  and 
defence,  witnesses  and  experts,  by  jokes  and  insults.  He  often 
expressed  his  persuasion  that  God  would  let  perish  court  and 
jury,  if  necessary,  to  stop  the  trial,  etc.  On  the  other  hand, 
when  in  prison,  he  behaved  there  generally  in  a  quiet,  modest, 
and  courteous  manner.  One  day  he  promised  one  of  his  guards 
in  the  court-room  that  he  would  abstain  further  from  disturbing 
the  proceedings,  and  when  on  breaking  this  promise  he  was  re- 
buked by  the  guard,  he  answered  that  he  was  influencing  the 
public  opinion  in  his  favor,  and  that  none  of  those  having  been 
present  on  that  day  in  the  court  would  doubt  his  insanity.  The 
evidence  showed  that  his  father,  a  descendant  of  a  Huguenot 
family,  who  was  an  honest  man,  formerly  court  clerk  and  after- 
ward cashier  in  a  banking-house,  had  been  of  a  peculiar  charac- 
ter, entertaining  especially  peculiar  opinions  on  religion.  He 
believed  that  he  was  able  by  means  of  his  faith  to  cure  like  Jesus 
Christ  any  disease,  and  he  seemed  to  prefer  the  promise  of  eter- 
nal life  which  Christ  made  to  his  believers,  to  the  earthly  life. 
A  brother  of  the  accused's  father  was  a  drunkard  during  his 
later  life.  The  mother  of  the  defendant  had  become  sickly  a 
short  time  before  his  birth  and  remained  so  until  her  death, 
which  followed  a  few  years  afterward.  Besides,  there  was  evi- 
dence offered  by  the  defence  tending  to  show  insanity  of  more 
distant  collaterals,  as  of  his  cousin,  a  girl  who,  it  was  said,  was 
brought  into  an  asylum  at  St.  Louis  for  mental  disease. 

According  to  the  statement  of  the  then  family  physician,  the 
accused  showed  in  1S76  traces  of  emotional  insanity.  It  was 
further  shown  by  the  evidence  that  he  imagined  himself  a  great 
politician,  although  usually  failing  in  success  with  his  lectures, 
which  he  used  to  advertise  in  an  eccentric  way;  that  he  had 
great  projects  in  mind  and  was  of  enormous  self-opinion  and 
vanity.  As  the  defendant  testified  in  his  own  behalf,  he  con- 
ceived one  day  the  idea  that  everything  could  become  straight 


478  MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

again  in  case  Garfield  was  removed,  and  later  on,  after  incessant 
prayers  that  it  might  be  done  otherwise,  his  persuasion  of  divine 
inspiration  was  confirmed,  and  he  realized  himself  to  be  the  tool 
of  God,  who  always  chooses  the  most  perfect  material  for  effect- 
uating His  designs.  In  this  way,  there  was  given  at  the  same 
time  the  opportunity  to  make  known  to  the  public  a  book  writ- 
ten by  him  on  religious  matters. 

On  behalf  of  the  defence,  Dr.  Kiernan,  of  Chicago,  and  Dr. 
Spitzka,  of  Kew  York,  were  called  as  medical  witnesses,  and 
both  testified  to  his  insanity.  The  former  said  that  the  prisoner 
suffered  from  inherited  organic  disease  of  the  brain  and  exhib- 
ited a  debilitated  power  of  judgment.  The  latter  thought  him  a 
moral  monstrosity,  but  would  not  say  that  his  unsoundness 
deprived  him  of  the  capacity  of  discriminating  right  from 
wrong. 

On  the  part  of  the  prosecution,  thirteen  experts  were  called 
to  the  stand,  who  declared  unanimously  that  he  was  sane  when 
he  committed  the  act.  Among  them  Dr.  Walter  Kempter,  of 
Wisconsin,  stated  that  the  head  form  of  the  defendant  was  in 
fact  abnormal,  which  had  been  urged  by  the  defence,  exhibiting 
a  very  noticeable  depression  on  one  side,  but  he  denied  that 
such  anomalies  could  furnish  a  certain  proof  of  insanity.  He 
said,  too,  that  he  had  never  seen  an  insane  person  pleading  his 
own  insanity.  Dr.  Noble-Young,  prison  physician  of  Washing- 
ton, testified  that  the  defendant  after  his  arrest  was  seized  by  a 
few  attacks  of  malarial  fever,  but  showed  otherwise  always  a 
normal  state  of  health. l  The  verdict  was  guilty.  The  prisoner 
was  sentenced  to  death  (on  the  4th  of  February,  1882)  after  a 
motion  for  a  new  trial  had  been  denied.  An  appeal  was  taken, 
especially  on  the  ground  that  Judge  Cox  had  erroneously  ex- 
cluded some  evidence  offered  for  the  purpose  of  proving  the  in- 
sanity of  the  defendant.  The  Court  of  Appeals  of  the  District 
of  Columbia  affirmed  the  judgment,  and  Guiteau  was  executed. 

There  is  a  striking  similarity  between  Guiteau's  case  and  both 
that  of  Prendergast,  the  murderer  of  Mayor  Harrison  of  Chicago, 
and  Czolgosz,  the  murderer  of  President  McKinley.  Whatever 
may  be  the  views  of  medical  authority,  judges  and  lawyers  al- 
most universally  maintain  that  all  of  these  men  were,  under  the 

l"Der  Neue  Pitaval,"  edited  by      xvii.,  Leipsic,   1882,  preface  and  p. 
Dr.    A.    Vollert,    Neue    Serie,    vol.       1;   10  Fed.  Rep.,  161. 


IMPAIRMENT   OTHER   THAN   INSANITY.  479 

application  of  well-settled  legal  principles,  justly  and  properly 
executed. 

Delusional  Insanity  in  States  Where  it  is  Held  That  the  Ability  to 
Distinguish  Eight  from  Wrong  icith  Respect  to  the  Particular  Act  Is 
Not  the  Sole  Test  of  Responsibility. — A  different  decision  has  been 
made  in  the  State  of  Alabama,  which  is  also  the  rule  in  all  courts 
where  the  right-aud- wrong  test  is  not  accepted  as  the  sole  one.1 
As  heretofore  stated,2  the  Supreme  Court  of  Alabama  has  repudi- 
ated, in  Parsons  v.  State,3  capacity  to  distinguish  between  right 
and  wrong  as  an  exclusive  test  of  responsibility  for  crime,4  and 
adopted  the  capacity  to  choose  between  right  and  wrong  as  a 
further  test.  The  court  in  the  same  case  added :  u  The  same  rule 
applies  to  delusional  insanity,  and  necessarily  conflicts  with  the 
old  rule  laid  down  by  the  English  judges  in  McNaghten's  case, 
that  in  cases  of  delusion  the  defendant  must  be  considered  in  the 
same  situation,  as  to  responsibility,  as  if  the  facts  with  respect 
to  which  the  delusion  exists  were  real. " 

And  in  Georgia,  where  in  consequence  of  an  insane  delusion 
the  will  is  impaired,  though  the  ability  to  discern  the  quality  and 
the  wrong  of  the  act  remains,  but  the  exercise  of  the  will  is  es- 
sential to  the  specific  intent  to  constitute  the  act  a  crime,  the  ac- 
cused is  excused  from  criminal  responsibility,  if  by  reason  of 
the  delusion  the  will  was  overmastered  with  respect  to  the  par- 
ticular act.5 

And  again  in  Georgia,  it  was  said  that  if  in  consequence  of 
a  delusion  the  will  is  overmastered,  and  there  is  no  criminal  in- 
tent, there  is  not  criminal  responsibility,  though  the  accused  has 
reason  sufficient  to  distinguish  between  right  and  wrong  as  to 
the  particular  act.8 

PHASES  OF  MENTAL  IMPAIRMENT  OTHER  THAN  IN- 
SANITY, AS  DEFENCES  TO  CRIMINAL  PROSECUTION. 

Somnambulism,  if  Established,  May  Be  a  De- 
fence.— The  cases  on  this  subject,  dealt  with  in  the  courts,  are 
not  frequent.  Yet  there  cannot  be  any  doubt  that  the  influences 
of  somnambulism,  when  proved,  will  be  fully  appreciated. 

1  See  supra,  p.  455.  s  Flanagan  v.  State,  30  S.  E.  Rep., 

2See  supra,  p.  455.  550;    103  Ga.,  619. 
381  Ala.,  577  ;  7  Am.  Crim.  Rep.,          'Taylor  v.  State,  105  Ga..  746;  31 

1889.  S.  E.  Rep.,  764. 
4  Supra,  p.  456. 


480  MENTAL,  UNSOUNDNESS — BECKER    AND   BOSTON. 

Iii  a  Kentucky  case,  one  Fain,  accused  of  crime,  offered  evi- 
dence of  having  been  affected  from  infancy  with  somnolentia  or 
somnambulism.  This  evidence  was  refused  by  the  court,  which 
was  held  upon  appeal  to  be  error,  and  the  conviction  which  fol- 
lowed was  reversed  for  this  and  other  errors.1 

Unconsciousness. — Where  the  defence  was  a  degree  of 
unconsciousness  which  deprived  defendant  of  knowledge  of 
what  she  was  doing,  it  was  held  proper  to  instruct  the  jury  that 
if  they  believed  this  from  the  evidence,  they  should  acquit.2 

Mesmerism  and  Hypnotism.3 — Mesmerism  is  so  called 
from  Frederick  Anton  Mesmer,  who  first  propounded  the  theory 
that  one  individual  could  influence  and  control  the  will  of  an- 
other by  the  use  of  animal  magnetism,  at  Paris  in  1778. 

The  phenomena  of  mesmerism  are  now  explained  by  modern 
hypnotism  or  artificial  somnambulism,  which  has  been  of  late 
extensively  studied.  "Hypnotism  is  also  occasionally  called 
Braidism  (after  the  English  surgeon  Braid  who  first  studied  the 
phenomena  of  mesmerism  scientifically)  and  neuro-hypnology." 4 

The  important  and  controlling  fact  as  to  all  forms  of  alleged 
mesmeric  or  hypnotic  control  is,  that  it  can  seldom  or  never  be 
exercised  by  one  person  over  another,  unless  that  other  in  the 
beginning  of  the  attempt  to  exercise  it  consents  in  some  degree 
to  its  exercise  and  thus  becomes  a  party  to  it ;  and,  moreover,  it 
can  rarely  overcome  the  intuitive  resistance  to  criminal  sugges- 
tions of  a  moral  person.5 

Hypnotism  was  set  up  as  a  defence  in  the  case  of  Eyraud  the 
Parisian  strangler,  jointly  indicted  with  a  woman  named  Bom- 
pard,  who  turned  state's  evidence  and  claimed  that  she  had  been 
hypnotized  by  Eyraud,  and  while  under  his  influence  was  in- 
duced to  take  part  in  the  crime  of  murder.  In  that  case  testi- 
mony to  establish  her  claim  was  rejected.6 

1  Fain  v.  Com..  78  Ky.,  183;  Axis-  3  Cf.    discussion    of    this    subject 

tin  Abbott,  a  Brief  for  the  Trial  of  from  the  medical  point  of  view  in 

Criminal  Cases,  N.  Y.,  1889,  p.  334.  Professor  Fisher's  article  on   Insan- 

The  Calif ornia  Penal  Code,  §  26,  subd.  ity,  supra,  p.  310. 

5,  provides  that  persons  committing  *  Century   Dictionary,  title  "Mes- 

a    crime    without    being    conscious  merism." 

thereof    shall    not    be    responsible.  5  See  Dawson:    "  Hypnotism  in  its 

This   is   said   to   apply  to   cases   of  Scientific   and     Forensic    Aspects," 

somnambulism  and  the  like.     People  The  Arena,  vol.   18,  p.    548-9;    Sud- 

v.  Methever,  132  Cal.,  326;  64Pac.  R.,  duth:   "Hypnotism  and   Crime,"  13 

481.  Med.  Leg.  Jour.,  239. 

*  State  v.  Lewis,   136  Mo.  84;  37  6  The    defence    attempted    in   this 

S.  W.  Rep.,  806.  case  is  explained  in  Tourette's  mono- 


INTOXICATION   AS   A    DEFENCE.  481 

In  this  country  there  has  not  yet  been  any  reported  case  in 
which  the  legal  aspect  of  hypnotism  has  been  seriously  or  exten- 
sively considered. x  The  newspaper  reports  of  such  cases  are  too 
uncertain  and  sensational  to  be  gravely  regarded.2 

Delirium  from  Fever  or  Overdose  of  Medicine. — 
As  it  is  recognized  by  the  courts  that  epileptic  seizures  may  for 
a  time  suspend  the  mental  capacity  necessary  for  criminal  re- 
sponsibility, so  the  same  may  be  stated  of  delirium  even  of  a 
lower  degree,3  resulting  from  intermittent  fever,  and  of  frenzy 
from  an  overdose  of  medicine. 

In  a  North  Carolina  case 4  the  defendant  was  convicted  of 
murder,  after  the  court,  on  a  plea  of  temporary  insanity,  had  re- 
fused to  charge  the  jury  that  he  was  not  responsible  if  he  was 
incapable  of  comprehending  the  nature  of  his  act,  and  this  in- 
capacity was  the  result  of  an  overdose  of  morphine.  On  appeal 
this  refusal  was  held  to  be  incorrect,  and  a  new  trial  was 
granted. 

INTOXICATION   AS   A   DEFENCE   TO    CEIMINAL   PRO- 
SECUTION.5 

Two  leading  principles  are  well  settled  with  respect  to  intox- 
ication in  its  relation  to  criminal  responsibility :  ( 1 )  That  drunk- 
enness of  itself  does  not  relieve  from  crime;8  and  (2)  that,  on  the 

graph  on  ''L'Hypnotisme  et  lesEtats  5  As  to  proof  of  intoxication,  by 

Analogues  au  Point  de  Vue  Medico-  opinion  evidence,  see  infra,  p.  529. 

Legal,"  Paris,  1889.  *  Drunkenness       as       a       Crime. 

1  The    defence    was   attempted    in  Drunkenness    is    itself    a    criminal 

People  v.  Worthington,  105  Cal.,  166;  offense  when  productive  of  disorderly 

38   Pac.    R.,   689,  but  failed   of  any  conduct,  and  the  disorderly  conduct 

substantial  proof.     It   played  some  is  then  usually  regarded  and  punished 

part  in  People  v.  Ebanks,  117  Cal.,  as  a  misdemeanor.     (See  the  penal 

652;  49  Pac.  R.,  1049;  40  L.  R.  A.,  laws    of    the    several    States,    title: 

269.     An  elaborate  note  is  annexed  Drunkenness,     Disorderly    Conduct, 

to  the  report  of  this  case  in  40  L.  R.  A.  Intoxication.) 

*  See  also  50  Alb.  L.  J.,  217,  377;  DEFINITIONS:  Drunkenness — Habit- 

47 id., 362;  51  id., 87;  Ellinger:  "Case  ual  Drunkard.     In  Michigan  drunk- 

of  Czynski,"  14  Med.  Leg.  Jour.,  150;  enness     is    a   crime:    it    was    there 

Chapm:  "  Forensic  Aspect  of  Hypno-  said   that,   a   drunkard   is   one   with 

tism,"  3    Am.    Lawyer,   534;    Bell,  whom    drunkenness    has    become    a 

"  Hypnotism  and  the  Law,"  13  Med.  habit,  and  that  one  who  had  been 

Leg.   Jour.,    54;     Case   of   Spurgeon  drunk  for  six  weeks  was  to  be  found 

Young    (Chautauqua    County,  New  guilty    of    drunkenness.     People    v. 

York),  14  Med.  Leg.  Jour.,  529.  Radley,  8  Det.  Leg.  N.,  467;  86  N.  W. 

1  People  v.   Slack,  90  Mich.,  448;  Rep.,  1029;    and  it  is  not  necessary 

51  N.  W.  R.,  533.  to  allege  that  he  is  a  habitual  drunk- 

4  State  v.  Rippy,  104  N.  C.,  752;  ard,    Ibid.     There  may  be  a  habit  of 

10  S.  E.  R.,  259.  intoxication,  though  the  one  so  ad- 
III.— 31 


482 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


other  hand,  settled  insanity  caused  by  alcoholic  excesses  may 
create  criminal  irresponsibility. 

Insanity  as  the  Result  of  the  Use  of  Alcohol. — 
Delirium  Tremens. — Under  the  decisions  of  the  courts  of 
the  different  States  of  this  country,  there  cannot  be  any  doubt 
that  the  properly  so-called  delirium  tremens  and  similar  states 
are  treated  as  to  criminal  responsibility  in  the  same  way  as  in- 
sanity produced  by  any  other  cause,  and  the  same  legal  test 
is  applicable.1  "A  fixed  frenzy  or  insanity,  as  delirium  tremens 


dieted  may  occasionally  resist  temp- 
tation, ibid.  See  supra,  p.  429,  for 
sale  of  intoxicating  liquor  as  tort. 

An  habitual  drunkard  is  stated  to 
be  one  who  becomes  commonly  or 
frequently  intoxicated,  and  not  neces- 
sarily one  who  has  so  surrendered 
himself  to  the  habit  that  he  must 
drink  to  excess  and  become  intox- 
icated whenever  the  temptation  is 
presented  and  an  opportunity  af- 
forded. State  v.  Shmn,  63  Kan., 
638;  66  Pac.  R.,  650;  but  cf.  Herley 
v.  Kettle  (Tex.  Civ.  App.),  65  S.  W. 
R.,  48,  where  the  question  was  left 
to  the  jury,  and  its  finding  was  not 
disturbed;  and  Glenn  v.  Glenn,  87 
Mo.  App.,  377,  where  in  a  divorce 
case  an  allegation  that  defendant 
had  been  under  the  influence  of  in- 
toxicating drinks  for  a  year,  was  not 
equivalent  to  an  allegation  that  he 
was  an  habitual  drunkard.  See  also 
supra,  p.  380,  for  additional  defini- 
tion of  habitual  drunkard  under  di- 
vorce statutes. 

In  some  States  drunkenness  in  a 
public  place  is  a  criminal  offence; 
see  Bordeaux  v.  State,  31  Tex.  Cr. 
Rep.,  37,  Rosenstein  v.  State  (Ind.), 
36  N.  E.  Rep.,  652;  9  Ind.  App., 
290;  State  v.  Tincher  (Ind.),  21 
Ind.  App.,  142;  51  N.  E.  Rep.,  943; 
City  of  St.  Joseph  v.  Harris.  59 
Mo.  App.,  129;  City  of  Gallatin  v. 
larwater,  44  S.  W.  Rep.,  750;  143 
Mo.,  40;  People  v.  Markell.  20  Misc. 
R.  (N.  Y.),  149;  45  N.  Y.  Supp.,904; 
People  v.  Mulkins,  25  Misc.  Rep. 
(N.  Y.),  599;  54  N.  Y.  Supp.,  414. 
In  Massachusetts  the  person  arrested 
for  drunkenness  may  show  that 
he  has  not  already  been  convicted 
of  that  offence  twice  within  one 
year  preceding,  and  may  then  be 
discharged  without  trial.  Mass.  Laws, 


1891,  c.  427.  See  Commonwealth  v. 
Morrissey,  32  N.  E.  Rep.,  664; 
157  Mass.,  471;  and  in  Massachu- 
setts it  has  been  held  that  it  is 
within  the  Constitutional  power  of 
the  legislature  to  punish  drunken- 
ness. Commonwealth  v.  Morrissey, 
supra.  In  Vermont  it  is  a  crime 
for  one  arrested  for  being  drunk 
to  fail  to  disclose  where  and  from 
whom  he  obtained  the  intoxicant. 
In  re  Carpenter,  41  Atl.  Rep.,  1042. 
Under  a  general  welfare  clause  in 
a  municipal  charter,  the  corporation 
can  enact  ordinances  to  punish  open 
and  notorious  drunkenness.  Village 
of  Fairmont  v.  Meyer,  83  Minn.,  456; 
86  N.  W.  R.,  457. 

As  A  CONTEMPT.  In  Pennsylvania 
it  has  been  held  to  be  contempt  to 
attend  Court  while  intoxicated. 
Commonwealth  v.  Clark,  13  Pa.  Co. 
Ct.  Rep.,  439. 

As   FOUNDATION   OF   ANOTHER'S 

DUTY.  (See  Torts,  supra,  p.  429.)  In 
some  States  it  is  a  crime,  and  in  some 
it  gives  rise  to  a  private  right  of  ac- 
tion, to  sell  or  give  intoxicating  liquor 
to  a  drunken  person,  or  habitual 
drunkard;  these  provisions  and  their 
operation  are  illustrated  in  the 
following  cases:  State  v.  Donovan, 
10  N.  D.,  203;  86  N.  W.  Rep.,  709; 
Barnes  r.  State,  19  Conn.,  398;  Mapes 
v.  People,  69  111.,  523;  Humpeler  v. 
People,  92  111.,  400;  Dudley  v.  Saut- 
bine,  49  Iowa,  650;  31  Am.  Rep., 
165;  State  v.  Ward,  75  Iowa,  637; 
36  N.  W.  Rep.,  765;  State  v.  Heck, 
23  Minn.,  549;  State  v.  Farr,  34 
W.  Va.,  84;  11  S.  E.  Rep.,  737.  See 
also  Farrell  v.  State,  45  Ind.,  371; 
Deveny  v.  State,  47  Ind.,  208;  Will- 
iams v.  State,  48  Ind.,  306;  Miller 
v.  State,  5  Ohio  St.,  275. 

1  It   is  error,  therefore,  to   permit 


DELIRIUM   TRKMENS.  483 

or  'mania  apotu,'  destroys  all  legal  responsibility,  and  although 
induced  by  voluntary  intoxication,  is  a  good  defence.  It  annuls 
responsibility,  provided  the  mental  condition  can  stand  the  tests 
applied  in  other  forms  of  insanity.  The  insane  person  is  no 
more  punishable  for  his  acts  than  if  the  delirium  had  proceeded 
from  causes  not  under  his  control. " l 

"Permanent  insanity  produced  by  habitual  intoxication  ex- 
cuses a  criminal  act,"  and  "when  the  mind  is  destroyed  by  long- 
continued  habit  of  drunkenness,  or  where  the  habit  of  intoxica- 
tion caused  an  habitual  madness ;  and  where  a  person  is  insane 
at  the  time  he  commits  the  crime,  he  is  not  punishable,  although 
such  insanity  be  remotely  occasioned  by  undue  indulgence  in 
spirituous  liquors,  or  from  what  in  a  moral  sense  is  a  criminal 
neglect  of  duty.  For  if  the  reason  be  perverted  or  destroyed  by 
a  fixed  delusion,  though  brought  on  by  his  own  vices,  the  law 
holds  him  not  accountable."2 

To  the  same  effect  is  the  following  ruling  of  a  New  York 
court:  "Simple  drunkenness  does  not  in  itself  constitute  insan- 
ity, but  if  a  person  is  in  a  state  of  delirium  tremens  at  the  time  of 
doing  an  act,  and  is  therefore  unable  to  distinguish  the  quality 
of  the  act  as  right  or  wrong,  he  is  relieved  from  criminal  re- 
sponsibility. " 3  Kulings  in  other  States  show  a  similar  tendency.4 
To  constitute  insanity  caused  by  intoxication  a  defence  to  mur- 
der, it  must  be  "  settled  insanity, "  and  not  a  mere  temporary 
mental  condition ; 5  even  though  that  condition  be  a  temporary 
diseased  mental  condition,8  or  a  temporary  frenzy  or  iii- 

evidence     that     though     a     person  State  (Fla.),  36  So.  R.,   161;    State 

suffering  with  delirium  tremens   has  v.  Kavanaugh  (Del.),  53  Atl.  R.,  335; 

no    more    control    over    his    actions  4    Penn.,  131;    State   t>.    Potts,   100 

than    a    man    suffering    from    other  N.  C.,  457;  6  S.  E.  R.,  657. 

delirium,  still  he  is  sane.     French  v.  *  "Am.  and  Eng.  Ency.  of  Law," 

State,  93  Wis.,  325;  67  N.  W.  Rep.,  1st  ed.,  iv.,  713.    State  v.  Harrigan, 

706.     But  in  California  it  was  held  9  Houst.  (Del.).v^.69;    31  Atl.  Rep., 

that  Penal  Code,  §  26,  subd.  5,  pro-  1052;  State  v.  Dsiris,  9  Houst.  (Del.), 

viding    that    persons    committing   a  407;    33   Atl.    Rep.,   55;     People  v. 

crime  without  being  conscious  there-  Fellows  (Cal.),  54  Pac.  R.,  830. 

of  shall  not  be  responsible,  applies  *  People  v.  O'Connell,  62  How.  Pr., 

to  cases  of  somnambulism  (see  supra,  436;    abstr.  B.  c.  in  13  Weekly  Dig., 

p.  479)    and  the  like  and  not  to  in-  95;  affirmed  in  id.,  536. 

sanity    produced    by    delirium    ire-  *  State  v.  Hand,  supra ;    State  v. 

mens.     People  v.  Methever,  132  Cal.,  Kavanaugh  (Del.),  supra. 

326;  64  Pac.  R.,  481.  6  People  v.  Travers,  88  Cal.,  233; 

1  "Am.  and  Eng.  Ency.  of  Law,"  26  Pac.  Rep.,  88. 

1st  ed.,  iv.,  714,   2d  ed.,  xvii.,  414,  'State  v.   Kraemer,  49  La.  Ann., 

and     cases    there     cited.     State    v.  766;    22  So.  Rep.,  254;   contra  cases 

Hand,  2  Hardesty  (Del.),  149;  41  Atl.  cited  infra,  p.  485. 
Rep.,  192;  1  Marv.,  545;  Thomas  v. 


484  MENTAL   UNSOUNDNESS  —  BECKER   AND   BOSTON. 

sanity.1  The  courts  show  a  tendency  to  apply  the  tests  of  respon- 
sibility rather  strictly  in  cases  of  alleged  alcoholic  insanity.2 

Art.  40a,  of  the  Texas  Penal  Code,  providing  that  tempo- 
rary insanity  produced  by  the  recent  use  of  intoxicating  liquors 
does  not  destroy  the  responsibility  for  crime  when  defendant 
voluntarily  makes  himself  intoxicated,  does  not  apply  to  delir- 
ium tremens,  the  immediate  cause  of  which  is  abstinence  from 
liquor  after  a  prolonged  intoxication  and  which  is  always  an 
involuntary  result  thereof.3 

In  Wisconsin  it  was  held  error  to  charge  the  jury,  in  effect, 
that  intoxication  resulting  in  total  or  partial  suspension  of  brain 
function  was  voluntary  madness;  and  that  if  the  person  while 
sober  is  sane,  this  condition  does  not  relieve  him  from  responsi- 
bility for  the  commission  of  a  crime ;  and  to  refuse  to  charge 
that  if  drunkenness  brings  on  a  disease  which  causes  such  a  de- 
gree of  madness  even  for  a  time  that  it  would  relieve  from  crim- 
inal responsibility  if  caused  in  any  other  way,  defendant  was  not 
responsible.4 

Where  delirium  tremens  is  set  up  as  a  defence,  the  delirium 
must  exist  at  the  time  the  act  was  committed,  as  there  is  no  pre- 
sumption of  its  existence  from  antecedent  fits  from  which  the  ac- 
cused recovered ;  for  this  is  a  mere  transient  derangement  of  the 
mind,  and  there  is  no  presumption  of  its  recurrence  or  continu- 
ance.5 Insanity6  or  delirium  tremens7  as  a  secondary  effect  of 
long  continued  excessive  drinking,  if  it  so  deprived  a  man  of  his 
reason  that  he  could  not  perceive  the  moral  qualities  of  actions 
or  tell  right  from  wrong,  is  a  complete  excuse.6  Intoxication 
before  and  at  the  time  of  a  homicide  is  insufficient  to  prevent  a 
conviction  of  murder,  in  the  absence  of  a  prolonged  debauch  and 
fixed  insanity  produced  by  drink,8  or  in  the  absence  of  a  want 
of  knowledge  of  ,/ight  and  wrong  with  respect  to  the  particular 
act.9  I 

Decisions  Holding  That  Alcoholic  Insanity  Must  be  of  Permanent 

1  State  v.  Clevenger,  156  Mo.,  190;  Zorn,  22  Ore.,   591,  contra  supra,  p. 

56  S.    W.    Rep.,    1078;     Longley  v.  483,  and  infra, .p.  485. 

Commonwealth,  2  Va.  Supr.  Ct.  Rep.,  *  Wagner  v.  State,  116  Ind.    181 

660;  37  S.  E.  Rep.,  339.  •  State  v.  Wilson,  104  N.  C.,  868; 

*  State  v.  Rigley,  62  Pac.  R.,  679.  10  S.  E.  Rep.,  315. 

3  Kelly  v.  State,  31  Tex.  Crim.  R.,  7  State  v.  Agnew,  10  N.  J.  L.  J.,  165. 

216;   20  S.  W.  Rep.,  357.  8  Com.   v.   McMillan,    144  Pa.   St., 

4Terrill  v.  State,  74  Wis.,  278;    42  610;    22  Atl.,  1029. 

N.  W.  Rep.,  243.     And  see  State  v.  9  Kite  v.  Commonwealth,  31  S.  E. 

Rep.,  895;   96  Va.,  489. 


ALCOHOLIC   INSANITY.  485 

Form;  That  Is,  Chronic  Disease  cw  a  Eesult  of  Alcohol  Must  Be 
Shown. — The  opinion  enunciated  by  many  courts  seems  to  be 
that  alcoholic  insanity,  to  exempt  from  crime,  must  be  of  a  rel- 
atively permanent  character;  while,  on  the  other  hand,  mere 
temporary  though  decided  alcoholic  "  insanity  "  is  not  deemed 
sufficient  to  cause  that  effect.  "Temporary  insanity,  or  uncon- 
sciousness of  what  one  is  doing,  occasioned  by  intoxication,  is 
no  excuse  for  crime,"  and  "temporary  insanity  resulting  im- 
mediately from  voluntary  intoxication  does  not  destroy  legal 
responsibility  or  constitute  a  defence  for  crime. "  * 

Contrary  Rule  in  Some  States.  — There  are,  however,  decisions 
to  be  found  in  some  States  which  hold  a  different  view  on 
this  matter.  As,  for  instance,  the  following  Texas  ruling: 
To  raise  the  question  of  temporary  insanity  from  the  voluntary 
recent  use  of  liquor  on  a  trial  for  murder,  the  drinking  must 
precede  the  homicide,  and  the  effect  must  be  operative  on  the 
mind  at  the  time  of  the  killing  to  the  extent  of  rendering  the 
accused  temporarily  insane.2 

Intoxication  so  excessive  as  to  deprive  a  person  of  reason, 
when  not  indulged  in  for  the  purpose  of  committing  crime,  may  re- 
lieve him  from  liability  for  a  crime.0 

The  English  courts  have  held  generally  on  this  subject  the 
principles  which  are  perhaps  dominating  in  the  United 
States.  A  state  of  disease  brought  about  by  a  person's  own  act, 
as  delirium  tremens,  caused  by  excessive  drinking,  is  no  excuse 
for  committing  a  crime  unless  the  disease  so  produced  is  perma- 
nent.4 On  the  other  hand,  we  meet  with  some  rulings  in  the 
English  courts  which  allow  alcoholic  insanity  even  of  a  mere 
temporary  character  as  a  defence  to  crime,  as  we  have  seen  it  to 
be  allowed  in  some  States  in  this  country.  These  rulings  state 
that  the  question  is  whether  there  is  insanity  or  not ;  it  is  imma- 
terial whether  it  was  caused  by  the  person  himself  or  by  the 
vices  of  his  ancestors,  and  it  is  immaterial  whether  the  insanity 
is  permanent  or  temporary.  If  a  man  was  in  such  a  state  of  in- 
toxication that  he  did  not  know  the  nature  of  his  act  or  that  his 
act  was  wrongful,  his  act  would  be  excusable. 

1  "Am.  and  Eng.  Ency.  of  Law,"          J  Gonzales  v.  State,  31  Tex.  Grim. 
Isted.,  iv.,  pp.  714,  716.     Longley  v.       Rep.,  508;    21  S.  W.  Rep.,  253. 
Com.,  2  Va.   Sup.  Ct.    R.,  600;    37          3  O'Crady  v.  State,  36  Neb.,  320; 
S.  E.  R.,  339.  54  N.  W.  R.,  556. 

« 1  Hale  P.  C.,  32;    4  Blacks.,  26. 


486  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

According  to  J.  Dixon  Mann  the  "permanency"  required  by 
a  great  number  of  courts  refers  presumably  "  rather  to  a  contin- 
uance of  the  symptoms  for  a  definite  time  after  the  individual 
has  ceased  to  indulge  in  alcohol,  than  to  an  absolutely  permanent 
condition."  ' 

Probably  the  better  rule  is  that  if  intoxication  produces  a  sec- 
ondary unsound  mental  state  which  is  not  intoxication,  that  disease 
will  be  considered  insanity,  though  it  be  speedily  curable.2 

Voluntary  Intoxication  not  Resulting  in  Perma- 
nent Insanity. — While  intoxication  resulting  in  a  positive  and 
settled  state  of  insanity  affords  absolute  exemption  from  criminal 
responsibility,  other  states  of  mental  disturbance  caused  by 
alcohol  are  generally  regarded  in  a  wholly  different  light  and  do 
not  exempt  from  all  responsibility,  even  though  temporarily  the 
ability  to  distinguish  between  right  and  wrong  with  respect  to 
the  particular  act  may  be  destroyed.3 

The  Common-Law  View  of  Voluntary  Intoxication. — Drunken- 
ness, whatever  its  temporary  mental  consequences,  at  common 
law  does  not  affect  criminal  responsibility  in  any  respect.  An 
act  is  none  the  less  a  crime  because  the  person  perpetrating  it 
happened  to  be  in  a  state  of  intoxication  at  the  time,  because 
voluntary  intoxication  is  no  excuse  for  crime,  even  when  the 
intoxication  is  so  extreme  that  the  person  is  insensible  to  his 
surroundings  and  unconscious  of  his  acts.  As  voluntary  drunk- 
enness neither  excuses  nor  justifies  crime,  therefore  intoxication 
at  the  time  of  committing  an  offence  cannot  be  set  up  as  a  de- 
fence. Drunkenness  is  no  excuse  for  crime,  neither  is  any  state 
of  mind  resulting  from  drunkenness,  unless  it  be  a  permanent 
and  continuous  result.* 

1  J.  Dixon  Mann,  "For.  Med.,"  etc.,  be  his  capacity  in  other  particulars; 

Phila.,  1892,  p.  360.  but  if  he  does  not  possess  this  degree 

2C/.  Reg.  v.  Davis  (Eng.),  14  Cox  of  capacity,  then  he  is  not  so  respon- 

C.  C.,  563.  sible.     State  v.  O'Neil,  51  Kan.,  651: 

»  See  People  v.  Kloss,  1 15  Cal.,  567;  33  Pac.,  287. 

47  Pac.  Rep.,  459.     But  in  Kansas,          4  People  v.  Travers,  88  Cal.,  233; 

where  intoxication  was  the  defence  26  Pac.  Rep.,  88;    People  v.  Young, 

in  a  homicide  trial,  it  was  said  that  102  Cal.,   411;    36  Pac.   Rep.,   770; 

where  a  person  has  sufficient  mental  State  v.  Murphy  (rape),  118  Mo.,  7; 

capacity  to  understand  the  nature  25  S.  W.  Rep.,  95;  State  v.  Fiske,  63 

and  quality  of  the  acts  constituting  Conn.,  ^88;   28  Atl.  Rep.,  572;   Com. 

the  crime,  and  the  mental  capacity  v.  Woodley  (Pa.  Sup.),  31  Atl.  Rep., 

to  know  whether   they  are  right  or  202;    Conley  v.   Commonwealth,    17 

wrong,  he  is  generally  responsible  if  Ky.  L.  R.,  678;   32  S.  W.  R.,  285. 
he  commits  such  acts,  whatever  may 


VOLUNTARY   INTOXICATION. 


48? 


This  principle  was  established  by  many  earlier  decisions  of 
the  courts  in  relation  to  different  crimes,  as,  for  instance,  blas- 
phemy,1 perjury,2  homicide,3  and  it  is  maintained  by  a  great 
number  of  later  cases  in  all  parts  of  the  United  States,  most  fre- 
quently in  reference  to  homicide.4 

Voluntary  intoxication,  as  the  phrase  is  used  in  the  treatment 
of  this  subject,  does  not  exclude  intoxication  produced  by  an 
uncontrollable  desire  to  drink.5  On  the  other  hand,  however, 
voluntary  drunkenness  which  is  the  cause  of  a  personal  injury 
does  not  make  a  crime  out  of  an  accidental  infliction:  for  in- 
stance, a  homicide,  from  the  accidental  discharge  of  a  revolver 
in  the  hands  of  an  intoxicated  person,  is  not  a  felony  merely 
because  of  the  drunkenness  and  its  voluntary  character.8  In 
other  words,  voluntary  drunkenness  does  not  supply  the  ele- 
ments of  premeditation  or  malice.  Nor  does  intoxication  ag- 
gravate a  crime.7 


1  People  v.  Porter,  2  Park.  Cr.  R., 


14. 

2  People  v.  Willey,  2  Park.  Cr.  R., 
19. 

3  People  v.   Rogers,   18  N.  Y.,  9, 
citing  Plod.,  19;  3  T.  Co.,  46;  4  Co., 
125;    Bac.  Max.,  V.;    7  Carr.  and  P., 
297,  317;    5  Mas.  C.  C.   R.,  28;     1 
Curt.  C.  C.  R.,  1;    2  Park.,  223,  235; 

1  Hale,  32;    4  Blackst.,  26;    1  Lewin 
Cr.  C.,  75.     See  People  v.  Robinson, 

2  Park.  Cr.  R.,  235,  affirming  1  id., 
649;   Friery  v.  People,  54  Barb.,  319; 
2  Keyes,  424. 

4  McCarty  v.  Com.  (Ky.),  20  S.  W. 
Rep.,  229;  Carpenters.  Com.,  92  Ky., 
452;    18  S.  W.  Rep.,  9;    Houston  v. 
State,  26  Tex.  App.,  657;    14  S.  W. 
Rep.,  352;  Gonzales  v.  State,  31  Tex. 
Grim.  Rep.,  508;  21  S.  W.  Rep.,  253; 
Kelly  v.  State,  31  Tex.  Cr.  R.,  216; 
Rather  v.  State  (Tex.),  9  S.  W.  Rep., 
69;    Aszman  v.  Stats,  123  Ind.,  347; 
24  N.   E.   Rep.,    123;    Bernhardt  v. 
State,  82  Wis.,  23;    51  N.  W.  Rep., 
1009;    Fonville  v.  State,  91  Ala.,  39; 
8  So.  Rep.,  688;   Springfield  v.  State, 
96    Ala.,    81;      11    So.    Rep.,    250; 
State  v.  Fiske,  63  Conn.,  388;  23  Atl. 
Rep.,  572;    People  v.  Lane,  100  Cal., 
379;    34  Pac.  Rep.,  855;    People  v. 
Vincent,  95  Cal.,  425;  Pac.  Rep.,  581 ; 
McCook  v.  State,  91   Ga.,  740;    17 
S.  E.  Rep.,  1019;    State    v.  Ashley, 
45  La.  Ann.,  1036;   13  So.  Rep.,  738; 


Davis  v.  Com.,  16  Va.  L.  J.,  464; 
15  S.  E.  Rep.,  388;  Garner  v.  State, 
28  Fla.,  113;  9  So.  Rep.,  835;  State 
v.  Wilson,  104  N.  C.,  868;  10  S.  E. 
Rep.,  315;  O'Grady  v.  State,  36  Neb., 
320;  54  N.  W.  Rep.,  556  (forgery); 
Chrisman  v.  State,  54  Ark.,  283;  15 
S.  W.  R.,  889;  State  v.  O'Neil,  51 
Kan.,  651;  33  Pac.  R.,  287;  State  v. 
Davis,  9  Houst.  (Del.),  407;  33  Atl. 
Rep.,  55;  Commonwealth  v.  Gilbert, 
165  Mass.,  45;  42  N.  E.  Rep.,  336; 
State  v.  Kindred,  148  Mo.,  270;  49 
S.  W.  Rep.,  845;  State  v.  Brown, 
181  Mo.,  192. 

In  Georgia  the'  code,  §  4301,  de- 
clares that  drunkenness  is  no  excuse 
for  crime  unless  occasioned  by  the 
fraud  or  contrivance  of  another,  in 
order  to  have  a  crime  perpetrated. 
So,  if  persons  give  whiskey  to  another 
"in  a  social  way  and  with  no  view  or 
purpose  at  the  time  "  to  induce  him 
to  commit  a  crime,  and  afterward, 
while  he  is  so  drunk  that  he  knows 
not  what  he  does',  procure  him  to 
commit  a  crime,  he  is  legally  respon- 
sible." McCook  v.  State,  91  Ga.,  740; 
17  S.  E.  R.,  1019. 

5  See  infra,  p.  498,  "  Dipsomania  "  ; 
p.  496,  "  Involuntary  Intoxication." 

•State  v.  Cross,  42  W.  Va.,  253; 
24  S.  E.  Rep.,  996. 

7McIntyre  v.  People,  38  111.,  514: 
State  v.  Donovan,  61  Iowa,  369;  16 


488  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

Illustrative  Cases. — In  Virginia  it  was  held  that  a  moderate 
degree  of  drunkenness  will  be  wholly  irrelevant  on  the  question 
of  responsibility.  One  who  had  fired  several  shots  at  his  wife, 
and  at  persons  who  attempted  to  interfere,  and  on  being  arrested 
by  a  policeman  shot  and  killed  him,  is  guilty  of  murder  in  the 
first  degree,  even  though  he  was  to  some  degree  drunk  at  the 
time. 1 

In  North  Carolina,  on  a  trial  for  murder  the  court  instructed 
the  jury  that  drunkenness  was  no  excuse  for  crime,  but  that  in- 
sanity as  a  secondary  effect  of  long  continued  excessive  drinking, 
if  it  so  deprived  a  man  of  his  reason  that  he  could  not  perceive 
the  moral  qualities  of  actions,  or  tell  right  from  wrong,  was  a 
complete  excuse ;  that  if  defendant  was  so  affected  by  a  blow 
which  he  had  formerly  received  that  when  he  drank  liquor  he 
lost  his  reason,  etc.,  and  knowing  this  he  voluntarily  drank  and 
became  frantic,  etc.,  and  slew  deceased  without  justification,  he 
was  guilty  of  murder.  The  defendant  was  convicted,  and  on 
appeal  it  was  held  that  the  above  charge  was  correct  and  the 
judgment  was  affirmed.2 

In  the  District  of  Columbia  it  is  "neither  an  excuse  nor  a 
palliation."3 

Intoxication  as  Bearing  upon  Specific  Intent. — In 
certain  crimes  the  specific  intent  to  commit  the  crime  is  essential. 
Thus,  entering  a  house  is  not  burglary  unless  done  with  the  in- 
tent to  steal ; 4  in  States  where  murder  is  divided  into  degrees, 
the  first  requires  premeditation ;  and  everywhere  homicide  is  not 
murder  but  some  degree  of  manslaughter  if  committed  without 
intent  to  kill.5  As  wre  have  seen,  voluntary  intoxication,  which 
may  often  produce  temporary  incapacity  to  distinguish  between 
right  and  wrong  and  hence  from  a  psychological  point  of  view 
incapacity  to  form  a  criminal  purpose,  is  nevertheless  rejected 

N.  W.  Rep.,  206;   Ferrell  v.  State,  43  2  State  v.  Wilson,  104  N,  C.,  863; 

Tex.,  .503.  10  S.  E.  R.,  315.    This  case  appar- 

The  many  dicta  in    the  old  cases  ently  refers  to  permanent  insanity, 

and  text-books  to  the  contrary  must  Cf.  State  v.  McDaniel,  115  N.  C.,  807; 

be  taken  to  mean  merely  that  drunk-  20  S.  E.  R.,  622;    State  v.  Kale,  124 

enness  renders  the  offence  more  des-  N.  C.,  816;  32  S.  E.  R.,  892. 

picable  in  a  moral  sense.     People  v.  3  Harris  v.  U.  S.,  8  App.  D.  C    20- 

Porter,   2    Park.  Cr.    R.,    14;    Coke's  Lanckton  v.  U.  S.,  18  App.  D.  C    348 

Littleton,  247;  4  Blackstone  Comm.,  4  X.  Y.  Penal  Code,  sec.  496 

5  Cf.  N.  Y.  Penal  Code,  sees.  183, 

1  Davis  v.  Com.,  16  Va.  L.  J.,  464;  184. 
15  S.  E.  R.,  388. 


INTOXICATION   AND   INTENT.  489 

by  the  courts  as  an  excuse  for  a  criminal  act.  The  reasons  of 
justice  and  public  protection  which  have  led  to  this  rule  are  now 
generally  thought  not  to  require  the  exclusion  from  consideration 
by  the  jury  of  evidence  of  such  intoxication  as  bearing  upon 
specific  intent.  The  mental  effects  of  intoxication  may  deprive 
a  man  of  the  capacity  to  premeditate  murder  or  to  form  an 
intent  to  steal ;  and  though  his  consequent  incapacity  to  distin- 
guish between  right  and  wrong  even  will  not  free  him  altogether, 
it  will  relieve  him  from  guilt  of  the  higher  degrees  of  his  crime. 

Statutory  Regulation. — In  California,1  New  York,2  Oregon,3 
Texas,4  Utah,5 and  a  few  other  States,6  the  matter  has  been  reg- 
ulated by  statute. 

The  New  York  rule  as  embodied  in  the  Penal  Code  is  a  fair 
statement  of  the  prevailing,  but  not  the  common-law  rule  in  the 
United  States.  The  New  York  Penal  Code  provides  in  section 
22  that  "No  act  committed  by  a  person  while  in  a  state  of  vol- 
untary intoxication  shall  be  deemed  less  criminal  by  reason  of 
his  having  been  in  such  condition.  But  whenever  the  actual 
existence  of  any  particular  purpose,  motive,  or  intent  is  a  neces- 
sary element  to  constitute  a  particular  species  or  degree  of  crime, 
the  jury  may  take  into  consideration  the  fact  that  the  accused 
was  intoxicated  at  the  time,  in  determining  the  purpose,  motive, 
or  intent  with  which  he  committed  the  act."  The  principle  in- 
volved in  the  first  sentence  of  the  section  was  derived  from  the 
common  law,  and  is  generally  recognized  as  the  rule  in  the 
United  States.  The  remainder  is  an  innovation.7 

1  Calif.  Penal  Code,  sec.  22.    When-  permitting   the   jury   in   a   case   in- 
ever  the  actual  existence  of  any  par-  volving    actual    motive,  purpose,  or 
ticular  purpose,  motive,  or  intent  is  a  intent    to  consider  the  fact  that  the 
necessary  element  to  constitute  any  accused  was  intoxicated  at  the  time, 
species  or  degree  of  crime,  the  fact  See  State  v.  Hansen,  25  Ore.,  391, 
of  intoxication    may  be   considered.  35  Pac.  R.,  976;    State  v.  Weaver, 
Held   to   permit  such   consideration  58  Pac.  R.,  109. 

only  as  bearing  on  degree  of  crime,  4  Texas  Penal  Code,  art.  40  a. 
People  v.  Vincent,  95  Cal.,  425;    30  *  Utah  Penal  Code,  sec.  20. 
Pac.    R.,   581;    People  v.   Methever,  •  Cf.  People  v.  Odell,  1  Dak.,  197; 
132    Cal.,    326;     64    Pac.    R.,    481.  46  N.  W.  R.,  601. 
See  also  People  v.  Gordon,  103  Cal.,  "  In  1881  it  was  held  by  the  Court 
568;    37  Pac.   R.,  534;    cf.  Whitten  of  Appeals  that  the  rule  was  well 
v.  State,  22  So.  R.,  483.    See  People  settled  that  voluntary  intoxication  of 
v.  Gilmore   (Cal.),  53  Pac.   R.,  806;  one  who  without  provocation  corn- 
People  r.    Lane,    100  Cal.,  379;    34  mitted  a  homicide,  although  amount- 
Pac.  R.,  856.  ing  to  a  frenzy,  did  not  exempt  him 

2  N.  Y.  Penal  Code,  sec.  22 ;  People  from  the  same  construction   of  his 
v.  Pekarz.  185  N.  Y.,  470.  conduct    and    the  same  legal  infer- 

3  Oregon,  Hill's    Code,    sec.  1,358,  cnces,  upon  the  question  of  intent  as 


490 


MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 


The  New  Yorlc  statute  has  been  applied  where  the  issue  was 
intent  to  steal  in  entering  a  building,  constituting  burglary;1 
premeditation,  constituting  homicide,  murder  in  the  first  degree.2 

The  Texas  statute3  is  peculiar.  It  provides,  "neither  intoxi- 
cation nor  temporary  insanity,  produced  by  the  voluntary  recent 
use  of  ardent  spirits,  shall  constitute  any  excuse  for  the  commis- 
sion of  crime,  nor  shall  intoxication  mitigate  either  the  degree 
or  penalty  of  crime ;  but  temporary  insanity  caused  by  liquor 
may  be  shown  by  defendant  in  mitigation  of  the  penalty,  and  in 
cases  of  murder  to  determine  the  degree  of  murder  of  which  the 
defendant  may  be  found  guilty."  It  will  thus  be  seen  that  noth- 
ing short  of  temporary  insanity  can  be  considered  at  all  in  Texas. 
If  temporary  insanity  exist,  it  may  mitigate  the  penalty  of  any 
crime,  but  change  the  degree  of  murder  only.4 

The  New  Yorlc  Rule  Now  Generally  Adopted  in  Other  States. — 
The  principle  established  by  the  New  York  Penal  Code  respect- 
ing intoxication,  as  above  set  forth,  is  to-day  recognized  generally 
in  most  of  the  United  States,  as  is  shown  by  the  reported  cases 
in  the  different  States,  especially  in  cases  of  homicide.5  Some 


affecting  the  grade  of  his  crime,  as 
were  applicable  to  a  person  entirely 
sober.  Flanagan  v.  People,  86  N.  Y., 
559. 

While  this  case  was  pending  on 
appeal,  and  largely  because  of  the 
seeming  severity  of  the  rule  as  there 
applied,  the  new  law  in  the  State  of 
New  York  was  established  by  its  Pe- 
nal Code,  section  22,  quoted  above. 

1  People  v.  Burns,  2  N.  Y.  Cr.  R., 
415. 

2  People  v.  Conroy,  2  N.  Y.  Cr.  R., 
247;  ,33  Hun.,  119;  aff'd  97  N.  Y.,  62; 
People  v.  Cassiano,  1  N.  Y.  Cr.  R., 
505:    30  Hun.,  388;    People  v.  Leo- 
nardi,  143  N.  Y.,  360;    38  N.  E.  R., 
372;    People  v.  Mills,  98  N.  Y.,  176; 
People  v.  Fish,  125  N.  Y.,  136;   etc., 
etc. 

3  Texas  Penal  Code,  art.  40  a. 

4  Houston   v.    State,    26   Tex.    Cr. 
App.,  657;    14  S.  W.  R.,  352.     See 
Evers  v.  .State.  31  Tex.  Cr.  App.,  318; 
20  S.  W.  R.,  744:    Edwards  v.  State, 
54  S.  W.  R.,  589;    Little  v.  State,  61 
S.   W.   R,,  483;    King  v.   State,  64 
S.  W.  R.,  245;    Cleland  v.  State,  65 
S.  W.  R.,  189;  Scott  v.  State,  12  Tex. 
Cr.  App.,  31;  Crew  v.  State,  23  S.  W. 
R.,  14;  Delgado  v.  State,  29  S.  W.  R., 


1070;  Ayers  v.  State,  26  S.  W.  R., 
396;  Gonzales  v.  State,  36  Tex.  Cr. 
App.,  508;  21  S.  W.  R.,  253;  Wright 
v.  State,  37  Tex.  Cr.,  627;  40  S.  W.  R., 
491 ;  White  v.  State,  30  S.  W.  R..  556. 
5  See  also  cases  cited  infra,  pp. 
491-493,  and  supra,  p.  488  and  p.  489. 
King  v.  State,  90  Ala.,  612;  8  So.  R., 
856;  Fonville  v.  State,  91  Ala.,  39; 
8  So.  R.,  688;  Chatham  v.  State,  92 
Ala.,  47;  9  So.  R.,  607  (larceny); 
Walker  v.  State,  91  Ala.,  76;  9  So.  R., 
87;  Springfield  v.  State,  96  Ala.,  81; 
11  So.  R.,  250;  Chrisman  v.  State, 
54  Ark.,  283;  15  S.  W.  R.,  889; 
State  v.  Fiske,  63  Conn.,  388;  98  Atl., 
572;  State  v.  Faino  (Del.),  2  Hard., 
153;  1  Marv.,  492;  41  Atl.  R.,  134; 
Garner  v.  State,  28  Fla.,  113;  9  So. 
R.,  835;  Crosby  v.  People,  137  111., 
325;  27  N.  E.  R.,  49;  Schwabacher 
v.  People,  165  111.,  618;  46  N.  E.  R., 
809  (burglary);  Booker  v.  State,  156 
Ind.,  435;  60  N.  E.  R.,  156;  54 
L.  R.  A.,  391;  State  v.  O'Neil,  51 
Kan.,  651;  33  Pac.  R.,  287;  Conley 
v.  Com.,  17  Ky.  Law  R.,  678;  32 
S.  W.  R.,  285;  State  v.  Hill,  46  La. 
Ann.,  27;  14  So.  R.,  294;  Com.  v. 
Dorsey,  103  Mass.,  412;  as  explained 
in  Hopt  v.  People,  104  U.  S.,  631: 


INTOXICATION  AND   INTENT.  491 

few  States  adhere  to  the  severe  common  law  rule,  or  yield  to 
only  slight  modifications  of  it.1 

In  crimes,  however,  where  specific  intent  need  not  be  proved 
or  may  be  presumed  against  the  defendant,  his  intoxication  can- 
not be  considered  at  all.2  And  in  all  cases,  if  it  once  appears 
that  an  intent  existed,  intoxication  thereupon  becomes  no  palli- 
ation and  immaterial.3 

There  has  been  some  difference  of  opinion  as  to  whether 
intoxication  can  reduce  a  homicide  from  murder  in  the  first 
degree  to  manslaughter  on  the  ground  of  incapacity  to  form  an 
intent  to  kill,  or  only  to  a  lower  degree  of  murder,  on  account 
of  incapacity  to  premeditate.4  This  question  is  not  likely  to 
arise  where  the  matter  is  regulated  by  statute. 

Illustrative  Cases.  — In  a  Utah  case  the  defendant,  one  Hopt, 
was  convicted  and  sentenced  for  murder  in  the  first  degree.  The 
Supreme  Court  affirmed  the  judgment.  On  a  writ  of  error  Jus- 
tice Gray,  of  the  United  States  Supreme  Court,  delivered  the 
following  opinion :  "  At  common  law,  indeed,  as  a  general  rule, 
voluntary  intoxication  affords  no  excuse,  justification,  or  exten- 
uation of  a  crime  committed  under  its  influence.  But  when  a 
statute  establishing  different  degrees  of  murder  requires  delib- 
erate premeditation  in  order  to  constitute  murder  in  the  first  de- 
gree, the  question  whether  the  accused  is  in  such  a  condition  of 

O'Grady  v.  State,  36  Neb.,  320;  54  very  moment  his  co-conspirator  was 
N.  W.  R.,  556  (forgery);  Warner  v.  actually  committing  the  acts  charged, 
State  (N.  J.),  29  Atl.  R.,  505;  Wilson  McLeroy  v.  State,  120  Ala.,  274;  25 
v.  State,  60  N.  J.  Law,  171;  37  Atl.  So.  R.,  247.  In  a  forgery  case, 
R.,  954;  State  v.  Hansen,  25  Ore.,  drunkenness  not  at  the  time  of  exe- 
391;  35  Pac.  R.,  976;  Com.  v.  cuting  the  forgery,  but  at  the  time 
Dudash,  204  Pa.,  124;  53  Atl.  R.,  of  attempting  to  utter  the  forged 
756;  State  v.  Ford  (S.  Dak.),  92  instrument,  State  v.  Peterson,  129 
N.  W.  R.,  18;  Wilcox  v.  State,  94  N.  C.,  556;  40  S.  E.  R.,  9. 
Tenn.,  106;  Davis  v.  Com.,  16  Va.  3  State  v.  West.  157  Mo.,  309;  57 
L.  J.,  464;  15  S.  E.  R.,  388;  State  v.  S.  W.  R.,  1071  (stopping  a  train  and 
Davis  (W.  Va.),  43  S.  E.  R.,  99;  attempting  to  rob  passengers  con- 
Bernhardt  v.  State,  82  Wis.,  23;  51  clusively  proves  intent).  In  New 
N.  W.  R.,  1009;  Hempton  v.  State,  Jersey  it  was  held  that  where  de- 
Ill  Wis.,  127;  86  N.  W.  R.,  596;  fendant,  though  intoxicated,  had  the 
Gustavenson  v.  State  (Wyo.),  68  capacity  to  form  an  intent,  and  did 
Pac.  R.,  1006.  See  31  Cent.  Law  form  and  execute  the  intent  to  take 
J.,  108,  notes  and  cases  collated.  the  life  of  deceased,  the  intoxica- 

1  State  v.  Morgan,  40  S.  C..  345;  tion  does  not  reduce  the  crime  to 
18  S.  E.  R.,  937;    State  v.  O'Reilly,  murder  in  the  second  degree.  Warner 
126   Mo.,   597;    29  S.    W.    R.,  577;  v.  State,  56  N.  J.  L.,  686;   29  Atl.  R., 
State  v.  Sneed,  88  Mo.,  138.  505. 

2  E.g.,  in    a    conspiracy  case  the          *  See  King  v.  State,  90  Ala.,  612; 
intoxication  of  the  accused  at  the  8  So.  R.,  856. 


492  MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

mind,  by  reason  of  drunkenness  or  otherwise,  as  to  be  capable  of 
deliberate  premeditation,  necessarily  becomes  a  material  subject 
of  consideration  by  the  jury.  The  law  has  been  repeatedly  so 
ruled  in  the  supreme  judicial  court  of  Massachusetts  in  cases 
tried  before  a  full  court,  and  in  cases  of  other  States.  And  the 
same  rule  is  expressly  enacted  in  the  Penal  Code  of  Utah,  sec- 
tion 20." l 

In  Alabama  the  courts  have  held  that  when  the  intoxication 
goes  so  far  as  actually  to  deprive  a  person  of  the  capacity  to 
form  the  essential  felonious  or  malicious  intent,  without  which 
the  act  committed  is  not  a  crime,  this  has  not  only  a  bearing  on 
the  degree  or  species  of  the  crime,  as  in  case  of  homicide,  but 
can  even  excuse  him  from  any  guilt  at  all.  Intoxication  so  great 
as  to  render  a  person  incapable  of  forming  a  felonious  intent  is 
a  defence  to  a  prosecution  for  larceny.2 

So  in  Nebraska  it  was  held  that,  although  intoxication  does 
not  justify  or  excuse  crime,  intoxication  so  excessive  as  to  de- 
prive a  person  of  reason,  when  not  indulged  in  for  the  purpose 
of  committing  crime,  may  relieve  him  from  liability  for  a  crime 
while  so  intoxicated.3  And  when  he  is  accused  of  assault  with 
intent  to  rape,  his  intoxication  may  be  shown  to  determine 
whether  he  was  capable  of  entertaining  the  intent.4 

And  so  also  in  Arkansas,  in  a  case  of  murderous  assault  the 
same  rule  was  followed:  "Though  generally  voluntary  drunk- 
enness is  no  defence  to  a  crime,  yet  where  an  intent  is  an  essen- 
tial element  of  the  crime  committed  it  may  be  shown  that  the 
accused  was  too  drunk  to  entertain  the  necessary  intent."5 

1Hopt  v.  People,  104  U.  S.,  631  a  Chatham  v.  State,  92  Ala.,  47; 

(Stewart  Chaplin,  "Cases  on  Criminal  9  So.  R.,  607;    State  v.  Kavanaugh 

Law,"  Boston,   1891,  p.  78)— citing  (Del.),  53  Atl.  R.,  335  (larceny);   see 

for    the    common    law    as    formerly  also  State  v.  Snow  (Del.),  51  Atl.  R., 

held:    U.    S.  v.   Drew,  5    Mas.,  28;  607,  holding  that  inasmuch  as  an  in- 

U.  S.  v.  McGlue,  1  Curt.,  1 ;  Fed.  Gas.,  tent  to  steal  is  essential  to  the  crime 

Xo.    15,679;     Com.    v.    Hawkins,    3  of  burglary,   an  intoxicated   person 

Gray  (Mass.),  463;   People  v.  Rogers,  who  enters  the  house  of  another  be- 

18  N.  Y.,  9.     For  the  exception  as  lieving  it  to  be  his  own  is  not  guilty 

by  the  New  York  statute:    Com.  v.  of  a  crime.     But  cf.  State  v.  Ford 

Dorsey,    103    Mass.,    412;     Pirtle   v.  (S.  Dak.),  92  N.  W.  R.,  18. 

State,  9  Humph.  (Tenn.),  663;   Kelly  3  O'Grady  ?>.  State,  36  Neb.,  320; 

v.  Com.,   1   Grant.    (Pa.)  Cas.,  484;  54  N.  W.  R.,  556. 

People    v.    Belencia,    21    Cal.,    544;  *  Head  v.  State,  43  Neb.,  30;    61 

State   v.    Johnson,    40   Conn.,    136;  N.  W.  Rep.,  494;   see  also  Latimer  v. 

Pigman  v.  State,  14  Ohio,  555;  Com-  State,  55  Neb.,  609;    76  N.  W.  R., 

piled  Laws  of  Utah  of  1876  pp.  568,  207;    Hill  v.  State,  42  Neb.,  503;    60 

569.     For  fuller  citation  of  cases,  see  N.  W.  R.,  916. 

tuora,  p.  490.  5  Chrisman  v.  State,  54  Ark.,  283; 


DEGREE   OF   INTOXICATION.  493 

In  Tennessee  it  is  permissible  to  show  defendant's  immoder- 
ate use  of  drugs  aud  whiskey,  to  fix  the  degree  of  crime  depend- 
ing on  deliberation  and  malicious  purpose.1 

In  Connecticut,  on  a  trial  for  assault  with  intent  to  murder, 
the  court  charged  that  intoxication  was  no  defence,  but  should 
be  considered  where  a  specific  intent  was  necessary,  and  that 
defendant  was  not  guilty  if  he  was  so  intoxicated  as  to  have  lost 
his  intelligence,  so  that  there  was  a  reasonable  doubt  whether  he 
was  able  to  form  a  purpose  to  kill  or  to  know  what  he  was  doing, 
and  it  was  held  that  this  charge  was  not  prejudicial  to  defendant.2 

MODERN  EULE  AS  TO  INTOXICATION  BEQUIRES  CONSIDER- 
ATION OF  ITS  DEGREE  OR  EXTENT. — A  necessary  consequence 
of  the  rule  permitting  evidence  of  intoxication  to  determine  the 
intent  or  degree  of  crime  is  that  the  degree  of  intoxication  must 
be  taken  into  account ;  a  difficult  question  which  could  not  arise 
under  the  strict  early  rule.  For  the  question  whether  the  accused, 
in  a  given  case,  was  able  to  form  the  intent,  deliberation,  or  pre- 
meditation required  for  the  particular  crime  depends  entirely  on 
the  prior  question  as  to  the  degree  of  intoxication.3 

The  prevailing  rule  appears  to  be  that  the  intoxication  must 
be  so  great  as  practically  to  destroy  the  capacity  to  deliberate, 
or  to  form  a  guilty  intent.4  But  in  New  York  the  statute  has 
been  construed  to  mean  that  intoxication  is  in  any  case  to  be 
considered  simply  as  bearing  upon  the  question  whether  the  ac- 
cused did  in  fact  so  deliberate.5 

In  Florida,  on  the  trial  of  an  indictment  for  murder  in  the 

15  S.  W.  Rep.,  889.     And  see  also  same  effect  where  statutory  offence 

Crosby  v.  People,   137  111.,  325;    27  of    assault    with     intent     to    ravish 

N.  E.  Rep.,  49;    Fonville  v.  State,  included  the  crime  of    assault,  Whit- 

91  Ala.,  39;    8  So.  Rep.,  688;    King  ten  v.  State,  22  So.   R.,  483;  and  to 

v.    State,  90  Ala.,  612;    8  So.  Rep.,  same    effect,    Brennan     v.    People, 

856.  (Colo.)  86  Pac.  R.,  79. 

l\Vilcox  17.  State,  94  Tenn.,  106;  'Garner  v.  State,  28  Fla.,  113;  9 

28  S.  W.  Rep.,  312.  So.  R..  835;    Bernhardt  v.  State,  82 

2  Stater.  Fiske,  63  Conn.,  388;  28  Wis.,  23;    51  N.  W.  R.,  1009.     See 

Atl.  R.,  572.     But  where  the  crime  Wright  v.  State  (Tex.  Cr.  App.),  40 

of  assault  with  intent  to  kill,  by  stat-  S.  W.  Rep.,  491 ;   37  Tex.  Cr.,  627. 
ute  included  as  an  element  the  crime          *  Casat  v.  State,  40  Ark.,  511;  Asz- 

of  assault  with  a  deadly  weapon,  of  man  v.  State,  123  Ind.,   347;  24   N. 

which  specific  homicidal  intent  is  not  E.  R.,  123;  Booher  v.  State,  156  Ind., 

an  essential  part,  it  was  proper  to  re-  447;    60    N.   E.   R.,     155;  State    v. 

fuse  to  charge  that  if  .  the  defendant  Bruce,  48  Iowa,  536;  30  Am.  R.,  403; 

was    unable    from    intoxication     to  Keenan  v.  Commonwealth,  44  Pa., 

form    an    intent  he    should    be   ac-  55:   84  Am.  Dec..  814. 
quitted.     People   ?•.    Lane,     100  Cal.,          5  People  v.   Leonard!,   143   N.   Y., 

379;   34  Pac.    R.,  856.     See    also  to  360. 


494  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

first  degree,  it  was  held  error  to  charge  that  voluntary  intoxica- 
tion is  no  excuse  for  crime  committed  under  its  influence,  and 
that  if  a  person  is  sober  enough  to  form  the  intention  to  shoot 
another  and  does  shoot  and  kill  him,  the  law  presumes  that  he 
is  sober  enough  to  form  a  premeditated  design  to  kill  him,  and 
he  is  criminally  liable  for  the  act ;  since,  in  such  case,  the  fact 
that  defendant  was  voluntarily  intoxicated  is  to  be  considered  in 
determining  whether  he  was  in  a  condition  of  mind  capable  of 
forming  a  premeditated  design.1 

In  Wisconsin  the  court  charged  that:  "If  you  shall  find  that 
defendant  at  the  time  he  struck  the  blow  was  in  such  a  condition 
from  the  use  of  spirituous  liquor  that  he  was  incapable  of  form- 
ing an  intent  to  kill,  then  you  may  consider  the  question  of  in- 
toxication ;  ...  in  short,  was  he  at  the  time  in  such  a  condition 
mentally  as  to  be  incapable  of  forming  this  premeditated  design 
to  effect  death  1 "  It  was  held  to  be  no  error  to  refuse  to  charge : 
"If  you  have  a  reasonable  doubt  whether,  at  the  time  of  the  kill- 
ing, defendant  had  sufficient  capacity  deliberately  to  think  upon 
and  rationally  to  determine  so  to  kill,  you  cannot  find  him  guilty 
of  murder  in  the  first  degree,  although  such  inability  was  the 
result  of  intemperance."2 

In  Delaware  it  was  held  that  intoxication  will  not  reduce 
homicide  below  the  grade  of  murder  in  the  first  degree  unless 
accused  "did  not  know  what  he  was  doing."3 

In  Oregon  it  was  held  that  an  instruction,  that  while  volun- 
tary drunkenness  of  itself  cannot  avail  as  a  defence  to  a  charge 
of  murder  in  the  first  degree,  yet  it  should  be  considered  on  the 
question  of  whether  the  defendant  committed  the  act  with  delib- 
eration and  premeditation,  in  connection  with  all  the  other  facts, 
in  determining  the  degree  of  guilt,  properly  covers  the  question 
of  intent.4  But  where  the  evidence  shows  that  accused  was  in 
possession  of  his  full  mental  powers,  a  charge  on  the  law  of  in- 
toxication is  properly  refused.5 

Judge  Peckham's  Opinion  in  People  v.  Leonardi. — In  People 
v.  Leonard!  (New  York)6  the  trial  judge  charged  the  jury 

1  Garner  v.  State,  28  Fla.,  113;  9  4  State  v.  Zorn,  22  Ore.,  591;  30 

So.  R.,  835.  Pac.  R.,  317. 

J  Bernhardt  r.  State,  82  Wis.,  23;  4  Lapey  v.  State,  29  Tex.  App., 

51  N.  W.,  1009.  63;  14  S.  W.  R.,  398. 

'  State  v.  Davis,  9  Houst.,  407;  33  5  143  N.  Y.,  360;  c/.  People  v. 

All.  Rep.,  55.  Fish,  125  N.  Y.,  136;  People  v. 

Corey,  148  N.  Y.,  505. 


PEOPLE   V.    LEONAKDI.  495 

in  a  murder  case,  where  the  defendant  was  much  intoxicated 
when  he  committed  the  homicide,  that  if  the  defendant  "was 
sober  enough  to  know  what  he  was  about,  and  that  the  act  was 
wrong,  then  his  intoxication  and  his  motive  would  both  exist 
and  the  one  would  not  destroy  the  other.  If  his  intoxication 
made  him  more  excitable,  and  led  him  the  more  readily  and 
easily  to  commit  the  crime,  to  form  the  intent,  and  to  reach  a 
conclusion,  as  the  result  of  deliberation  upon  it,  then  his  intoxi- 
cation would  not  help  him.  He  must  be  so  completely  intoxi- 
cated in  order  to  be  excused  as  to  be  destitute  of  the  capacity  to 
realize  the  wrongful  nature  of  his  act ;  that  his  acts  are  wholly 
aimless  and  without  purpose."  The  defendant  was  found  guilty 
of  murder  in  the  first  degree.  The  Court  of  Appeals  reversed  the 
conviction  on  the  ground  that  the  charge  required  too  high  a 
degree  of  intoxication  to  reduce  the  homicide  to  murder  in  the 
second  degree  or  manslaughter.  The  court  say,  by  Peckhain, 
J. :  "  We  do  not  think  that  under  this  statute  the  intoxication 
need  be  to  such  an  extent  as  necessarily  and  actually  to  preclude 
the  defendant  from  forming  an  intent  or  from  being  actuated  by 
a  motive,  before  the  jury  would  have  the  right  to  regard  it  as 
having  any  legal  effect  upon  the  character  of  defendant's  act. 
.  .  .  That  a  man  may  be  even  grossly  intoxicated  and  yet  be 
capable  of  forming  an  intent  to  kill  or  do  any  other  criminal  act 
is  indisputable,  and  if,  while  so  intoxicated,  he  forms  an  intent 
to  kill  and  carries  it  out  with  premeditation  and  deliberation,  he 
is  without  doubt  guilty  of  murder  in  the  first  degree,  and  the 
jury  should,  when  such  a  defence  is  interposed,  be  so  instructed. 
It  is  a  most  important  and  far-reaching  statute  in  its  possible 
effects,  and  the  jury  ought  to  be  warned  that  where  the  criminal 
act  is  fairly  and  clearly  proved,  the  fact  of  intoxication  as  furnish- 
ing evidence  of  the  want  of  the  criminal  intent  which  the  proof 
might  otherwise  show,  should  be  considered  by  it  with  the  great- 
est care,  caution,  and  circumspection,  and  such  fact  ought  not  to 
be  allowed  to  alter  the  character  or  grade  of  the  criminal  act 
unless  they  have  a  fair  and  reasonable  doubt  of  the  existence  of 
the  necessary  criminal  purpose  or  intent  after  a  consideration  of 
such  evidence  of  intoxication.  ...  It  should  still  be  remem- 
bered that  voluntary  drunkenness  is  never  an  excuse  for  crime." 
Criminal  Intent  Sometimes  Antecedent  to  Intoxi- 
cation.— It  should  be  clearly  stated  in  considering  voluntary  in- 


496  MENTAL,   UNSOUNDNESS — BECKER  AND  BOSTOM. 

toxication  as  affecting  guilt  that  we  assume  that  the  accused  when 
getting  drunk  did  not  have  any  criminal  intent  in  so  doing.  It 
is  common  experience  that  some  criminals  drink  to  engender  in 
themselves  the  courage  or  recklessness  necessary  for  the  execu- 
tion of  the  criminal  design  previously  conceived ;  and  that  again 
others,  who  are  saturated  with  the  idea  but  not  yet  decided  to 
commit  the  crime,  in  this  ambiguous  state  of  mind  start  to  drink 
hoping  they  may  thus  be  emboldened  to  commit  the  crime. 
Such  facts,  showing  "peculiar  malignant  deliberation,"  can- 
not be  allowed  to  have  any  other  effect  than  to  aggravate  the 


crime. 

Intoxication  as  a  Collateral  Issue. — Intoxication  may 
frequently  be  admissible  of  proof,  not  as  bearing  on  the  issue  of 
mental  capacity  directly,  but  because  material  as  tending  to  throw 
light  on  the  circumstances  of  the  case.2 

Involuntary  Intoxication. — When  speaking  of  volun- 
tary intoxication,  we  excluded  the  case  of  one  forced  to  drink 
by  others,  either  by  means  of  physical  constraint  or  of  serious 
threats,  and  equally  the  case  where  the  person  induced  to  take 
the  drink  did  so  not  under  his  own  but  under  the  authoritative 
responsibility  of  another,  as  of  his  physician.  We  also  excluded 
the  case  of  fraud ;  for  instance,  where  a  strong  drink  was  sub- 
stituted, without  knowledge  of  the  person  in  question,  for  a 
harmless  one,  and  he  so  becomes  the  victim  of  malice  of  others, 
perhaps  even  the  tool  for  their  felonious  designs.  We  also  ex- 
cluded the  states  of  temporary  intolerance  to  alcohol,  provided 
the  individual  did  not  know  or  could  reasonably  not  be  expected 
to  foresee  this  peculiarity.3  On  the  other  hand,  there  arises  the 
presumption  that  the  drunkenness  is  to  be  regarded  as  voluntary 
when  the  person  is  aware  of,  or  ought  to  be  cautioned  against, 
such  intolerance,  especially  in  case  the  latter  presents  a  habitual 
condition.  Yet  it  must  be  admitted  the  question  which  arises  in 
this  connection  is  a  very  difficult  one.  It  follows  further,  that  a 
person  who  indulged  in  liquor  to  greater  extent  than  he  sincerely 
wished,  but  did  so  animated  and  stimulated  "in  a  social  way,"  is 
to  be  considered  as  under  voluntary  intoxication;  for  still,  he 

1  See  Wharton  on  Crim.  Law  (10th      State  (Fla.),  35  So.  R.,  665;  State  r. 
ed.),  sec.  49;  State  v.  Kale,  32  S.  E.       Truitt  (Del.),  62  Atl.  R.,  790. 
Rep.,  892;   124    N.  C.,  816;  Nevling          2  Jenkins  v.  State,  93  Ga.,  1;    18 
v.  Com.,    98  Pa.    St.,   323;  Cook  v.       S.  E.  R.,  992. 

1  Roberts  v.  People,  19  Mich.,  401. 


INVOLUNTARY    INTOXICATION.  497 

had  his  own  will,  although  he  did  not  follow  his  own  feeling  or 
inclination.1 

In  regard,  to  the  influence  which  involuntary  intoxication  has 
on  the  question  of  guilt,  the  "  American  and  English  Encyclo- 
pedia of  Law  "  says : 

"  If  a  person  be  made  drunk  by  fraud  or  stratagem  of  an- 
other,2 or  by  the  unskilful  ness  of  his  physician,  he  is  not  re- 
sponsible for  his  acts ;  and  a  man,  owing  to  temporary  debility 
or  disease,  maddened  by  the  quantity  of  wine  which  he  usually 
takes  in  his  normal  condition,  is  not  voluntarily  insane."3 

Indeed,  considering  the  fact  that  the  statutes  and  court  deci- 
sions in  New  York  and  elsewhere  are  referred  to  as  determining 
that  voluntary  drunkenness  does  not  exempt. from  crime,  we 
may  assume  the  contrary  in  case  of  involuntary  intoxication, 
and  so  the  only  difficulty  which  remains  is  the  exact  definition 
of  wbat  is,  in  a  given  case,  to  be  regarded  at  law  as  voluntary  or 
involuntary  intoxication.  In  some  States  a  definition  is  given 
by  the  statutes  themselves. 

The  Code  of  Georgia,  section  4,301,  declares  that  drunken- 
ness is  no  excuse  for  crime  unless  occasioned  by  the  fraud  or 
contrivance  of  another,  in  order  to  have  a  crime  perpetrated. 
So,  if  persons  give  whiskey  to  another,  "in  a  social  way  and  with 
no  view  or  purpose  at  the  time  to  induce  him  to  commit  a  crime, 
and  afterward,  while  he  is  drunk,  that  he  knows  not  what  he 
Joes,  procure  him  to  commit  crime,"  it  is  held  that  he  is  legally 
responsible.4 

The  responsibility  in  each  case  depends  on  the  question 
whether  the  drunkenness  was  voluntarily  produced  by  the  free 
will  of  the  accused.  In  such  case  the  accused  is  responsible  for 
the  act  committed  while  intoxicated.  Of  course,  he  is  irresponsi- 
ble when  he  is  insane  (if  his  insanity  be  of  a  character  to  relieve 
him  of  responsibility5),  and  if  while  so  insane  and  thus  deprived 

1  McCook  v.   State,   91   Ga.,   740;  1st  ed.,  vol.  iv.,  p.  715,  citing  State  v. 
17  S.  E.  R.,  1019;   see  supra,  p.  496.  Johnson,   40  Conn.,    136;    Choice  v. 
In  its  criminal  results,   with  volun-  State,  31  Ga.,  424;    Rogers  v.  State, 
tary  intoxication    is  classed  intoxi-  33  Ind.,  543;    Roberts  v.  People,  19 
cation  which  is  the  result  of  an  urt-  Mich.,  401;    People  v.   Robinson,  2 
controllable  impulse    to  drink.     See  Park.  Cr.  R.,  235. 

State  v.  Haab,  105  La.,  230;  29  So.         4  McCook   v.   State,    91    Ga,,    740; 

R.,  725.  17  S.  E.  R.,  1019. 

2  Pearson's  case  (Eng.),  2  Lewin,          5  In  such  case  the  insanity  is  the 
Cr.  Cas.,  144.  defence,  not  the  drunkenness;    and 

*  "Am.  and  Eng.  Ency.  of  Law,"     such  insanity  must  be  of  a  character 
III.— 32 


498  MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 

of  the  knowledge  of  right  and  wrong,  he  becomes  intoxicated 
and  then  commits  a  crime,  he  cannot  be  punished  for  it,  because 
his  insanity  pei verted  or  destroyed  his  moral  faculty.1 

DIPSOMANIA  AS  A  PHASE  OF  INVOLUNTARY  INTOXICATION. 

It  has  been  clai  ined  by  some  medical  authorities  and  con- 
tested by  others2  that  there  exists  a  species  of  insanity  called 
dipsomania,  which  results  in  an  uncontrollable  desire  for  alcohol, 
paralyzing  in  this  regard  the  powers  of  will,  although  not  in- 
fluencing noticeably  the  integrity  of  intellect.  This  impulse 
is  said  often  to  lead  into  a  state  of  absolute  intoxication. 
Such  mental  anomaly  has  repeatedly  been  relied  on  as  a  defence 
to  criminal  acts  which  had  been  committed  in  a  drunken  state, 
and  this  plea  has  become  more  and  more  frequent  in  later  times. 
We  have  mentioned  this  subject  above  in  connection  with 
impulsive  insanity,  to  which  it  appertains  from  a  medico- 
psychological  point  of  view,  but  refer  to  it  here  for  practical 
reasons. 

First  we  will  consider  the  condition  of  alleged  dipsomania 
according  to  the  "right-and-wrong  test."  The  courts  which  pre- 
serve that  test  as  an  exclusive  one  presume  conclusively  that  a 
corresponding  power  of  will  exists  wherever  there  is  the  faculty 
of  discriminating  right  from  wrong  in  reference  to  the  particu- 
lar act.  Therefore,  when  criminal  responsibility  comes  under 
consideration,  they  prevent  a  limine  any  question  from  being 
raised  other  than  that  of  the  knowledge  of  right  or  wrong.  Ac- 
cordingly, in  those  States  where  this  test  exclusively  dominates, 
there  is  room  only  for  a  plea  of  such  insanity  as  affects  the  in- 
tellect, but  not  that  which  has  its  apparent  effect  only  on  the 
will,  and  consequently  a  plea  based  on  an  abnormal  condition  of 
mind  resulting  from  dipsomania  is  irrelevant  at  law. 

Such  is  the  view  taken  of  dipsomania  by  the  New  York 
courts.  An  appetite  for  strong  drink  so  powerful  as  to  overcome 
the  will  of  the  accused,  and  to  amount  to  a  disease,  where  he  was 
able  to  distinguish  between  right  and  wrong  at  the  time  and  in 

to  excuse  the  act  of  getting  drunk;       Kraemer,  49  La.  Ann.,  766;    22  So. 
the  addition  of  drunkenness  to  in-       Rep.,  254. 
sanity  does  not  withdraw  the  pro-          l  See  note  5,  page  497. 
tection    due    to   insanity.     State    v.          *  See   article   on   Insanity  in .  this 

volume,  p.  259. 


DIPSOMANIA.  499 

respect  to  the  act  committed,  will  not  exonerate  him  from  re- 
sponsibility for  the  crime.1 

In  a  wholly  different  way  such  a  plea  is  dealt  with  in  those 
States  where  the  right-and-wroug  test  is  not  the  exclusive  one. 
In  those  States  there  exists  no  particular  legal  test  of  i  esponsi- 
bility  at  all,  or  a  test  is  admitted  of  the  "power  to  choose." 
Where,  therefore,  a  person,  in  regard  to  a  particular  act,  though 
knowing  right  from  wrong,  has  so  far  lost  this  power  in  conse- 
quence of  a  mental  disease,  however  caused,  he  will  be  exempt 
from  crime.  The  courts  in  those  States  have  consequently  ad- 
mitted a  plea  based  on  such  an  abnormal  condition  as  that  caused 
by  dipsomania.  The  only  question  submitted  to  the  jury  is  in 
each  case  whether  such  disease  exists,  and  this  preliminary  ques- 
tion once  settled,  they  may  find  whether  the  accused  labored 
under  such  an  abnormal  condition  produced  by  this  disease. 
The  judicial  authorities  even  in  those  States  use  the  greatest 
possible  precaution  in  every  given  case  to  avoid  the  abuse  of 
such  a  defence. 

As  marking  this  tendency  we  quote  a  judicial  opinion  which 
admitted  the  plea  of  insanity  from  dipsomania  in  principle,  but 
would  not  allow  its  consequences  to  be  drawn  to  their  full  ex- 
tent, preferring  a  middle  course.  On  a  trial  for  murder,  where 
defendant  pleaded  insanity,  the  court  instructed  that  "if  the  jury 
believe  the  prisoner  was  a  dipsomaniac,  and  by  reason  of  the 
influence  of  such  disease  became  so  drunk  as  to  be  unconscious 
of  his  acts,  and  the  act  was  done  while  in  this  condition,  then  the 
presumption  of  malice  would  be  rebutted  and  the  prisoner  was 
guilty  of  manslaughter."  The  prisoner  was  convicted.  On 
appeal  the  charge  was  held  correct  and  the  conviction  sus- 
tained.2 

Arising  from  the  hypotheses  (1)  that  the  crime  was  com- 
mitted in  a  state  of  unconsciousness  caused  by  intoxication,  and 
(2)  that  the  intoxication  was  caused  by  the  disease,  it  seems  to 
us  that  there  should  have  been  two  alternatives  left  for  the  de- 
cision of  the  jury,  viz.:  (1)  Either  the  disease  destroyed  the 

1  Flanagan  v.  People,  86  N.  Y.,  559;  336;  see  also  State  v.  Haab,  105  La., 

13  Weekly  Dig..  242.     See  People  v.  230;   29  So.  R.,  725. 
Otto,  38  Hun,    99;  4  N.  Y.  Cr.  Rep.,          'State  v.   Potts,    100  N.   C.,  457; 

154;    People  r.  Leary,  105  Cal.,  486;  6  S.  E.  R.,  657;    State  v.  McDaniel 

39  Pac.   R.,  24;    Commonwealth  v.  115  N.  C.,  807;  20  S.  E.  Rep.,  622. 
Gilbert,  165  Mass.,  45;   42  N.  E.  R., 


500  MENTAL    UNSOUNDNESS — BECKER   AND    BOSTON. 

moral  faculty  arid  was  consequently  the  only  cause  of  the  intoxi- 
cation, in  which  case  they  should  acquit;  (2)  or  the  disease  did 
not  wholly  destroy  the  will,  but  influenced  it  considerably,  in 
which  case  they  should  find  the  prisoner  guilty  of  a  lower  grade 
of  homicide,  either  murder  of  a  lower  degree  or  manslaughter, 
according  to  the  stronger  or  lesser  influence  of  the  disease.  The 
first  alternative  has  been  wholly  disregarded  by  the  court  in 
the  case  just  cited. 

The  English.  Law  of  Temporary  Intoxication. — 
Except  the  cases  of  delirium  tremens  and  analogous  condi- 
tions as  created  above,  the  English  courts  do  not  recognize  in 
any  way  intoxication  as  bearing  on  the  question  of  guilt.  A 
crime  committed  during  drunkenness  is  as  much  a  crime  as  if  it 
were  committed  during  sobriety,  and  the  jury  has  nothing  to  do 
with  the  fact  that  the  man  was  drunk.  The  prisoner  is  supposed 
to  know  the  effect  of  drink,  and  if  he  took  away  his  senses  by 
means  of  drink,  it  is  no  excuse  at  all.1 

The  man  who  chooses  to  drink  to  excess,  and  when  drunk 
from  time  to  time  commits  acts  of  brutal  violence,  must  be  taught 
that  he  is  answerable  both  for  being  under  the  influence  of  alco- 
hol and  for  the  acts  such  influences  induce.2 

The  above  principle  is  usually  carried  out  to  its  full  effect  in 
grave  crimes,  and  is  applied  even  to  cases  where  a  person,  by 
reason  of  his  natural  constitution,  shows  a  particular  intolerance 
to  alcohol,  and  therefore  approaches,  when  intoxicated,  p  state 
of  real  insanity. 

MENTAL  INCAPACITY  FROM  DRUGS. 

With  respect  to  intent  and  motive,  the  rule  with  reference  to 
intoxication  from  liquor  applies  to  a  similar  mental  condition 
produced  by  the  use  of  drugs.  However,  where  the  condition  is 
produced  wholly  or  partly  by  voluntary  indulgence  in  drugs,  the 

1  Regina  v.  Williams,  Old  Bailey,  provocation  has  been  given,  because 
1886.  the  question  is  in  such  cases  whether 

2  Sir  Henry  James  in  a  case  re-  the  fatal  act  is  to  be  attributed  to  the 

Jorted    by    The    Times    newspaper,  passion  of  anger,  excited  by  the  pre- 

an.  4th,    1892.     See  on  the  whole  vious  provocation;   and  that  passion 

matter  J.  Dixon  Mann,  "For.  Med.,"  is  more  easily  excitable  in  a  person 

Phila.,   1893,  p.  359.     But  see  Rex  when  in  a  state  of  intoxication  than 

v.  Thomas,  7  Car.  &  P.,  820,  where  when  he  is  sober."    Cf.  Reg.  v.  Doody, 

Parke,  B.,  says:  "Drunkenness  may  6  Cox  Cr.  Cas.,  463;   Reg.  v.  Gamlin, 

be  taken  into  consideration  in  cases  1  Post.  &  F.,  90. 
where  what  the  law  deems  sufficient 


EVIDENCE   OF   MENTAL   UNSOUNDNESS.  501 

defence  is  not  governed  by  statutes  relating  to  the  defence  of 
"  intoxication "  ; l  and  where  the  intoxication  is  produced  by 
drugs,  and  not  by  the  voluntary  use  of  ardent  spirits,  it  has  been 
held  that  a  statute  declaratory  of  the  common-law  measure  of 
responsibility  of  persons  intoxicated  by  liquor  is  so  far  inap- 
plicable that  a  person  intoxicated  by  drugs  is  excused  if  he  does 
not  know  the  character  of  his  act  and  its  consequences,  and  has 
not  sufficient  will  power  to  refrain  from  the  act.2 

EVIDENCE   OF   MENTAL   UNSOUNDNESS. 

IN  GENERAL. 

The  starting-point  of  any  judicial  inquiry  into  sanity  is  the 
presumption  of  fact  based  upon  experience  that  every  man  is 
sane.  The  presumption  of  sanity  has  its  principal  bearing  upon 
the  burden  of  proof.  The  general  rule  is  that  the  burden  of 
proof  is  on  the  party  to  the  litigation  who  asserts  insanity.  This 
subject  is  fully  treated  below.3 

The  nature  of  admissible  evidence  to  prove  insanity  by  con- 
troverting the  presumption  of  sanity  may  be  gleaned  from  the 
various  parts  of  this  article  dealing  with  the  different  phases  of 
mental  unsouudness  and  their  legal  relations.4  There  are,  how- 
ever, many  reported  cases  which  pass  upon  the  admissibility  of 
evidence  near  the  border  of  relevancy  or  materiality,  as  well  as 
upon  the  weight  of  different  species  of  proof ;  and  it  is  our  main 
purpose  to  collect  and  discuss  some  of  the  more  significant  of 
these  decisions. 

THE  ALLEGED  LUNATIC  AS  A  WITNESS  OF  His  OWN 
INSANITY. 

The  alleged  lunatic  is  generally  permitted  to  take  the  stand 
in  his  own  behalf  and  testify  as  to  his  own  symptoms. 5  Under 
the  common  law  in  its  early  strict  form,  a  person  might  not 
"stultify "  himself  by  alleging  his  own  insanity."  Moreover, 

1  Edwards  v.  State,  38  Tex.  Cr., 386;  4  For  an  example  of  a  suggestive 
43  S.  W.  Rep.,  112;  39  L.  R.  A.,  262  case  as  to  the  line  of  proof  that  may 
(cocaine  and  morphine):  Edwards  v.  be  followed,  see  Ruter  v.  Mut.  Life 
State  (Tex.  Cr.  App.),  54  S.  W.  R.,  Ins.  Co.,  169  U.  S.,  139;    18  Sup.  Ct., 
589.  300;  aff'g  70  Fed.,  954;    17  C.  C.  A., 

2  Cannon  v.  State  (Tex.),  56  S.  W.  537. 

R.,351.  5  C/.     "Insane    Persons    as    Wit- 

3  See  "Burden  of  Proof,"  infra,  p.       nesses,"  siijrra,  p.  421. 
556.  '  Supra,  p.  354. 


502  MENTAL  UNSOUNDNE&S — BECKER   AND   BOSTON. 

the  doctrine  of  interest  disqualified  a  party  to  an  action  from 
testifying  in  his  own  behalf.  But  these  strict  rules  have  been 
modified  in  most  jurisdictions.  The  evidence  of  a  defendant 
tending  to  exculpate  him  from  a  criminal  charge  on  the  ground 
of  insanity  is  regarded  as  competent,  provided  he  is  a  competent 
witness  for  himself  under  some  statutory  abolishment  of  the 
common-law  disqualification  for  interest,  and  he  may  testify  (if 
the  law  of  the  State  allows  the  defense)  that  he  was  seized  with 
an  uncontrollable  impulse  to  commit  the  crime.1 

Even  with  respect  to  testimony  by  the  defendant  himself, 
however,  the  rule  as  to  opinion  evidence  must  be  observed. 
Neither  in  criminal  nor  in  civil  cases  would  the  witness  be  allowed 
to  volunteer  the  mere  inexpert  opinion  that  at  the  time  he  exe- 
cuted a  contract  or  committed  an  unlawful  act  he  was  suffering 
from  a  mental  disease.  He  must  confine  his  testimony  to  the  ob- 
jective facts  from  which  the  court  may  draw  its  conclusion  as  to 
his  sanity  at  the  time  in  question.2 

In  any  case,  before  the  alleged  incompetent  may  testify  in 
his  own  behalf,  either  to  prove  his  sanity  or  his  insanity  at  the 
given  time,  the  court  must  first  pass  upon  the  question  whether 
such  person  is  competent  to  be  a  witness.3 

When  the  inquiry  is  into  the  present  sanity  of  a  person,  for 
the  purpose  of  having  him  adjudged  incompetent,  an  oral  exami- 
nation is  frequently  had  during  the  trial.  The  alleged  incompe- 
tent takes  the  witness-stand  and  is  subjected  to  a  direct  and 
cross-examination,  designed  to  exhibit  to  the  jury  his  mental 
qualifications  or  defects.  And  in  any  trial  where  the  present 
mental  condition  of  a  party  has  relevancy  to  the  issue,  the  jury 
are  privileged  to  consider  his  demeanor  upon  the  witness-stand 
along  with  the  other  evidence.4 

'Abbott  v.  Commonwealth,  23  Burgle,  123  Cal.,  303;  55  Pac.  R. 

Ky.  L.  R.,  226;  62  S.  W.  R.,  715;  cf.  998.  But  his  demeanor  on  the  stand 

supra,  p.  450,  as  to  irresistible  im-  must  not  be  irrelevant  by  reason  of 

pulse.  lapse  of  time  and  changed  mental 

•  O'Connell  v.  Beecher,  21  App.  condition;  see  Bowden  v.  People,  12 

Div.,  298;  47  N.  Y.  Supp.,  334.  Hun  (N.  Y.)(  85,  where  it  was  held 

3  Supra:  "Insane  Persons  as  Wit-  error  to  charge  the  jury  that  they 
nesses,"  p.  421.  might  consider  defendant's  physique, 

4  Commonwealth  v,  Buccieri,    153  apparent  age,  and  conduct  at  the  trial, 
Pa.  St.,  535;    26  Atl.  R.,  228;    32  upon  an  issue  of  insanity  from  deliri- 
W.  N.  C.,   113;    see  also  People  v.  um  tremens  six  months  before. 


CONDUCT  AS  EVIDENCE   OF  INSANITY.  503 

THE  ALLEGED  LUNATIC'S  CONDUCT  AS  EVIDENCE  OF  His 

INSANITY. 

The  law  allows  a  wide  scope  of  evidence  of  acts  tending  to 
show  the  mental  state  of  the  person  whose  sanity  is  in  question.1 

Declarations. — His  conversations  are  broadly  admissible 
as  evidence  of  insanity.  This  does  not  offend  the  rule  against 
hearsay  evidence,  because  the  conversations  are  not  received  to 
prove  the  assertions  which  he  made  in  the  course  of  them,  but 
merely  to  show  by  his  words  his  mental  state  at  the  time  of  ut- 
terance. And  the  same  rule  applies  to  written  declarations.2 
Thus,  a  testator's  verified  answer  in  a  previous  litigation, 
setting  up  weakness,  inability  to  read  and  write  or  transact  busi- 
ness intelligently,  is  admissible  as  tending  to  show  mental  con- 
dition at  the  time  of  the  execution  of  the  will.3 

Taking  the  view  that  all  acts  tending  to  throw  light  on  the 
mental  condition  of  the  accused  are  pertinent,  the  Georgia  court 
permitted  an  affidavit  subscribed  by  him  at  a  previous  term  of 
court  to  be  introduced.4 

But  the  rule  must  not  be  abused  by  allowing  hearsay  proof  of 
extraneous  facts  to  creep  in,  under  the  guise  of  evidence  of  insane 

1  Flanagan  v.  State,  103  Ga.,  619;  Jones  v.  Roberts,  37  Mo.  App..  165; 

30  S.  E.  R.,  550.  Sheehan  v.   Kearney   (Miss.),  35  L. 

*  Clark  v.  Hill,  69  Mo.  App.,  541;  R.  A.,  102;  21  So.  R.,  41;  Middleditch 

In  re  Potter's  Will,   161  N.  Y.,  84;  v.  Williams.  45  N.  J.  Eq.,  726;  4  L.  R. 

55  N.  E.  R.,  387,  reversing  17  App.  A.,  738;  17  Atl.  R.,  826;  Whitman  v. 

Div.,    267;     45    N.   Y.   Supp.,   563;  Morey,  63  N.  H.,448;  2  Atl.  R.,  899; 

In  re  Brunor,  21    App.   Div.,    259;  Waterman  v.  Whitney,  11  N.  Y.,  157; 

47  N.  Y.  Supp.,  681;    Clark  v.  Hill,  62  Am.  Dec.,  71;   In  re  Woodward's 

69    Mo.    App.,    541;     Barbour    v.  Will,  167  N.  Y.,  28;  60  N.  E.  R.,  233; 

Moore,  4  App.  D.  C.,  535;   Waugh  v.  Herster  v.  Herster,  122  Pa.  St.,  239; 

Moan,  200    111.,  298;    65  N.  E.  R.,  16  Atl.  R.,  342;   Swope  v.  Donnelly, 

713.      See  generally  on  this  subject,  7  Pa.  Dist.  R.,  448;  21  Pa.  Co.  Ct.  R., 

the    following    contested-will    cases:  167;   Robinson  v.  Robinson,  203  Pa., 

Appeal    of  Vivian,   74  Conn.,   257;  400;  53  Atl.  R.,  253;   Peery  v.  Peery, 

50     Atl.    R.,    797;    Ball    v.    Kane,  94  Tenn.,  328;  29  S.  W.  R.,  1;   Kirk- 

(Del.)  39  Atl.  R.    778;    Towsen   v.  patrick  v.  Jenkins,  96  Tenn.,  85;  33 

Moore.  11  App.  D.  C.,  377;    Hill  v.  S.  W.  R..  819;    Mclntosh  v.  Moore, 

Balrus,  158  111.,  314.  318,  41  N.  E.  22  Tex.  Civ.  App..  22;  53  S.  W.  R., 

Rep.,  912;  Bower  v.  Bower,  142  Ind.,  61;   Patterson  v.  Lamb,  21  Tex.  Civ. 

194;  41  N.  E.  Rep.,  523,  525;    In  re  App.,  512;  52  S.  W.  R.,  98;    Bryant 

Goldthorp,  94  Iowa,  336;  62  N.  W.  v   Pierce,  95  Wis.,  331;  70  N.  W.R., 

Rep.,    845;     Manatt    v.    Scott,    106  297;    In  re  Loermecker's  Will,   112 

Iowa,  203;  76  N.  W.  R.,  717;   Lane  Wis.,  461:   88  N.  W.  R.,  215. 

v.  Moore,  151  Mass.,  87;  23  N.  E.  R.,  'Manatt  v.  Scott,  106  Iowa,  203: 

387;   In  re  Merriman.  108  Mich.,  454;  76  N.  W.  Rep.,  717. 

66  N.  W.  R.,  372;   Moore  v.  McDon-  4  Flanagan  v.  State,  103  Ga.,  619; 

aid,  68  Md.,  321;   12  Atl.  R.,   117;  30  S.  E.  R.,  550. 


504  MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 

declarations.  Thus,  evidence  of  declarations  not  inconsistent 
with  mental  soundness  is  rightly  excluded  when  there  was  no 
precedent  proof  of  mental  disease  until  three  years  afterward.1 

Whole  Conversation  Admitted.  —Where  the  declarations  of  the 
alleged  incompetent  are  proved,  it  is  proper  to  admit  the  whole 
conversation,  including  the  words  said  by  both  or  all  persons 
present.2 

In  Criminal  Cases  Accused  Must  Have  Been  Cautioned. — 
Where  statements  of  an  accused  to  an  officer  are  incompetent  as 
admissions  because  the  officer  failed  to  caution  him  as  required 
by  the  usual  statute,  they  are  also  incompetent  against  him  on 
the  issue  of  his  sanity.3 

Declarations  as  Proof  or  Explanation  of  Facts.  — Sometimes  the 
declarations  are  offered  in  evidence  after  the  death  of  a  testator, 
to  explain  apparently  insane  actions.  Declarations  then  stand 
upon  a  different  footing.  They  must  have  been  made  at  or  about 
the  time  of  such  acts.4  In  cases  where  undue  influence  is  alleged, 
if  testator's  declarations  are  proved  merely  to  exhibit  the  quality 
of  his  mind,  the  only  evidentiary  question  is  whether  they  have 
any  probative  force.  If  they  tend  to  prove  nothing  the  court 
may  of  course  exclude  them,  but  otherwise  they  are  admissible 
on  the  same  grounds  as  in  any  other  litigation  where  mental 
capacity  is  in  issue.5  When,  however,  the  declarations  are  of- 
fered to  prove  the  facts  stated  by  the  testator  as  facts,  they  are  not 
competent  except  as  admissions  or  declarations  against  interest. 

There  is,  however,  an  intermediate  category  of  admissible 
declarations  of  a  testator — those  which  tend  to  prove  material 
facts  as  to  what  ideas  were  operating  in  his  mind  at  the  time. 
Such  are  not  offered  to  prove  mental  capacity.  Upon  the 
question  of  undue  influence,  however,  it  may  be  important  to 
know  what  were  testator's  motives,  feelings,  or  designs,6  or 
his  inclinations  toward  legatees.7 

'Crossan    v.    Crossan    (Mo.),    70  ney  (Miss.),  21  So.  R.,  41;   35  L.  R. 

S.  W.  R.,  136.  A.,  102;   In  re  Dickson's  Est.,  20  Pa. 

2  In  re  Potter's  Will,  161  N.  Y.,  84,  Co.  Ct.  R.,  152. 

55  N.  E.  R.,  387;  State  v.  Constan-  s  Mallory  v.  Young,  94  Ga     804: 

tine  (Wash.),  93  Pac.  R,,  317.  22  S.  E.  R.,  142;    Bryant  v.  Pierce, 

See  article  on  "Coroners,"  in  this  95  Wis.,  331;    70  N.  W.  R.,  297. 

work,  vol.  i.,  p.  809.    Earth  v.  State  6  Bartxmr  v.  Moore,  4  App.  D.  C., 

46  S.  W.  Rep.,  228;  39  Tex.  Cr.,  381.  535;   In  re  Munger,  38  Misc.  R.,  268: 

'lements   v.    McGinn    (Cal.),    33  77  N.  Y.  Supp.,  648. 

Pac.  R.,  920;   see  Barbour  v.  Moore,  7  Bush  v.  Delano,  113  Mich.,  321: 

4  App.  D.  C.,  535;   Sheehan  v.  Kear-  71  N.  W.  R.,  628. 


CONDUCT  AS   EVIDENCE   OF  INSANITY.  505 

On  these  inquiries  testator's  statements,  oral  or  in  letters, 
may  be  competent.1  But  care  must  be  taken  not  to  violate  the 
rule  against  hearsay.  The  declarations  must  be  kept  within  the 
res  gestac  rule,  and  the  evidence  must  be  confined  to  statements 
practically  contemporaneous  with  the  acts  in  question.  Testa- 
tor's statement  that  he  was  influenced  would  be  hearsay  and  inad- 
missible to  prove  the  fact.2 

Declarations  as  Admissions.  —  It  would  seem  quite  clear  that  the 
usual  rule  as  to  admissions,  that  they  may  be  proved  as  against 
the  party  to  an  action  who  made  them,  does  not  apply  to  an  ad- 
mitted or  adjudged  insane  party.  The  presumption  that  a  per- 
son will  not  make  untruthful  statements  against  his  own  inter- 
est presupposes  mental  capacity  to  realize  what  facts  are  against 
his  interest.3  Frequently  insane  persons  pretend  to  confess  to 
the  most  wicked  crimes.  Statements  of  this  character  are  com- 
petent evidence  on  the  issue  of  insanity,  however,  without  much 
regard  to  their  truth  or  falsity.  For  if  true,  the  admitted  acts 
themselves  may  bear  upon  the  issue,  and  if  false,  the  statements 
may  bear  upon  the  issue.  Thus,  the  admissions  of  one  that  he 
tortured  and  killed  goslings  and  turkeys  have  been  allowed  to 
be  proved  in  order  to  show  his  attitude  toward  animal  life,  as 
tending  to  indicate  his  mental  condition.4 

Illustrations  of  Competent  Evidence  as  to  Con- 
duct.— As  we  have  stated,  the  scope  of  the  evidence  of  the 
alleged  incompetent's  condition  is  very  broad.5  A  few  illustra- 
tive cases  may  make  the  general  character  of  such  evidence  clear. 

Thus,  evidence  of  a  witness  who  had  the  defendant  in  custody, 
that  he  had  conversations  with  her,  from  the  time  of  the  arrest 
to  the  time  of  trial,  that  she  was  unconcerned,  thought  she  had 
done  right,  seemed  unconscious  of  her  condition,  had  no  fear  of 
punishment,  laughed  and  sang,  has  been  deemed  pertinent.8 

On  the  other  hand,  to  rebut  the  defence  of  insanity,  evidence 

'Slinglaff  v.  Bruner,  174  111.,  561,  affairs.     Ruffner  v.   Luther,    19   Pa. 

51    N.    E.    R.(    772;     Schieffelin    v.  Co.  Ct.  R.,  349. 

Schieffelin  (Ala.),  28  So.  R.,  687.  4  Hart  v.  Miller,  64  N.  E,  R.,  239 

2  Towson  v.  Moore,  11  App.  D.  C.,  (Ind.  App.):    c/.  Waterman  v.  Whit- 

377.  ney,  11  N.  Y.,  157;    Redf.  on  Wills. 

*  Piaster   v.  Rigney,  97   Fed.,  12;  3d  ed.,  p.  538. 

38  C.  C.  A.,  25.      After  an  adjudica-  5  Flanagan  v.  State,  103  Ga.,  619; 

tion  as  a  habitual  drunkard,  his  ad-  30  S.  E.  R.,  550. 

missions  are  not  competent  against  "Green  v.  State,  64  Ark.,  523;  43 

him,   because  he   has  been  decreed  S.  W.  Rep.,  973. 
incompetent    to    manage    his    own 


506  MENTAL   UNSOUNDNESS — BECKER   AND  BOSTON. 

has  been  held  proper  that  the  defendant  had  been,  at  a  time 
shortly  preceding  the  criminal  act,  working  daily  as  a  carpenter 
and  doing  his  work  with  skill.1 

In  the  leading  Massachusetts  case  of  Commonwealth  v.  Pome- 
roy,2  Wells,  J.,  said:  "Upon  the  question  of  sanity  at  the  time 
of  committing  an  offence,  the  acts,  conduct,  and  habits  of  the 
prisoner  at  a  subsequent  time  may  be  competent  as  evidence  in 
his  favor.  But  they  are  not  admissible  as  of  course.  When 
admissible  at  all,  it  is  upon  the  ground  either  that  they  are  so 
connected  with  or  correspond  to  evidence  of  disordered  or  weak- 
ened mental  condition,  preceding  the  time  of  the  offence,  as  to 
strengthen  the  inference  of  continuance,  and  carry  it  by  the  time 
to  which  the  inquiry  relates,  and  thus  establish  its  existence  at 
that  time ;  or  else  that  they  are  of  such  a  character  as  of  them- 
selves to  indicate  unsoundness  to  such  a  degree  or  of  so  perma- 
nent a  nature  as  to  have  required  a  longer  period  than  the  inter- 
val for  its  production  or  development." 

In  a  case  where  the  defence  admitted  the  commission  of  the 
acts  charged  in  the  indictment  and  pleaded  insanity,  the  trial 
judge  nevertheless  allowed  the  prosecution  to  prove  the  circum- 
stances of  such  acts,  the  prisoner's  conduct  before  and  at  the 
time  of  them,  and  afterward,  and  his  subsequent  statements  and 
confessions.  And  in  charging  the  jury  the  court  intimated  that 
the  State  had  been  allowed  to  go  into  these  details  so  that  the  jury 
might  judge  of  the  defendant's  sanity,  and  so  that  a  basis  might 
be  obtained  for  hypothetical  questions  to  be  propounded  to  the 
experts.3 

Justice  McLean,  of  the  United  States  Supreme  Court,  holding 
a  criminal  trial  at  Circuit,4  thus  charged  the  jury:  "In  such 
cases  the  important  fact  to  be  ascertained  is,  whether  the  person 
charged  can  discriminate  between  right  and  wrong.  If  he  be 
unable  to  do  this,  he  is  not  a  proper  subject  of  punishment. 
And  this  fact  can  be  best  ascertained,  not  by  any  medical  theory, 
but  by  acts  of  the  individual  himself.  .  .  . 

"The  defendant  in  this  case  accounted  for  the  amount  of 
money  he  had  in  possession  by  saying  he  received  it  as  the  price 

1  Barnett  v.  State  (La.),  39  So.  R.,  C.  Ct.  Ohio),  6  McLean,  121.  In  the 

778.  United  States  courts  the  trial  judges 

2 117  Mass.,  143.  are  permitted  to  comment  upon  the 

»  United  States  r.  Chisholm  (U.  S.  evidence  more  freely  than  in  some  of 

C.  Ct.  Ala.),  153  Fed.,  808.  the  State  courts. 

*  United   States   v.   Shults   (U.   S. 


DECLARATION   OF   THIRD    PARTIES   AS   EVIDENCE.          507 

of  a  colt.  He  changed  the  notes  he  had  for  gold  and  silver, 
knowing  that  the  notes  might  not  be  current  at  the  place  to  which 
he  might  go.  Or  he  might  fear  that  the  notes  might  be  identi- 
fied by  those  who  forwarded  them  in  the  mail.  On  either  sup- 
position it  showed  a  sound  reflection  on  the  consequence  of  his 
acts  should  he  be  arrested.  He  absconded,  and  was  arrested 
several  miles  from  home,  on  his  way  to  the  West.  He  was  found 
in  a  close  room  of  a  boat,  the  door  of  which  was  locked ;  and  it 
is  proved  that  when  he  came  to  the  boat  the  previous  evening,  he 
engaged  the  room  and  requested  that  the  door  should  not  be 
opened  to  any  one.  This  shows  an  apprehension  that  he  would 
be  pursued,  and  a  desire  to  escape  the  pursuit. 

"These  acts  would  seem  to  be  unmistakable  evidence  of  a 
sense  of  guilt,  and  a  desire  to  escape  punishment.  .  .  .  Upon  the 
whole,  gentlemen,  if  you  think  from  the  evidence  in  the  case  that 
the  defendant  in  violating  the  mail  knew  he  was  doing  wrong, 
and  that  he  was  liable  to  be  punished  for  the  act,  he  is  a  proper 
subject  for  punishment." 

DECLARATIONS  OF  THIRD    PARTIES  AS  EVIDENCE. 

Admissions.1 — The  admissions  of  one  of  several  parties  in- 
terested in  sustaining  or  defeating  a  will  cannot  be  used  against 
others ;  therefore  the  admissions  of  one  such  person  that  a  testa- 
tor was  insane  are  not  admissible  in  evidence  in  a  proceeding  to 
refuse  or  revoke  probate,2  unless  he  was  the  sole  individual  inter- 
ested in  sustaining  or  defeating  the  will,3  or  unless,  perhaps, 
they  were  made  in  the  presence  of  the  other  interested  parties.4 

But  where  the  admissions  or  declarations  are  those  of  the  sole 
beneficiary,  and  they  tend  to  indicate  that  the  beneficiary  ad- 
mitted mental  incapacity,  they  are  competent  to  prove  the  alle- 
gation.5 

The  admissions  may  be  by  conduct  as  well  as  by  spoken 

•See   infra,    p.    518,    for  declara-  Wood   v.   Carpenter,    166   Mo.,   465; 

tions    of    the    alleged    incompetent  66  S.  W.  Rep.,  172. 

as    bearing     upon     alleged     undue  » Egbers  v.  Egbers,  177  111.,  82;  52 

influence.  N.  E.  Rep:,  285.    In  such  case  they 

2  Roller  v.  Kling  (Ind.),  49  N.  E.  can  be  used  as  admissions  against  in- 

Rep.,     948;    Whitelaw's     Admr.     v.  terest. 

Whitelaw's  Admr.,  96  Va.,  712;    32  4  See  In  re  Yorke's  Est,,  6  Pa.  Dist. 

S.  E.  Rep.,  458;    Roush    v.  Wensel,  R.,  321. 

15   Ohio    Cir.    Ct.    R.,    133;     In   re  *Steele  v.  Helm,2Marv.,237(Del.); 

Yorke's  Est.,   6  Pa.   Dist.   R.,  321;  43  Atl.  R.,  153. 


508          MENTAL  TJNSOUNDNESS — BECKER   AND  BOSTON. 

words;  for  instance,  evidence  of  a  suit  brought  by  testator's 
daughter  against  her  father  has  been  deemed  competent  as  an 
admission  that  she  regarded  him  as  of  sound  mind.1 

EVIDENCE  OF  THE  INSANITY  OF  EELATIVES. 

The  question  of  the  extent  to  which  evidence  of  the  insanity 
of  others  is  admissible  to  show  a  hereditary  taint  has  received 
little  discussion.2  In  Michigan  evidence  of  the  insanity  of  a 
sister  and  a  niece  of  a  testator,3  and  in  Arkansas,  of  a  brother  of 
a  person  accused  of  crime,4  and  of  ancestors  (after  evidence  of 
defendant's  insanity)  5  was  held  competent  on  the  question  of  his 
mental  capacity  as  tending  to  show  the  possibility  of  hereditary 
taint. 

Evidence  of  this  class  is  necessarily  of  a  corroborative  or 
cumulative  character.  It  has  alone  no  probative  force,  but  when 
preceded  by  independent  direct  proof  of  irrational  acts  on  the 
part  of  the  alleged  incompetent  it  aids  the  inference  of  insanity.6 

Thus,  there  being  no  other  proof  tending  to  show  defendant's 
insanity,  evidence  of  the  insanity  of  his  uncle  was  deemed  in- 
competent, especially  where  the  particular  form  of  the  latter's 
insanity  was  not  shown  ;7  and  evidence  of  insanity  in  the  family 
of  a  testator  has  been  excluded  where  there  was  no  evidence  of 
his  own  insanity.8  But  in  Kentucky  the  very  act  of  parricide 
without  apparent  motive  was  held  sufficient  evidence  of  the  in- 
sanity of  the  accused  to  justify  the  introduction  of  evidence  of 
insanity  of  the  mother,  grandfather,  and  other  near  relatives  of 
the  accused.9  And  too  large  a  measure  of  testimony  directly 
tending  to  show  insanity  must  not  first  be  required.10 

In  Colorado  it  was  held  error  to  instruct  the  jury  that  they 
were  to  consider  evidence  as  to  the  insanity  of  defendant's  father 

1  Ketteman    v.    Metzger,    23    Ohio  6  State  v.  Christmas,  6  Jones  (L.). 
Cir.  Ct.  R,.,  61.  471  (N.  Car.). 

2  See   the  subject   of   Heredity   in  7  State  v.  Van  Tassel,  103  Iowa,  6; 
Insanity,  this  work,  vol.  iii.,  p.  164.  72  N.  W.  Rep.,  497. 

3  Prentisr.  Bates,  93  Mich.,  234;  53  8  Laros  v.   Commonwealth,  84  Pa. 
N.  W.  Rep.,  153;    Grant,  J.,  dissent-  St.,    200;   State  v.  Cunningham,  72 
ing,   Morse,   C.   J.,   dissenting  as  to  N.  C.,  469;   Bradley  v.  State,  31  Ind., 
niece.  492;    Berry  v.  Safe  Dep.  &  Trust  Co. 

4Shaeffer  v.  State,  61  Ark.,   241;       (Md.),  53  Atl.  R.,  720. 
32  S.  W.  Rep.,  679.  9 Murphy    v.    Commonwealth,    92 

"Green    ?;.    State,    64  Ark.,    523;       Ky.,  485;    8  S.  W.  R.,  163. 
43  S.  W.  Rep.,  973.  '"See    Hagan    v.   State,    5    Baxt. 

(Tenn.),  615. 


EVIDENCE   OF   THE   INSANITY    OF   RELATIVES.  509 

and  aunt  only  in  case  they  entertained  a  reasonable  doubt  as  to 
defendant's  insanity  at  the  time  of  the  homicide.1 

Insanity  of  what  Relatives  Competent  Evidence.  — Evidence  of  the 
insanity  of  collateral  kindred,2  unless  very  near,5  has  not  been  ad- 
mitted. Evidence  of  the  imbecility  of  descendants  (e.g.,  grand- 
children) has  been  held  insufficient  to  indicate  insanity  of  the 
ancestor ;  it  did  not  appear  that  the  insanity  was  of  a  hereditary 
character,  since  although  another  grandchild  was  also  imbecile, 
the  imbecility  was  directly  accounted  for  by  a  disease  with  which 
the  ancestor  was  not  afflicted.4 

The  Insanity  of  Relatives  Must  be  Proved  by  Evidence  that  Would 
be  Competent  to  Prove  Insanity  Generally. — Evidence  of  a  non- 
expert witness  that  the  alleged  incompetent's  father  was  a  suf- 
ferer from  paresis,  and  that  he  had  observed  the  indications  of 
the  disease  in  the  father,  and  noted  the  same  manifestations  in 
the  son,  was  not  admitted  in  a  Vermont  case.5 

The  insanity6  or  personal  peculiarities7  of  kindred  are  not  to 
be  proved  by  reputation8  or  tradition7  in  the  family.6 

General  Principles  as  to  Evidence  of  Insanity  of  Relatives.  — To 
deduce  general  principles  from  these  decisions:  it  would  seem 
that  where  medical  science  recognizes  heredity  as  a  predisposing 
cause  of  insanity,  the  existence  of  that  cause  may  be  shown, 
actually,  by  the  mental  condition  of  ancestors,  and  inferentially, 
by  mental  unsoundness  in  near  blood  relatives.  But  that,  as  the 
mere  existence  of  the  predisposing  cause  does  not  necessarily  de- 
termine mental  unsoundness  in  the  subject,  such  evidence  alone 
will  not  overcome  the  presumption  of  sanity.  And  therefore, 
if  there  be  no  other  evidence  tending  to  show  mental  unsound- 
ness,  such  evidence  may  properly  be  rejected  as  incompetent, 
because  it  is  only  in  connection  with  other  evidence  that  it  can 
indicate  more  than  a  speculative  possibility  not  amounting  to 
proof.  Hence,  a  court  in  its  discretion  may  first  require 
other  evidence  tending  to  show  mental  unsoundness  before  ad- 
mitting evidence  of  the  insanity  of  blood  relatives.  And  as  to 

1  Jones  v.  People,  23  Colo.,  276;  47  4  Hawley  v.  Griffin  (Iowa),  82  N. 

Pac.  R.,  275.  W.  Rep.,  905. 

"State    r.    Soper,    148    Mo.,    217;  *  In  re  McCabe,  40  Atl.  Rep.,  52; 

49  S.  W.  R.,  1007.  70  Vt,,  155;  cf.  infra,  p.  547. 

•Commonwealth  v.    Wireback,  190  'Snell  v.   United  States,   16  App. 

Pa.  St.,  138;   42  Atl.  R..  542;   43  W.  D.  C.,  501. 

N.  C.,  506.  7  State  v.  Leuth,  50  Ohio  C.  C.  R., 

94. 


510          MENTAL  TJNSOUNDNESS — BECKER  AND  BOSTON. 

the  degree  of  relationship  essential,  since  medical  science  has  not 
fixed  the  limits  within  which  hereditary  taint  shows  itself,  there 
may  be  degrees  in  which  the  inference  of  hereditary  or  atavistic 
predisposition  would  be  purely  speculative  and  consequently 
without  weight  as  proof.  In  remote  degrees,  therefore,  no  valid 
exception  could  be  taken  to  a  refusal  to  admit  evidence  of 
insanity  of  relatives.  In  nearer  degrees,  the  admission  or 
exclusion  of  such  testimony  would  be  a  matter  of  judicial 
discretion. 

COLLATERAL,  ISSUES  RESPECTING  MENTAL  CONDITION. 

At  Other  Times. — Such  evidence  is  admissible  to  show 
its  condition  at  the  time  in  question.  For  instance,  upon  a 
murder  trial,  evidence  of  the  condition  of  the  mind  of  the  ac- 
cused, both  before  and  after  the  homicide,  has  been  admitted  as 
tending  to  show  the  condition  at  the  time  of  the  act ; 1  and  the 
evidence  has  been  permitted  to  extend  to  the  condition  imme- 
diately before  and  at  the  time  of  the  trial.2  So  far  has  evidence 
of  prior  and  subsequent  mental  condition  been  deemed  determi- 
native of  mental  condition  in  the  intervening  time,  in  Pennsyl- 
vania, that  an  instruction  was  approved  which  stated  that  it  is 
contrary  to  every  principle  of  psychological  science  that  a  person 
should  be  sane  immediately  before  and  after  a  crime  and  insane 
at  the  time  of  its  commission.3 

The  evidence  should  relate  reasonably  to  the  period  of  time 
with  respect  to  which  sanity  or  competency  is  in  dispute ; 4  thus, 
indications  of  eccentricity  or  insanity  thirty  years  later  than  the 
time  under  consideration  are  too  remote  to  prove  insanity  at  the 
earlier  date.5  But  great  latitude  is  allowed,  in  the  discretion  of 
the  court,6  in  the  time  with  respect  to  which  testimony  may  be 
given;  for  instance,  in  one  case  witnesses  were  permitted  to 

'State  v.  Newman,  57  Kan.,  705;  2  People  v.  Hoch,  150  N.  Y.,  291; 

47  Pac.  R.,  881.  44  N.  E.  Rep.,  976. 

In  Taylor  v.  U.  S.,  7  App.  D.  C.,  *  Commonwealth  v.  Wireback,  190 

27,  evidence  of  general  conversations  Pa.  St.,  138;    42  Atl.  Rep.,  542;    43 

of  the  accused  on  the  day  of  the  horn-  W.  N.  C.,  506.    But  cf.  supra,  Mania 

icide  was  excluded,  ana  it  was  said  Transitoria,  p.  261. 

that  evidence  of  an  actuating  cause  4  Sharp  v.  Merriman  (Mich.),  66  N. 

of  an  alleged  insane  paroxysm  was  W.  Rep.,  372. 

inadmissible      without      substantial  sHawley  v.  Griffin  (Iowa),  82   N. 

proof    of    latent    insanity    or    latent  W.  Rep.,  905. 

tendency  to  insane  paroxysm.  6  Supra,  p.  503. 


THE   CONDITION   OF   THE   MIND    AT    OTHER   TIMES.         511 

relate  conditions  eight  years  anterior  to  the  event  and  two 
and  a  half  years  thereafter;1  and  in  another  it  was  held 
not  to  be  error  to  permit  an  expert  witness  to  express  his 
opinion  as  to  the  result  of  an  examination  into  the  mental 
condition  of  defendant,  made  seven  years  prior  to  the 
homicide  under  investigation.2  Where  in  a  will  contest 
proponent's  evidence  is  permitted  to  cover  a  long  period 
of  time,  contestant's  evidence  should  be  permitted  to  cover 
the  same  period.3  And  similarly,  in  a  criminal  trial  where 
the  evidence  of  the  defence  covered  a  period  of  ten  years 
prior  to  a  homicide,  it  was  held  error  to  allow  the  prose- 
cution to  cover  a  period  of  twenty  years,  and  it  was  said  that 
evidence  of  sanity  should  be  confined  to  the  period  covered  by 
the  defence.4 

Illustrative  Cases. — In  New  York  evidence  that  defendant  was 
within  a  year  previous  to  the  offence  engaged  in  the  enforcement 
of  the  excise  law,  as  complainant  and  witness,  and  that  his  acts 
impressed  others  as  rational,  was  admitted.5 

In  Delaware  evidence  of  defendant's  mental  condition  several 
months  before  a  homicide  of  which  he  was  accused  was  held  ad- 
missible under  the  defence  of  insanity.6  And,  in  Wisconsin, 
where  the  condition  was  continuous,  it  was  error  to  exclude  evi- 
dence of  defendant's  acts,  conduct,  and  declarations  several  days 
after  the  homicide.7 

Though  a  marriage  is  not  to  be  annulled  or  deemed  null  when 
collaterally  assailed,  on  the  ground  of  insanity,  unless  the  in- 
sanity existed  at  the  time  of  the  marriage,8  yet  to  determine  that 
fact  evidence  of  condition  before  and  after  the  ceremony  is  to  be 
considered.9 

The  presumption  of  the  continuance  of  insanity  of  a  perma- 
nent form  has  an  important  bearing  on  the  relevancy  of  proffered 
testimony  of  mental  condition  at  an  antecedent  time. 10  And,  con- 
versely, proof  of  diseased  mental  condition  after  the  act  in  ques- 

1  Howes   v.    Colboum,    165   Mass.,          *  State  v.  Harrigan  (Del.),  9  Houst., 
385;    43  X.  E.  Rep.,  125.  369;    31  Atl.  Rep.,  1052. 

2  People  v.  Hoch,  150  N.  Y.,  291;          'French    v.  State,    93   Wis.,   325; 
44  N.  E.  Rep.,  976.  67  N.  W.  Rep.,  706. 

*  Petefish  v.  Becker,   176  111.,  448;          "Supra,  p.  376. 

52  N.  E.  Rep.,  71.  '  Nonnemacher    v.    Nonnemacher, 

'Green  v.  State,    27  S.  W.  Rep.,  159  Pa.  St.,  634;  28  Atl.  Rep.,  439. 

5;    59  Ark.,  246.  10See  infra,  p.  551,  as  to  presump- 

*  People  v.  Koerner,  154  N.  Y.,355;  tion  of  continuance. 
48  N.  E.  Rep.,  730. 


512  MENTAL   UNSOUNDNESS— BECKER   AND   BOSTON. 

tiou  may,  if  it  be  of  a  substantial  character,  raise  an  inference  of 
insanity  at  the  time.1 

Where  one  set  of  witnesses,  whose  veracity  was  unimpeached, 
testified  positively  that  at  the  time  of  the  execution  of  a  will 
there  was  no  sign  of  mental  aberration,  and  physicians  testified 
that  upon  their  examination  later  in  the  day  testator  was  in- 
capable of  making  a  will,  it  was  held  that  the  physician's  testi- 
mony could  not  be  considered  as  tending  to  show  incompeteucy 
at  the  time  of  its  execution.2  It  would  seem,  however,  that  this 
case  is  to  be  regarded  as  establishing  a  rule  only  for  its  own  or 
very  similar  circumstances ;  for,  generally  speaking,  evidence  of 
mental  condition  at  other  times  is  relevant  and  to  be  considered 
as  bearing  upon,  and,  in  proper  cases,  as  establishing  the  mental 
condition  at  the  time  of  the  act  in  question. 

Weight  of  Evidence. — Of  course,  remoteness  of  the  time  to 
which  the  evidence  refers  weakens  its  effect.  Thus,  where  the 
only  evidence  was  of  the  mental  condition  of  testatrix  two  years 
after  making  the  will,  that  was  not  deemed  sufficient  evidence  to 
invalidate  the  will.3 

Evidence  Tending  to  Show  Another  Degree  of 
Mental  Incapacity. — Such  evidence  has  been  excluded  as 
immaterial ;  for  instance,  evidence  of  lack  of  sufficient  intelli- 
gence to  travel  to  a  distant  town  has  been  excluded  as  immaterial 
where  the  issue  was  whether  deceased,  killed  on  a  railroad  track, 
was  capable  of  appreciating  the  danger  of  his  position  on  the 
track.4 

And  in  a  will  contest  evidence  that  a  testator  was  incompe- 
tent to  transact  business  at  the  time  of  making  a  will  and  prior 
thereto  has  been  regarded  as  immaterial  and  inadmissible,  on  the 
ground  that  such  mental  iucompetency  is  not  the  standard  of 
testamentary  incapacity.5  But  it  is  apprehended  that,  inasmuch 
as  the  state  of  mind  of  the  testator  is  the  matter  to  be  determined 
as  a  fact  in  order  to  apply  to  it  the  standard  of  competency  which 
is  the  legal  measure,  it  would  be  improper  to  exclude  evidence 

'Com.  v.  Pomeroy,  117  Mass.,  143.  dispute  over  her  husband's  will,  had 

2  Lange  v.  Wiegand  (Mich.),  85  N.  advanced  money  to  settle  the  claim 
W.  Rep.,  109;   7  Bet.  Leg.  N.,  673.  of  one  of  her  children,  that  fact  was 

3  In  re  King's   Will,   29   Misc.    R..  held  inadmissible  as  evidence  of  her 
(N.  Y.  Surr.),  268;    61  N.  Y.  Supp.,  incapacity  to  transact  ordinary  busi- 
238.  ness.     Pooler  v.  Christman,  145  111., 

4 St.    Louis    S.     W.     Ry.     Co.     v.      405;  34  N.  E.  Rep.,  57. 
Shiflet  (Tex.),  58  S.  W.  Rep.,  945.  s  Brackney  v.  Fogle,  156  Ind.,  535; 

In   Illinois,   where  testatrix,   in  a      60  N.  E.  R.,  303. 


PROOF  OF  INFLUENCES  TENDING  TO  PRODUCE  INSANITY.       513 

tending  to  show  mental  condition  merely  because  it  failed  to 
show  a  condition  amounting  to  iiicoinpetency  in  the  particular 
case,  and  that  the  better  rule  would  exclude  opinion  evi- 
dence as  to  a  degree  of  competency  differing  from  the  legal 
standard,  but  would  not  exclude  evidence  of  facts  tending  to 
show  the  actual  mental  condition  of  the  testator  at  the  time 
of  the  execution  of  the  will.  Evidence  should  not  be  excluded 
merely  because  it  is  weak  or  does  not  prove  the  whole  case  at  a 
breath.1 

Proof  of  Influences  Acting  upon  the  Alleged  In- 
competent, Tending  to  Produce  Insanity. — When  there 
is  precedent  proof  of  a  weakened  condition  of  a  person's  mind, 
or  predisposition  to  insanity,  occurrences  to  such  person,  includ- 
ing statements  made  to  him,  are  admissible  as  tending  to  prove 
insanity ;  and  this  is  especially  true  in  criminal  cases,  where  the 
rules  against  speculative  testimony  are  somewhat  relaxed ;  and 
especially  in  those  states  where  a  reasonable  doubt  of  insanity 
requires  acquittal.2  In  general,  it  may  be  said  that  the  truth  or 
falsity  of  statements  so  made  is  immaterial,  upon  the  question 
of  their  aduiissibility  at  least.3 

A  frequent  example  of  this  class  of  evidence  is  afforded  by 
the  cases  of  homicide  or  attempted  homicide  following  the  dis- 
closure of  a  wrong  done  to  a  near  relative,  as  wife  or  daughter.4 
In  such  cases  it  is  often  maintained  as  a  defence  that  the  knowl- 
edge of  the  wrong  caused  temporary  insanity.  Owing  to  the 
possibility  of  the  abuse  of  the  defence  of  insanity  in  cases  of  this 
kind,  the  courts  have  been  cautious  in  admitting  proof  of  such 
disclosures.  Where  it  was  sought  to  show  a  state  of  mental  ex- 
citement caused  the  night  previous  to  a  homicide  by  the  accused 
discovering  improper  conduct  between  his  wife  and  a  man — not 
the  deceased — who  was  in  the  house  with  her,  and  by  the  insult- 
ing language  used  toward  him  by  that  man,  the  evidence  was 
held  too  vague  to  be  admitted.5  In  an  Indiana  case  the  prisoner, 

1  EVIDENCE  EXCLUDED  FOR  WEAK-  2  People  v.  Wood,  126  N.  Y.,  249; 

NESS. — Evidence    of    dislike,    In    re  Abbott   v.    Commonwealth,    21    Ky. 

Spencer's  Est.,  96  Cal.,  448;    31  Pac.  Law  R.,    1372;     55  S.   W.   R.,    196; 

R.,    453;     evidence    of    mistakes    in  State  v.  Bradley  (La.),  45  So.  R.,  120. 

arithmetic,  Berry  v.  Safe  Dep.  &  Tr.  3  People  v.  Wood,  supra. 

Co.  (Md.),  53  Atl.  R.,  720;    evidence  *  State  v.  Constantine  (Wash.),  93 

of  unconcern  after  the  commission  of  Pac.,  317. 

a  criminal  act,  Com.  v.  Pomeroy,  117  "State  v.  Graviotte,  22  La.  Ann., 

Mass.,  143.  587. 
III.— 33 


514  MENTAL  UNSOUNDNESS — BECKER  AND  BOSTON. 

accused  of  the  murder  of  his  wife,  offered  to  prove  that  she  had 
been  for  a  long  time  living  in  adultery  with  another  man ;  there 
was  no  direct  proof  of  insanity ;  held  inadmissible. 1 

As  epileptic  fits  tend  to  produce  insanity,  evidence  showing 
that  accused  suffered  from  them  should  be  admitted." 

Where  the  defence  is  an  abnormal  mental  condition  incapaci- 
tating the  accused  from  forming  a  design  to  kill,  evidence  of  the 
use  of  intoxicating  liquors  tending  to  produce  such  condition  is 
admissible,3  as,  also,  evidence  of  any  other  adequate  disturbing 
cause.3 

But  such  external  influences  must  have  a  tendency  to  cause 
insanity.  The  condition  of  mind  of  the  murdered  person  is  or- 
dinarily utterly  immaterial  on  a  prosecution  for  the  murder ;  evi- 
dence of  it  is,  therefore,  ordinarily  inadmissible ; 4  and,  likewise, 
specific  acts  of  violence  of  deceased  toward  the  accused  have  been 
deemed  immaterial  on  the  issue  of  the  insanity  of  the  accused.5 

Evidence  on  the  Border-line  of  Relevancy. — Evi- 
dence to  disprove,  as  well  as  to  prove  mental  unsounduess  must 
be  reasonably  pertinent  to  the  particular  question  at  issue,  and 
not  merely  speculative  in  its  pertinency.  For  instance,  where 
the  defence  in  a  homicide  case  was  insanity,  and  the  supposed 
motive  for  the  crime  was  resentment  against  the  murdered  woman 
for  taking  the  side  of  the  wife  of  the  accused  against  the  accused 
in  a  dispute  which  led  to  a  separation  of  the  husband  and  wife, 
and  the  separation  was  assigned  as  the  cause  of  the  insanity,  it 
was  held  inadmissible,  for  the  purpose  of  rebutting  this  idea,  to 
show  how  lightly  the  marriage  tie  sat  on  the  accused,  by  evidence 
that  after  a  divorce  from  a  former  wife  he  had  lived  with  a 
sporting  woman.8  Of  course,  the  chief  objection  to  this  testi- 
mony was  its  highly  prejudicial  and  unfair  character. 

In  Texas  it  was  regarded  as  permissible  to  show,  on  cross- 

1  Sawyer  v.  State,  35  Ind.,  80;    cf.  •  People  v.  Strait,  148  N.  Y.,  566; 
Sanchez  v.  People,  22  N.  Y.,  147.  42  N.  E.  Rep.,  1045. 

2  State  v.  Wright  (Iowa),  84  N.  W.  Evidence    that    testator    did    not 
Rep.,  541;  cf.  Guetig  y.  State,  63  Ind.,  make   out   his   own   tax   lists,    after 
278;    see  on  the  subject  of  epilepsy,  executing  his  will,  together  with  the 
supra,  p.  445.  tax  lists  themselves,  was  deemed  per- 

3  Hempton  v.  State,  111  Wis.,  127;  tinent  in  one  case.    Bower  v.  Bower, 
86  N.  W.  R.,  596.  142  Ind.,  194;    41  N.  E.  Rep.,  523. 
^  *  State  v.  Punshon,  133  Mo.,  44;  34  In  another,  evidence  of  how  testatrix 
S.  W.  Rep.,  25.  acted  when  her  mental  condition  was 

*  State  v.  Marshall  (Or.),  57  Pac.      mentioned  in  her  presence    was  ad- 
R-,  902.  mitted.     In  re  Fenton's  Will  (Iowa), 

66  N.  W.  Rep.,  99;  97  Iowa,  192. 


TRANSACTIONS   WITH   PERSONS   SINCE   BECOME   INSANE.      515 

examination  by  the  State,  that  a  near  neighbor  had  not  heard  of 
any  insanity  of  the  accused  until  after  the  homicide.1  And  in 
California  similar  evidence  was  admitted  where  the  defence  was 
partial  insanity  and  delusions,  as  tending  to  show  that  no  such 
delusions  or  insanity  existed,  and  also  that  defendant  was  sane 
on  other  matters  than  those  as  to  which  the  evidence  might  show 
that  he  was  insane. " 

Where  the  alleged  incompetency  arose  from  what  were  claimed 
to  be  insane  delusions  about  the  dishonesty  of  neighbors  of  a  tes- 
tator, evidence  was  admitted  to  show  their  reputation  for  hon- 
esty, as  tending  to  show  that  testator's  assertions  were  due  to  an 
insane  delusion.9 

PRIVILEGE  AGAINST  EVIDENCE  OF  TRANSACTIONS  WITH 
PERSONS  SINCE  BECOME  INSANE. 

The  competency  of  witnesses  with  respect  to  transactions  with 
insane  persons  is  now  usually  a  matter  of  statutory  regulation.4 

Statutes  frequently  provide  in  substance  that  a  party  cannot 
testify  as  to  a  personal  transaction  with  another  party  who  has 
become  insane,  unless  the  guardian  or  committee  has  first  testi- 
fied as  to  the  same  transaction,  or  the  testimony  of  such  insane 
person  has  theretofore  been  given  in  evidence.5  But  usually 
such  statutes  do  not  in  any  way  hinder  testimony  as  to  transac- 
tions with  persons  since  insane  whose  estates  are  not  affected  by 
the  litigation  or  who  are  not  parties.6  Nor  do  they  preclude  a 
mere  suppletory  oath  to  identify  books  and  papers,  in  themselves 
competent  evidence.7 

'  Merritt  v.  State,  39  Tex.  Cr.,  70;  Rives,  17  So.  Rep.,  416;  35  Fla.,  89; 

45  S.  W.  Rep.,  21.  Hamilton  v.  Starr   (Tex.  Civ.  App.), 

2  People  v.  Hubert,  119  Cal.,  216;  27  S.  W.  Rep.,  587;    Trowbridge  r. 

51  Pac.  Rep.,  329.  Stone's  Admr.,  42  W.  Va.,  454;    26 

s  Titus  v.  Gage,  39  Atl.  Rep.,  246;  S.  E.  Rep.,  363. 
70  Vt.,  13.  For  testimony  of  physicians  upon 

4  See  the  laws  of  the  several  States  the  mental  condition  of  their  patients, 
and    Territories;    Titles:     Evidence,  see  this  work,  title  "  Privileged  Corn- 
Witnesses.     See  Gamber  v.  Gamber,  munications    between     Patient    and 
24  App.  Div.  (N.  Y.),  446;    48  N.  Y.  Physician,"  vol.  i.,  p.  90. 

Supp.,  501.  6  Elliott    v.    Keith,    102  Ga.,    117; 

5  E.g.,  Code  W.  Va.,  c.  130,  §  23.  29  S.  E.  R.,  155;    in  this  case,  not- 
Towa   Code,    §    4604.     N.    Y.    Code  withstanding       the       incompetent's 
Civ.  Pro.,  §  829.  guardian  was  a  party. 

Watters   v.  McGreavy,    82   N.  W.  '  Chapin  r.  Mitchell  (Fla.),  32  So. 

Rep.,  949;  Scott  v.  Bassett,  194  111.,       R.,  875. 
602;    62  N.  E.  R.,  914;    Edwards  v. 


516  MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

EVIDENCE  OF  MENTAL   CAPACITY  TO  EXECUTE 

WILLS.1 

By  Whom  Proved. — It  is  said  that  the  proponent  need 
not  prove  testator's  sanity  by  all  of  the  subscribing  witnesses.2 
But  this  is  a  question  largely  dependent  upon  the  legislative  pro- 
visions of  the  several  States. 

Evidence  upon  mental  competency  is  not  confined  to  the  tes- 
timony of  the  subscribing  witnesses  of  a  will.3 

EVIDENCE  OF  TESTATOR'S  DECLARATIONS  AND  ACTS. — On 
the  issue  of  testamentary  competency  proof  of  the  words  and 
actions  of  the  testator  may  take  a  wider  range  than  in  cases 
involving  merely  the  construction  and  effect  of  wills.  Thus, 
though  his  declarations  of  testamentary  intent  before  and  after 
the  execution  of  the  will  would  not  ordinarily  be  admissible  to 
vary  or  alter  that  instrument,  they  may  be  proved  in  an 
action  to  invalidate  it  on  the  ground  of  mental  incapacity;4 
and  his  declaration  that  he  did  not  make  the  will  may  also  be 
proved.5 

The  WiU  Itself  as  Evidence  of  Insanity.  — The  will  itself  may  be 
considered  as  evidence  bearing  upon  the  sanity  of  the  testator 
when  he  made  it.  A  holographic  will,  clear  and  apt  in  language, 
made  in  the  absence  of  the  beneficiary,  so  that  undue  influence ' 
cannot  be  suspected,  is  deemed  in  itself  very  strong  evidence  of 
mental  capacity.7  The  reasonableness  and  propriety  of  the  con- 
tents of  the  will  may  be  considered ; 8  and  in  connection  with 
other  circumstances  tending  to  prove  incapacity,  the  apparent 

1  Cf.  the  preceding  general  discus-  nesses.     Ashworth  v.  McNamee  (Colo, 
sion  of  Evidence  of  Insanity.  App.),  70  Pac.  R.,  156. 

2  Kaufman  v.  Caughman,  27  S.  E.  4  Sheehan  v.   Kearney   (Miss.),   21 
Rep.,  16;    49  S.  C.,  159.  So.  R.,  41;    35  L.  R.  A.,  102;    Hese- 

See  In  re  Journeay's  Will,  15  App.  man  v.  Vogt,  181  111.,  400;    55  N.  E. 

Div.  (N.  Y.),  567;    44  N.  Y.  Supp.,  R.,  151;    but  see  Pyle  v.  Pyle,  158 

548;   interesting  in  that  the  witnesses  111.,  289;   41  N.  E.  R.,  999. 

to  will  and  codicil  of  the  testatrix  8  Ball  v.  Kane,  1  Penne.  (Del.),  90; 

whose  competency  was  attacked  were  39  Atl.  R.,  778. 

all   specialists    in    the    treatment    of  •  See  infra,  p.  521. 

nervous  and  mental  diseases  or  alien-  :  Territory  v.  Padilla,  8  New  Mex., 

ists.  510;    46  Pac.  R.,  346. 

3  In  re  Robinson's  Will,  190  111.,  95;  8  Appeal  of  Crandall,  63  Conn.,  365; 
60  N.  E.   Rep.,    194;    q.v.  also    for  28   Atl.    R.,    531.     It   is  proper  for 
practice  on  appeal  in  Illinois,  where  counsel  to  argue  that  the  testator's 
those  resisting  probate  are  limited  to  insanity  is  apparent  from  the  face  of 
the  testimony  of  the  subscribing  wit-  the  will.    Bradley  v.  Palmer,  193  111. 

15;   61  N.  E.  R.,  856. 


EVIDENCE   OF   MENTAL   CAPACITY    TO   EXECUTE   WILLS.      517 

injustice  of  its  provisions,  iii  view  of  evidence  of  the  testator's 
financial  condition.1 

And  to  aid  in  the  formation  of  a  just  opinion  as  to  the  bear- 
ing of  the  will  upon  the  question  of  sanity,  a  variety  of  collat- 
eral circumstances  may  be  inquired  into.  Evidence  of  the  situ- 
ation in  life  of  the  natural  objects  of  testator's  bounty  has  been 
admitted  as  tending  to  throw  light  upon  the  reasonableness  of 
the  will.2  It  is  competent  to  show  why  the  property  was  not 
given  to  heirs.3  And  where  it  was  contended  that  antipathy  to 
a  brother  was  not  substantially  founded,  it  was  held  proper  to 
show  that  the  brother  had  accused  testator  of  robbery  and  of  tak- 
ing undue  advantage  of  his  brothers ;  though  it  was  not  shown 
that  testator  had  heard  of  this  statement  before  making  his  will.4 

Evidence  as  to  the  kindliness  or  unkindliness  of  testator's  re- 
lations with  members  of  his  family  is  admissible  upon  the  reason- 
ableness of  its  provisions,5  such  as  the  disinheritance  of  children,8 
or  meagre  bequests  to  testator's  wife,  from  whom  testator  ac- 
quired a  large  part  of  his  property.7  It  is  generally  competent 
to  show  how  the  property  disposed  of  was  acquired.8  But  such 
evidence  must  of  course  have  some  pertinency  to  the  issues  in- 
volved.* 

Other  Evidence  of  Mental  Condition. — The  same  general  princi- 
ples already  discussed 10  apply,  of  course,  to  will  contests,  and  in 
general  it  may  be  said  that  evidence  is  admissible  of  testator's 
appearance,  conduct,  and  habits.11  For  the  general  purpose  of 
explaining  apparently  peculiar  or  eccentric  actions,  evidence  of 
testator's  declarations,  at  least  if  made  about  the  time  of  the 
actions  to  be  explained,  may  be  proved.12 

Papers  showing  a  business  transaction  a  few  months  previous 

1  Sim  v.  Russell,  90  Iowa,  656;   57      visions  of  the  will  unjust.     Aylward 
N.  W.  R.,  601.  v.  Briggs,  145  Mo.,  604;   47  S.  W.  R., 

2  Harbour  v.  Moore,  10  App.  D.  C.,       510. 

30.  7  Notwithstanding   the   widow   ac- 

*  Patten  v.  Cilley,  67  N.  H.,  520;  cepted    the    provisions    of   the    will. 

42  Atl.  Rep.,  47.    '  Pergason  v.  Etcherson,  91  Ga.,  785; 

4  Stevens  v.  Leonard,  154  Ind.,  67;  18  S.  E.  R.,  29. 

56  N.  E.  R.,  27.  8  In  re  Wilson's  Estate,   117  Cal., 

8  In  re  Burns's  Will,  121  N.  C.,  336;  262;  49  Pac.  R.,  172. 

28  S.  E.  R.,  519;    Howe  v.  Richards,  9  Whitelaw's  Admr.  v.  Whitelaw's 

(Iowa),  83  N.  W.  R.,  909;   Manatt  v.  Admr.,  96  Va.,  712;  32  S.  E.  R.,  458. 

Scott,  106  Iowa,  203;    76  N.  W.  R.,  10  Supra,  p.  503. 

717.  "  In  re  Evans's  Est.  (Iowa),  86  N. 

8  In  re  Burns's  Will,  supra.    But  it  W.  R.,  283. 

is  immaterial  in  any  case  to  prove  12  Clements    v.   McGinn  (Cal.),    33 

that  the  beneficiary  thinks  the  pro-  Pac.  R.,  920. 


518  MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 

to  making  the  will,  and  a  receipt  given  eleven  months  previously, 
have  been  admitted.1 

Evidence  of  Capacity  to  Revoke  Wills.  — "When  it  is  claimed  that 
a  will  was  revoked,  and  the  question  of  the  mental  capacity  to 
revoke  is  in  issue,2  it  is  apprehended  that  the  principles  above 
stated  will  be  applied,  and  that  declarations  of  the  testator  re- 
specting transactions  concerning  his  will  and  respecting  his  dis- 
position of  his  property  near  the  time  of  the  alleged  revocation 
are  admissible  on  the  question  of  capacity  to  revoke.3 

Evidence  of  Similar  Wills  Made  when  Sane. — In 
Texas  it  was  held  that  evidence  that  testatrix  while  unquestion- 
ably of  sound  mind  made  a  similar  will  was  not  admissible  on 
the  issue  of  mental  capacity  to  make  a  subsequent  will.4  But  in 
Kentucky,5  Missouri,6  and  Illinois7  the  contrary  view  is  taken. 

Where  a  previous  will  is  admitted,  for  the  purpose  above 
stated,  it  is  proper  to  admit  evidence  to  show  that  testator  was 
of  sound  mind  when  he  executed  it.8 

EVIDENCE   OF   UNDUE   INFLUENCE.9 

By  Whom  Proved. — The  testimony  of  others  than  sub- 
scribing witnesses  is  admissible.10 

Evidence  of  Testator's  or  Grantor's  Declarations. 
— The  general  rules  as  to  admissibility  of  declarations  of  one 
whose  sanity  is  in  question,  which  have  been  already  discussed, 
apply  in  some  measure  when  undue  influence  is  alleged.11  But  if 
the  declarations  are  not  offered  to  show  mental  susceptibility  and 
weakness, 12  but  for  some  other  purpose,  certain  qualifications  are 
to  be  noted. 

1  Messner  v.  Elliott,  184  Pa.  St.,  41;  was  held  error  to  permit  a  jury  to 
39   Atl.    R.,    47.      But   cf.    Kelly   v.  consider  on  the  question   of  sanity 
Odell  (111.),  48  N.  E.  R.,  158.  whether  the  provisions  of  the  will  are 

2  See  supra,  p.  392.  consistent  with  previously  expressed 

3  Mclntosh  v.  Moore,  22  Tex.  Civ.  intentions.      Pyle   v.    Pyle,    158   111., 
App.,  22;    53  S.  W.  R.,  611.  289;  41  N.  E.  Rep.,  999. 

4  Brown  v.  Mitchell,  26  S.  W.  Rep.,  8  Heseman  v.   Vogt,   181  III,  400; 
1059.  55  N.  E.  R.,  151. 

5  Powers'  Exr.  v.  Powers,  21  Ky.  •  On  the  subject  of  undue  influence 
Law  R.,  597;    52  S.  W.  Rep.,  845.  generally,  see  supra,  p.  414. 

6  McFadin  v.  Catron,  120  Mo.,  252;  10  Harp  v.  Parr,  168  111.,  459;    48 
25  S.  W.  R.,  506.  N.  E.  Rep.,  113. 

7  Heseman  v.  Vogt,   181  111.,  400;  »  See  supra,  p.  503. 

55  X.  E.  Rep.,  151;  Taylor  v.  Pe-  12  Where  they  are  admissible  under 
gram,  151111.,  106;  37  N.  E.  Rep.,  837.  the  general  principle.  In  re  Gold- 
Though  in  another  case  in  Illinois  it  thorp's  Estate,  94  Iowa,  336;  62  N. 


EVIDENCE   OF  UNDUE  INFLUENCE.  519 

Before  the  Execution  of  the  Will. — Statements,  conversations,  or 
testamentary  dispositions '  of  the  testator  previous  to  the  execu- 
tion of  the  will,  consistent  with  the  will,  are  pertinent  and  admis- 
sible to  rebut  the  charge  of  undue  influence.2  The  length  of  time, 
previous  to  the  execution,  to  which  the  inquiry  can  go  is  not 
limited  except  in  the  discretion  of  the  court.3  But  such  evidence 
is  to  be  received  with  much  greater  caution,  if  at  all,  when  offered 
to  prove  undue  influence.  In  Illinois  it  was  held  that  a  testa- 
tor's prior  declarations  might  be  shown  so  far  as  they  tended  to 
show  his  mental  condition  at  the  time  of  the  execution,  but  not 
his  declarations  of  the  disposition  that  he  intended.4 

The  mere  fact  that  the  will  is  at  variance  with  the  testator's 
expressed  intention  does  not  prove  undue  influence.5 

Declarations  After  the  Execution  oftJw  Will. — Owing  to  the  for- 
malities which  the  law  prescribes  for  the  execution  and  revoca- 
tion of  a  will,  statements  of  a  testator  contradictory  to  a  will 
executed  and  published  in  conformity  with  law,  are  inadmissible 
to  revoke  the  will  or  any  of  its  provisions ;  but,  nevertheless,  his 
declarations  made  shortly  after  the  execution  of  the  will  are  ad- 
missible, to  show  his  intentions,  affections,  and  relations  toward 
beneficiaries  and  others  at  the  time  of  its  execution.6  But  mere 

W.  R.,  845  (five  months  previous  to  Atl.   Rep.,   772;    seventeen  months, 

execution  of  will);     Hill  v.  Bahrus,  Appeal  of  Gunn,  63  Conn.,  254;    27 

158  111.,  314;   41  N.  E.  R.,  912;   In  re  Atl.  Rep.,  1113. 

Ross's  Will,  65  Hun,  626;    20  N.  Y.          In  Garland  v.  Smith,  127  Mo.,  567; 

Supp.,  520  (letters  written  soon  after  28  S.  W.  Rep.,  191;   29  S.  W.  R.,  836, 

execution  of  will  admitted  to  show  declarations  of  the  testator  respecting 

testatrix's  condition  of  mind);  as  are  the   principal   legatee,   several  years 

external   influences  affecting  mental  prior  to  the  execution   of  the  will, 

condition,  In  re  Burns's  Estate  (Tex.  were    held     inadmissible.     See    also 

Civ.  App.),  52  S.  W.  R.,  98.  Bonnemort  v.  Gill,  165  Mass.,  493;   43 

1  Kaenders    v.  Montague,   180  III.,  N.   E.    Rep.,    299.     See    also    infra, 
300;    54    N.     E.     Rep.,    321;    In  re  p.  523. 

Adams's  Estate,  10  Pa.  Dist.  R.,  237;          4  Hill  v.  Bahrus,  158  111.,  314;    41 

Perkins  r.  Perk,. is  (Iowa),  90  N.  W.  N.  E.  Rep.,  912.     See  also  Supra,p. 

R.,  55.  505. 

2  Hindman   v.  Van  Dyke,  153   Pa.          */n   re  Johnson's  Will,  7  Misc.  R. 
St.,  243;    25  Atl.  Rep.,  772;    Harp  v.  (N.  Y.),  220;   27  N.  Y.  Supp.,  649. 
Parr,  168  111.,  459;    48  N.  E.  Rep.,          •  In  re  Green's  Will  (Surr.),  20  N. 
113;    Kaufman  ?>.  Caughman,  49  S.  Y.  Supp.,  538:   In  re  Green's  Will,  67 
C.,  159;   27  S.  E.  R..  16;    In  re  Mun-  Hun   (N.  Y.),  527;    22  N.  Y.  Supp., 
ger,   38  Misc.   R.    (X.   Y.),   268;    77  1112;    Kirkpatrick  v.  Jenkins  Exrs., 
N.  Y.  Supp.,  648;    Sheehan  v.  Rear-  (Tenn.),  33  S.  W.   Rep.,  819;   Coghill 
ney,  21  So.  R.,  41;   35  L.  R.  A.,  102.  v.  Kennedy,  24  So.  R.,  459;    119  Ala., 

3  See  supra,  p.  510.     Evidence  of  641;   Sheehan  ?•.  Kearney,  21  So.  R., 
declarations,  consistent  with  the  will,  41;    35  L.  R.  A.,  102. 

admitted,  though  considerable  time  In  Moore  v.  Gubbins,  54  111.  App., 
had  elapsed:  four  years,  Hindman  163,  declarations  of  the  testator  from 
r.  Van  Dyke,  153  Pa.  St.,  243;  25  two  to  four  days  after  the  execution 


520  MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

expressions  of  regret  at  a  distant  subsequent  time, l  or  of  an  inten- 
tion to  make  a  new  will,3  are  not  material  on  the  issue  of  undue 
influence.  Though  when  expressions  of  dissatisfaction  were 
made  at  such  time  and  under  such  circumstances  as  to  tend  to 
show  a  state  of  mind  which  was  susceptible  to  undue  influence, 
and  other  evidence  tended  to  show  that  undue  influence  was  ex- 
ercised, they  have  been  admitted.3 

In  general,  subsequent  declarations  in  support  of  the  will  are 
admitted,  but  not  contrary  declarations  offered  to  show  undue 
influence.4  Generally  speaking,  a  will  cannot  be  impeached  or 
undue  influence  shown  by  the  subsequent  declarations  of  the  tes- 
tator;5 not  even  by  his  express  declaration  that  he  was  unduly 
influenced. ' 

Many  apparently  conflicting  decisions  can  be  reconciled  by 
the  consideration  that  in  cases  of  alleged  undue  influence  the 
weakness  and  susceptibility  to  influence  of  the  testator's  or  the 
grantor's  mind  are  important  issues;  wherefore  any  act,  declara- 
tion, or  circumstance  which  bears  upon  those  issues  may  be 
proved.7  Under  this  rule  statements  by  testator  which  would 
otherwise  be  excluded  as  hearsay, 8  or  as  merged  in  the  written 

of  the  will  were  admitted  to  show  "Gordon  v.   Burris,  141   Mo.,  602; 

absence  of  undue  influence.  43  S.  W.  R.,  642. 

1  In  re  Kaufman's  Est.,  117  Cal.,  7  Cases  cited  supra,  p.  503,  note  1,  2; 
288;    49  Pac.  R.,  192.  also  Patten  v.  Cilley,  67  N.  H.,  520; 

2  Manogue  v.  Hewell,  13  App.  D.  42  Atl.  R.,  47  (evidence  that  testator 
C.,  455.  was  of  strong  mind  and  not  easily  in- 

3  Campbell  v.  Barrera  (Tex.    Civ.  fluenced) ;  Robinson  v.  Robinson,  203 
App.),  32  S.   W.  Rep.,  724;    contra  Pa.  St.,  400;    53  Atl.  R.,  253  (evi- 
Cnlkins  Est.  v.  Calkins  (Cal.),  44  Pac.  dence    of   mental    weakness);     Olm- 
Rep.,  577;    112  Cal.,  296.  stead  ».  Webb,  5  App.  Div.  (N.  Y.),  38 

4  In  Jones  v.  Grogan,  98  Ga.,  552;  (age  and  physical   condition,  though 
'.'.5  S.  E.  Rep.,  590.  not  showing  incompetency) ;    Perret 

8Givin  v.  Givin  (Idaho),  48  Pac.  v.  Perret,  184  Pa.  St.,  131;  39  Atl. 
R.,  295;  Underwood  v.  Thurman,  R.,  33  (age,  etc.);  but  see  in  re 
111  Ga.,  325;  36  S.  E.  R.,  788;  Logan's  Estate,  195  Pa.  St.,  282;  45 
Schierbaum  v.  Schemme,  157  Mo.,  1;  Atl.  R.,  729  (criticising  evidence  of 
57  S.  W.  R.,  562;  Earp  v.  Edgington,  old  age,  forgetfulness,  etc.,  as  in- 
107  Tenn.,  23;  64  S.  W.  R.,  40.  But  sufficient  to  affect  the  issue  of  undue 
the  fact  that  testatrix  cried  when  she  influence  materially), 
spoke  of  contestant  in  connection  8  In  re  Gregory's  Est.,  133  Cal.,  131; 
with  the  will  has  been  admitted,  to  65  Pac.  R.,  315;  Calkins'  Est.  v.  Cal- 
show  her  feelings  toward  contestant.  kins,  112  Cal.,  296;  44  Pac.  R.,  577; 
Gordon  v.  Burns,  141  Mo..  602;  43  in  re  Metcalf's  Est.,  16  Misc.,  180; 
S.  W.  R.,  642.  And  evidence  tending  38  N.  Y.  Supp.,  1131;  Defoe  v.  Defoe, 
to  show  testator's  feelings  toward  a  144  Mo.,  458;  46  S.  W.  R.,  436;  Cog- 
beneficiary  or  contestant  is  generally  hill  v.  Kennedy,  119  Ala.,  641;  24 
admissible.  Coghill  v.  Kennedy,  119  So.  R.,  459;  cf.  Barbour  v.  Moore, 
Ala.,  641;  24  So.  R.,  459;  Oberdorfer  4  App.  D.  C.,  535. 
v.  Newberger  (Ky.),  67  S.  W.  R.,  267. 


OTHER  EVIDENCE  OF  UNDUE   INFLUENCE.  521 

instrument,  are  admissible,  not  to  establish  the  particular  facts 
which  he  may  have  then  asserted,  but  to  exbibit  his  thoughts 
and  purposes,  and  the  quality  of  his  niiiid. l 

Other  Evidence  of  Undue  Influence. — If  the  will  was 
valid  at  the  time  of  its  execution,  the  subsequent  condition  of 
testator's  mind  or  any  subsequent  undue  influence  to  prevent  a 
revocation  could  not  invalidate  it,  and  in  general  proof  of  subse- 
quent conditions  and  influences  is  incompetent.11  But  circum- 
stances occurring  after  the  execution  of  the  will  or  other  in- 
strument may  be  shown,  if  there  is  proof  to  show  that  such 
circumstances  were  a  continuation  of  conditions  existing  at  the 
time  the  will  was  executed.8  The  friendliness  of  relations 
among  the  testator,  the  beneficiaries,  and  the  testator's  relatives 
are  competent  to  be  shown.4  The  contents  of  the  will,5  and 
any  inequalities  or  inequities  therein, '  may  be  considered  just  as 
on  the  issue  of  competency,7  as  also  the  value  and  nature  of 
testator's  properties, 8  the  condition  in  life  of  the  persons  who  are 
the  natural  objects  of  his  bounty,' and, broadly,  all  circumstances 
having  real  pertinency  upon  the  question  of  the  freedom  of  his 
exercise  of  the  testamentary  or  contractual  act.10 

Undue  influence  may  be  proved  by  circumstantial  evidence." 
There  is  said  to  be  a  presumption  against  undue  influence  where 
the  beneficiary  is  one  with  whom  the  testator  has  maintained 
intimate  and  affectionate  relations  through  life.12 

ILLUSTRATIVE  CASES. — The  general  trend  of  authority  is 
that  evidence  of  any  facts  which  tend  to  explain  rationally  the 
provisions  made  by  the  testator  is  admissible  to  rebut  the  infer- 
ence of  undue  influence.  For  example,  the  fact  that  testator's 

1  E.g.,  not  to  establish  undue  in-  *  Henrich  v.  Saier  (Mich.),  82  N. 

fluence  asserted  in  them  by  testator,  W.  R.,  879;   in  re  Worth's  Will,  129 

but  to  show  his  state  of  mind  solely.  N.  C.,  223;   39  S.  E.  R.,  956. 

Wood  v.  Zibble  (Mich.),  92  N.  W.  R.,  7  Supra,  p.  516. 

348;   9  Det.  Leg.  N.,  489.  .      *  In  re  Woodward's  Will,  167  N.  Y., 

»  Thompson  v.  Bennett,  194  111.,  57;  28;   60  N.  E.  R.,  233. 

62  N.  E.  R.,  321.  »Barbour  v.  Moore,  10  App.  D.  C., 

*  Haines  v.  Hayden,  95  Mich.,  332;  30;    Manatt  v.  Scott,  106  Iowa,  203; 
54  N.  W.  R.,  911;    Walts   v.  Walts  76  N.  W.  R.,  717. 

(Mich.),  86  N.  W.  R.,  1032;    8  Det.  10  Blackman  v.  Edsall  (Colo.  App.), 

Leg.  N.,  446.  68  Pac.  R.,  790. 

4  Denning  v.  Butcher,  91  Iowa,  425;  n  Campbell  v.  Barrera  (Tex.   Civ. 

59  N.  W.  R.,  69;    Ketteman  v.  Metz-  Ap.),  32  S.  W.  Rep.,  724;   Ledwith  v. 

ger,  23  Ohio  C.  C.,  61;  Betts  v.  Betts,  Claffy,  18  App.  Div.,  115;    45  N.  Y. 

84  N.  W.  R.,  975.  Supp.,  612. 

*  Appeal  of  Crandall,  63  Conn.,  365;  "Harp  v.  Parr,   168  111.,  459:  48 
28  Atl.  R.,  531.  N.  E.  Rep.,  113. 


522  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

wife  had  made  a  will  discriminating  against  the  beneficiary  of 
testator's  will  and  that  testator  knew  it  before  he  made  his  will, 
has  been  deemed  admissible;  but  a  similar  division  of  her  prop- 
erty after  testator  made  his  will,  inadmissible. 1  Similarly,  the 
fact  that  the  wife  had  made  a  will  in  favor  of  testator  shortly  be- 
fore his  will  was  executed  has  been  deemed  admissible  of  proof. " 

Evidence  of  the  embarrassed  financial  condition  of  a  grantor 
has  been  held  material  in  determining  his  mental  condition, 
where  the  charge  of  undue  influence  was  made.3 

To  illustrate  the  broadness  of  scope  the  inquiry  may  take,  in 
one  case  in  Michigan  evidence  was  admitted  of  the  conduct  of 
proponent  and  those  active  in  her  interest ;  of  the  condition  of 
testatrix  at  the  time ;  of  two  earlier  wills  of  different  purport ; 4 
and  in  another  case,  of  the  extent  to  which  a  testator  had  aided 
or  failed  to  aid  his  next  of  kin.5 

Where  testatrix  recited  a  religious  vow  as  the  reason  for  a 
bequest,  it  was  pertinent  in  support  of  the  will  to  show  that  she 
was  not  required  to  take  the  vow.6 

Evidence  of  the  exclusion  of  friends  and  relatives  from  tes- 
tator is  admissible,7  as  is  also  evidence  from  a  sister  of  testatrix 
that  she  never  heard  testatrix  express  any  affection  for  propo- 
nents and  that  they  bothered  her, e  and  evidence  that  relatives 
of  a  wife,  the  testatrix,  would  not  permit  her  husband  to  attend 
the  funeral  or  see  the  body.9 

The  evidence  must  be  reasonably  pertinent ;  evidence  as  to 
the  medicines  taken  by  testator  is  immaterial,  where  there  is  no 
claim  that  they  affected  his  will  or  capacity ;  also,  that  his  wife, 
who  was  charged  with  undue  influence,  was  insane,  where  there 
was  no  offer  to  show  that  such  insanity  contributed  to  the  influ- 
ence.10 

1  Varner  v.  Varner,  16  Ohio  C.  C.,  masses,   after    frequent    visits    of   a 

386.  priest  to  testator,  not  proof  of  undue 

'Appeal  of  Vivian,  74  Conn.,  257;  influence. 
50  Atl.  R.,  797.  7  Even  after  the  making  of  the  will, 

3  Tucker  v.  Roach,   139  Ind.,  275;  Walts  v.  Walts  (Mich.),  86  N.  W.  R., 
38  N.  E.  Rep.,  822.  1030;  8  Det.  Leg.  N.,  446;  Davenport 

4  Sullivan  v.  Foley,  70  N.  W.  Rep.,  v.   Johnson   (Mass.),   65    N.    E.    R., 
322.  392. 

"Bush  v.  Delano,  113  Mich.,  321;  8  Coghill  v.  Kennedy,  119  Ala.,  641; 

71  X.  W.  Rep.,  628.  24  So.  R.,  459. 

6  In  re  Will's  Est.,  67  Minn.,   335;  •  In   re    Tibbetts'    Est.    (Cal.),    69 

69  N.  W.  Rep.,  1090.     See  Martin  v.  Pac.  R.,  978. 

Bowdem,  158  Mo.,  379;   59  S.  W.  R.,  10  Appeal  of  Vivian,  74  Conn.,  257; 

227,    bequest   to   an   archbishop   for  50  Atl.  R.,  797. 


EVIDENCE   OP   INTOXICATION.  523 

Accordingly,  it  has  beeii  held  inadmissible  to  show  the 
penurious  character  of  a  person  who  is  charged  with  using  undue 
influence  in  favor  of  another,  though  he  be  her  son.1  Evidence 
is  inadmissible  that  one  person  who  formerly  lived  in  testator's 
family  is  in  straitened  circumstances  and  a  more  worthy  object 
of  testator's  bounty  than  his  actual  beneficiary.2  And  testi- 
mony tending  to  show  immoral  relations  between  the  testator 
and  the  beneficiary  seven  years  before  the  will,  is  incom- 
petent.3 But  testator's  declarations  that  a  person  is  his  child 
and  evidence  of  his  relations  to  her  mother  have  been  deemed 
pertinent  as  showing  the  possibility  of  a  motive  for  exclu- 
sion;4 as  has  also  evidence  that  the  parents  of  contestant 
sued  testator ; B  and  evidence  that  property  disposed  of  by  the 
will  was  given  to  testator  by  his  sisters,  for  whom  he  made  no 
provision.6 

Evidence  of  influence  exerted  sixteen  years  prior  to  the  exe- 
cution of  the  will  has  been  held  too  remote  to  prove  undue  influ- 
ence, especially  in  the  absence  of  any  evidence  that  it  was  con- 
tinued. T 

Cases  of  undue  influence  almost  invariably  present  their  own 
peculiar  facts.  The  recent  cases  cited  in  the  subjoined  note 
further  illustrate  the  application  of  the  rules  of  evidence  in  cases 
where  undue  influence  was  alleged.8 

EVIDENCE  OF   INTOXICATION. 

Evidence  of  intoxication  is,  of  course,  inadmissible,  unless  it 
is  relevant  and  material.  The  cases  where  it  is  relevant  and 
material  as  a  defence  to  crime  are  treated  above. "  As  a  general 

'Calkins'  Est.  v.  Calkins,  112  Cal.,  11  So.  R.,  636;     Bulger  v.  Ross,  98 

296;  44  Pac.  Rep.,  577.  Ala.,  267;    12  So.  Rep.,  803;     In  re 

2  Same.     In  re  Kaufman's  Est.,  49  Hobbs,  73  Conn.,  462;    47  Atl.  Rep., 
Pac.  R.,  192.  678;     Gurley  v.  Park,  135  Ind.,  440; 

3  Flint's  Estate,  100  Cal.,  391;    34  35  N.  E.  Rep.,  279;    Haines  v.  Hay- 
Pac.  R.,  863.  den  (Mich.),54  N.  W.  Rep., 911;  Bois- 

4  Kirkpatrick  v.  Jenkins,  96  Tenn.,  aubin  v.  Boisaubin,  51  N.  J.  Eq.,  252; 
85;  33  S.  W.  Rep.,  819.  27  Atl.  R.,  624;    Ramsdell  v.  Street er 

6  Estes  v.  Bridgforth,  114  Ala.,  221 ;  (N.  J.  Pre.),  48  Atl.  R.,  575;  Bark- 

21  So.  Rep.,  512.  man  v.  Richards  (N.  J.  Pre.),  49  Atl. 

9  In  re  Ruffino's  Est.,  116  Cal.,  304;  R.,  831;  Chambers  v.  Chambers  (N. 

48  Pac.  Rep.,  127.  Y.),  61  App.  Div.,  299;  70  Supp.,  483; 

1  In  re  Shell's  Est.  (Colo.),  63  Pac.  Trezevant  v.  Rains  (Tex.  Civ.  Ap.), 

R.,  413.  25  S.  W.  R.,  1092. 

•Chandler  v.  Jost,    96  Ala.,  596;  " Supra,  p.  481. 


524  MENTAL  UNSOUNDNESS— BECKER  AND  BOSTON. 

rule,  it  is  material  in  determining  the  intent,  and  thereby  fixing 
the  existence  or  the  grade  of  the  crime  charged.1 

Evidence  of  frequent  intoxication  of  a  person  accused  of 
homicide  and  of  his  condition  at  such  times,  and  that  he  had  been 
drinking  on  the  day  of  the  homicide,  is  not  sufficient  evidence  of 
his  intoxication  on  that  day  to  call  for  an  instruction  to  the  jury 
upon  the  legal  effect  of  intoxication ; "  and  evidence  of  intoxica- 
tion four  or  five  hours  before  an  attempted  rape  had  been  ex- 
cluded. 8  But  evidence  of  intoxication  within  an  hour  before  a 
homicide,  and  that  accused  drank  twice  in  the  interval,  has  been 
deemed  sufficient  evidence  of  intoxication  at  the  time  of  the  offence 
to  call  for  an  instruction  on  the  legal  effect  of  intoxication. 4 

In  New  York  evidence  of  intoxication  of  the  defendant  a  few 
days  before  a  crime  and  leading  up  to  the  day  of  its  commission 
was  admitted  as  bearing  on  his  condition  that  day. 6 

These  cases  show  that  the  defence  of  intoxication  requires  dis- 
tinct proof. 

Where  intoxication  is  permitted  to  lower  the  grade  of  a  crime, 
and  defendant  was  intoxicated  at  the  time  of  its  commission, 
evidence  is  admissible  to  show  the  effect  generally  of  intoxicants 
on  the  accused.8  And  where  the  use  of  the  intoxicant  is  suffi- 
ciently near  in  point  of  time  to  justify  the  inference  of  intoxica- 
tion at  the  time  of  the  action  in  question,  it  is  error  to  exclude 
evidence  of  its  use,  though  it  be  only  a  mild  intoxicant.7 

Where  drunkenness  is  itself  a  crime,  as  in  Michigan,  it  is 
said  that  one  is  a  drunkard  with  whom  drunkenness  has  become 
a  habit;  evidence  tending  to  show  the  habit  is  admissible;  ac- 
cordingly it  was  deemed  proper  to  show  that  defendant  had  for- 
merly pleaded  guilty  to  similar  charges. 8 

» Supra,  p.  488;    but  cf.  People  v.  <  People  v.  Hill,  123  Cal.,  47;    55 

Miller,  114  Cal.,  10;   45  Pac.  R.,  986.  Pac.  R.,  692. 

See  also  People  v.  Gilmore,  53  Pac.  *  People  v.  Gaynor,  33  App.  Div. 

Rep.,  806.  (N.  Y.),  98;   53  N.  Y.  Supp.,  86. 

2  People  v.   Kloss,    115  Cal.,   567;  6  State  v.   Faino,  2  Hardesty,  153 
47  Pac.  Rep.,  459;    see  also  Com.  v.  (Del.). 

Cloonen,   191   Pa.  St.,  605;    25  Atl.  7  Mage  v.  State,  60  S.  W.  Rep.,  55 

R.,  145;  Wright  v.  State,  37  Tex.  Cr.  (cherry  bitters). 

App.,  627;  40  S.  W.  Rep.,  491.  8  People  v.  Radley,  8  Det.  Leg.  N., 

3  State  v.  Alcom,  137  Mo.,  121;   38  467;  86  N.  W.  Rep.,  1029. 
S.  W.  Rep.,  548. 


ADJUDICATIONS   OF   INSANITY    AS   EVIDENCE.  525 


ADJUDICATIONS  OP    INSANITY  AS  EVIDENCE. 

When  evidence  of  an  adjudication  of  sanity  or  insanity  is 
offered  to  prove  mental  condition,  questions  arise  as  to  its  com- 
petency, and  if  it  be  admissible,  as  to  its  effect,  whether  conclu- 
sive or  merely  prima  facie  proof.1 

The  relevancy  of  such  evidence  depends  in  a  given  case  partly 
upon  the  similarity  of  the  issue  of  insanity  adjudicated,  with  re- 
spect to  the  particular  phase  of  incompetency  that  was  in  ques- 
tion, and  partly  upon  the  remoteness  of  the  time  of  the  adjudi- 
cation. If  the  previous  inquiry  found  iucompeteiicy  of  the  very 
kind  and  in  respect  to  the  very  same  capacities  now  again  in  con- 
troversy, the  prior  adjudication  may  be  both  admissible  and  con- 
clusive.2 This  is  the  case  when  there  has  been  an  adjudication 
of  iucompetency  to  transact  the  ordinary  affairs  of  life,  and  a 
committee  has  been  appointed.  Thereafter  the  incompetent  is, 
by  force  of  the  adjudication  as  evidence,  conclusively  proved 
incapable  of  transacting  such  ordinary  affairs  of  life  as  the  mak- 
ing of  contracts  of  sale,  and  the  like.3 

But  an  adjudication  of  incapacity  to  do  one  thing  may  have 
little  or  no  bearing  on  the  question  of  competency  to  do  another 
thing.  If  it  related  to  a  different  sort  of  transaction  or  a  differ- 
ent degree  or  kind  of  alienism,  it  may  be  of  such  speculative 
import  upon  the  new  inquiry  as  to  be  deemed  wholly  incompe- 
tent, or  it  may  be  admissible  though  inconclusive.4 

Likewise,  if  the  former  adjudication  was  of  insanity  at  a  dif- 
ferent time,  especially  at  a  subsequent  time,  it  may  be  inadmis- 
sible, even  though  the  evidence  on  which  it  was  based  would  be 
pertinent  on  the  new  inquiry  also.5  For  an  adjudication,  like 

1  As  to  the  competency  and  effect  of  against  testamentary  capacity.  Ames 
such   adjudications  upon   the   ques-  v.   Ames   (Ore.),    67    Pac.    R.,    737; 
tions  of  competency  and  credibility  see  also  in  re  Johnson,  57  Cal.,  529; 
of  witnesses,  see  supra,  p.  422.  Harrison  v.   Bishop,    131    Ind.,    161; 

2  As   in   O'Reilly   i;.    Sweeney,    54  30  N.    E.    R.,    1069;     Linkmeyer  v. 
Misc.,  408;    105  N.  Y.  Supp.,  1033;  Brandt,  107  Iowa,  750;   77  N.  W.  R., 
Foran  v.  Healy  (Kan.),  85  Pac.  R.,  493;    Rice  v.  Rice,  50  Mich.,  448;    15 
751;    and  Soules  v.  Robinson  (Ind.),  N.  W.  R.,  545;    Brady  v.  McBride, 
62  N.  E.  R.,  999.  39  N.  J.  Eq.,  495;    Williams  v.  Rob- 

3  Last  note;  see  supra,  p.  369.  inson,  39  Vt.,  267;    in  re  Fenton's 
<Thus,    adjudication   of   incompe-      Will,  97  Iowa,  192;   66  N.  W.  R.,  99. 

tency  with  appointment  of  a  guardian  5  State  v.   Smith,  26  Wash.,  354; 

is  conclusive  only  against  incapacity  67    Pac.    R.,    70;     subsequent   time, 

to  contract  and  the  like;    not  con-  Small  v.   Champeny,    102   Wis.,   61; 

elusive,  though  prima  facie  evidence  78  N.  W.  R.,  407;   facts  on  which  ad- 


526          MENTAL  UNSOUNDNESS — BECKER  AND  BOSTON. 

any  judgment,  is  not  conclusive  of  all  the  facts  on  which  it  may 
have  been  based ;  only  of  the  fact  that  the  incompetent  was,  at  a 
certain  time  or  times  specified,  and  with  reference  to  certain 
things  specified,  without  mental  capacity. 

When  an  adjudication  of  insanity  has  been  made,  however, 
if  by  a  court  of  competent  jurisdiction,1  the  precise  facts  deter- 
mined upon  that  adjudication,  and  also  the  validity  of  the  ad- 
judication, cannot  be  collaterally  impeached.  The  adjudication 
can  be  revoked  only  in  a  direct  proceeding  for  that  purpose.2 

Previous  Adjudications  as  Evidence  in  Prosecu- 
tions for  Crime. — In  general,  an  adjudication  as  to  sanity  is 
not  competent  evidence  against  a  defendant  in  a  subsequent 
prosecution  for  crime.  Thus,  a  record  on  proceedings  to  ascer- 
tain whether  a  person  is  a  proper  subject  to  be  admitted  to  an 
asylum  for  the  insane,  wherein  he  was  found  sane  and  feigning 
lunacy,  is  inadmissible  to  rebut  evidence  of  insanity  offered  as  a 
defence  to  an  indictment  for  larceny.3  And  conversely  it  was 
held  that  an  order  of  commissioners  of  insanity  that  a  person 
was  a  fit  subject  for  treatment  in  a  hospital  for  the  insane  is 
neither  prima  facie  nor  conclusive  evidence  in  his  behalf  that  he 
was  insane,  on  a  prosecution  for  crime.  *  But  undoubtedly  a  pre- 
vious adjudication  of  insanity  is  some  evidence  for  the  accused 
where  the  defence  is,  not  guilty  by  reason  of  insanity.  In  Kan- 
sas where  a  person  was  duly  adjudged  insane  in  direct  proceed- 
ings and  ordered  to  be  confined  and  was  subsequently  discharged, 
but  not  restored  to  his  right  mind,  the  adjudication  and  the  rec- 
ord thereof  were  admitted  in  evidence  on  the  issue  of  insanity 
upon  an  information  for  crime  more  than  seven  years  afterward. 5 

In  Wisconsin,  on  the  separate  trial  permitted  in  that  State  of 
the  issue  of  insanity,  one  accused  of  crime  was  found  to  have  been 
sane  at  the  time  of  the  commission  of  the  act  charged ;  this  was 
held  not  to  preclude  proof,  on  the  trial  of  the  issue  of  guilt, 

judication     based     also     admissible,  '  Naanes  v.  State,   143  Ind.,  299; 

Hempton   v.    State,    111    Wis.,    127;  42  N.  E.  R.,  609;  cf.  People  v.  Ward, 

86  N.  W.  R.,  596.  105  Cal.,  335;   38  Pac.  R.,  945. 

1  McGee  v.   Hayes,   127  Cal.,  336;  *  Pflueger  v.  State,  46  Neb.,  493; 
59  Pac.  R.,  767.  64  N.  W.  R.,  1094;    cf.  Hempton  v. 

2  Isaacs  v.  Jones,  121  Cal.,  257;   53  State,  111  Wis.,  127;    86  N.  W.  R., 
Pac.    R.,    793;     Soules  v.    Robinson  596. 

(Ind.),    62    N.    E.    R.,    999;     in   re          'State  v.  McMurry,  61  Kan.,  87;  58 
Hoope's  Est.,  174  Pa.  St.,  373;    34      Pac.  R.,  961. 
Atl.  R.,  603. 


ADJUDICATION    EVIDENCE   AGAINST   THIRD    PARTIES.       527 

tending  to  show  that  his  mental  condition  was  such  as  to  make 
him  incapable  of  forming  the  specific  intent,  which  was  an  essen- 
tial element  of  the  crime  charged.  Incapacity  to  form  such  in- 
tent might  exist  consistently  with  the  sanity  found.1 

Illustrations  of  Previous  Adjudications  as  Evidence. 
— In  a  suit  attacking  an  exchange  on  the  ground  of  insanity  the 
record  of  an  inquisition  of  lunacy  had  twenty  days  after  the  ex- 
change and  adjudicating  insanity  was  held  not  admissible.2  But 
in  another  civil  action  it  was  held  merely  that  after  the  discharge 
of  a  patient  from  an  asylum  the  adjudication  of  insanity  upon 
which  he  was  committed  does  not  create  a  conclusive  presump- 
tion of  the  continuance  of  his  insanity.3  And  likewise,  in  a  will 
contest,  an  adjudication  of  restoration  to  sanity  in  proceedings  to 
set  aside  a  guardianship  was  said  not  to  be  conclusive  evidence 
of  continued  mental  capacity  to  the  date  of  its  entry.4 

In  a  suit  by  a  guardian  to  annul  the  marriage  of  his  insane 
ward,  also,  evidence  that  a  probate  court  had  found  that  he  had 
been  restored  to  sanity  is  not  conclusive  on  an  issue  whether  he 
ever  had  mental  capacity  to  ratify  the  marriage.5 

Adjudication  of  Insanity  as  Evidence  Against 
Third  Parties. — In  Texas  a  judgment  of  Maine  adjudging  a 
person  a  lunatic  and  appointing  a  guardian  of  his  property  was 
admitted  in  evidence  against  a  stranger  in  a  suit  over  the  luna- 
tic's title  to  land  in  Texas ;  the  appointment  of  the  guardian  was 
deemed  only  an  incident,  and  the  adjudication  of  mental  con- 
dition the  substance  of  the  adjudication ;  and  it  was  there  said 
that  at  common  law  a  judgment  declaring  a  person  non  compos 
mentis  and  appointing  a  guardian  is,  as  against  strangers,  prima 
facie  evidence  of  such  mental  uusouuduess;  as  being  the  adjudi- 
cation of  a  status,  analogous  to  a  judgment  in  rem,  though  not 
conclusive  like  a  judgment  in  rem.6 

In  Texas  it  was  held  that  a  judgment  of  insanity  isonly_pn'»i« 
facie  evidence  of  insanity  as  to  third  persons,  and  therefore  a 
grantee  by  deed  from  a  person  adjudicated  insane,  his  deed  hav- 
ing been  delivered,  pending  an  appeal  from  the  adjudication, 

1  Hempton  v.  State,  1 1 1  Wis.,  127;  4  In  re  Fenton's  Will,  97  Iowa,  192; 

86  N.  W.  Rep.,  596.  66  N.  W.  Rep.,  99. 

*  Rhoades  v.  Fuller,  40  S.  W.  Rep.,  5  Goodhart  v.  Speer,  7  Ohio  Dec., 

760.  47. 

1  Mutual  Life  Ins.  Co.  v.  Wiswell,  '  Herndon  v.  Vick,  18  Tex.  Civ. 

56  Kan.,  765;  44  Pac.  Rep.,  996.  App.,  583;  45  S.  W.  Rep.,  852. 


528  MENTAL  UNSOUNDNESS — BECKER   AND    BOSTON. 

was  not  precluded  upon  affirmance  of  the  adjudication  from 
offering  evidence  of  the  sanity  of  his  grantor  at  the  time  of  the 
execution  of  the  deed.1 

In  Pennsylvania  a  third  party,  affected  by  a  finding  of  lunacy, 
is  permitted  to  contest  the  finding;  where  the  alleged  lunatic 
died  pending  the  trial  of  issue  raised  by  the  traverse  by  the  third 
party,  the  traverse  was  quashed,  and  it  was  held  that  the  decree 
confirming  the  finding  of  lunacy  would  be  prima  fame  evidence 
against  the  third  party.2  But  in  New  York  it  has  been  held  in 
accordance  with  the  statute  that  an  adjudication  of  insanity  is 
conclusive  evidence  of  incapacity  to  make  any  contract,  includ- 
ing a  promise  of  marriage.3  The  Court  of  Appeals  said  in 
Banker  v.  Banker4  speaking  of  lunacy  proceedings:  "These 
proceedings  have  been  likened  to  proceedings  in  rem,  which  are 
conclusive  on  all  the  world  and  all  are  bound  to  take  notice  of 
them.  Actual  notice  is  not  necessary  and  whether  given  or  not 
is  not  material.  The  inquisition  is  conclusive  against  subsequent 
acts  and  dealings  and  presumptive  against  prior  ones."  Hence, 
the  finding  of  an  inquisition  two  days  after  a  marriage  that 
the  husband  is  of  unsound  mind,  and  that  he  has  been  so  for  six 
months,  is,  in  an  action  to  annul  a  marriage,  presumptive 
evidence  of  incapacity  at  the  time  of  the  marriage.  The  fact 
that  a  wife  had  notice  of  the  proceedings  does  not  affect  the 
question. 

The  principle  on  which  adjudications  of  lunacy  are  admissi- 
ble in  evidence  against  third  parties  seems  to  be  that  they  be- 
long to  the  class  of  determinations  by  competent  public  authority 
with  respect  to  matters  of  public  interest  lying  within  the  scope 
of  the  duty  of  such  authority.  The  public  interest  depends  upon 
the  fact  that  lunatics,  like  minors  and  others  more  or  less  under 
disabilities,  are  regarded  as  wards  of  the  State. 6 

1  Grimes  v,  Shaw,  2  Tex.  Civ.  App.,  Van  Dusen  v.  Sweet,  51  N.  Y.,  378. 
20;    21    S.  W.    Rep.,    718.      Accord:  Cf.  Sharbero  v.  Miller,  65  Atl.,  472 
Slaughter  v.   Heath,    127  Ga.,   747;  (N.   J.   Ch.);    O'Reilly  v.   Sweeney, 
57    S.    E.,    69.      See    Wigmore    on  54  Misc.,  408;    105  Supp.,  1033. 
Evidence,  vol.  2,  §  1671.  '  63  N.  Y.,  413.     See  also  Carter 

2  In  re  Gensemer's  Est.,  170  Pa.  St.,  v  Beckwith,  128  N.  Y.,  316;  Hart  v. 
96;   32  Atl.  Rep.,  561;   see  also  in  re  Demaer,    6   Wend..  497;    Osterhout 
Sampson,    19   Pa.   Co.   Ct.    Rep.,    1;  v.  Shoemaker,  3  Hill,  513;    Hughes 
5    Pa.     Dist.     R.,    717    (finding    of  v.  Jones,  116  N.  Y.,  67. 

habitual  intemperance).  5  See  Wigmore  on  Evidence,  vol. 

3  Banker  v.  Banker,  63  N.  Y.,  409;      2,  §1671  et  passim. 


EXPERT   WITNESSES.  529 

OPINIONS  OF  EXPERT  AND  NON-EXPERT  WITNESSES. 

A  definition  of  expert  and  non -expert  testimony  has  already 
been  given,1  so  it  is  not  necessary  to  repeat  it  here. 

Generally,  witnesses  must  testify  to  facts  within  their  own 
knowledge  and  not  to  opinions,  conclusions,  or  inferences.  To 
draw  conclusions  or  inferences  is  the  province  of  the  court  or 
jury,  except  in  cases  where  expert  testimony  is  allowed. 

Under  the  Roman  law  experts  were  permitted  to  inform  the 
judex  or  judge  as  to  physical  laws  or  phenomena.2  And  it  was 
allowed  in  France  from  about  1532. 3  In  England,  on  the  appeal 
of  Mayhew,  the  accused  prayed  that  the  court  would  see  the 
wound  to  ascertain  if  there  had  been  a  maiming.  The  court, 
because  the  wound  was  new,  did  not  know  how  to  adjudge,  and 
the  accused  asked  that  the  wound  be  examined  by  surgeons, 
which  was  done.4 

EXPEET    WITNESSES. 
TESTIMONY  UPON  HYPOTHETICAL  QUESTIONS. 

In  all  cases  in  which  insanity,5  in  any  of  its  various  forms, 
comes  into  question,  the  courts  allow  physicians  or  alienists  to 
give  their  opinions,  before  the  trial  jury,  as  to  the  sanity  of  the 
alleged  insane  person,  but  not  as  to  his  responsibility,  for  that  is 
deemed  a  question  of  law.8  This  opinion  is,  according  to  the 
usual  rule  of  practice,  given  in  answer  to  a  hypothetical  question 
embracing  substantially  all  the  evidence  in  the  case  relating  to 
that  subject.7 

'Chap.  V,  p.  49  et  seq.  of  vol.  i.,  for  expert  opinion.     State  v.  Robin- 

where   will   be   found   general    rules  son,  12  Wash.,  491;  41  Pac.  R.,  884. 

relating  to  expert  evidence.  8  People  v.  Tuczkewitz,  149  N.  Y., 

2  L.  8,  £  1,  xi.;  L.  3,  §  4,  xi.,  6.  240;  43  N.  E.  Rep.,  548.  Cf.  Lindsay 

J2  Beck's  "Med.  Juris.,"  896.  v.  White  (Tex.  Civ.  App.),  61  S.  W. 

•28  Ass.  pi.,  5;    9  H.  7,  16;    7  H.  R.,438. 

6,  11;   Buckly  v.  Rice,  Plow.,  125.  '  Green  v.  State.  64  Ark.,  523;  43 

*  But  drunkenness  (when  not  dip-  S.  W.  Rep. ,973.     Even  when  the  de- 

somania)  is  not  properly  the  subject  fence  has  not  produced  witnesses  who 

of    expert    testimony;     it    may    be  testify  that  the  accused  was  insane 

proved    by   observation.     People   v.  at  the  time  of  the  homicide,  if  there 

Martin,  15  Misc.,  6;  36  N.  Y.  Supp.,  has  been  evidence  tending  to  show 

437.     And  while  the  general  effect  of  that  he  had  an  affection  of  the  brain, 

a  drug  on  the  mental  faculties  is  the  Jordan    v.    People    (Col.),    36    Pac. 

subject  of  expert  testimony,  it  has  Rep.,    218.     But    the    hypothetical 

been   held   that  its  effect  upon  the  question  cannot  be  based  upon  the 

veracity  of  a  witness  is  not  a  matter  theory  of  the  existence  of  conditions 
III.— 34 


530 


MENTAL  UNSOUNDNESS— BECKER  AND   BOSTON. 


The  hypothetical  question  need  not  embrace  all  the  evidence 
on  the  subject;  each  side  may  submit  a  different  hypothetical 
case,  based  on  the  hypothesis  of  facts  which  it  deems  proved.1 
And  either  party  has  the  right  to  assume  for  the  purposes  of  the 
questions  that  the  evidence  tending  to  support  its  theory  is  true.2 
It  is  proper,  however,  for  the  court  to  see  that  it  embodies  all 
the  material  facts  bearing  on  the  issue,3  but  there  is  no  error  in 
allowing  an  answer  to  a  hypothetical  question,  embracing  such 
of  the  facts  in  evidence  bearing  upon  insanity  as  one  party 
deems  proper,  though  it  does  not  embrace  all  the  facts  in  evidence, 
provided  the  opposite  party  be  given  full  opportunity  to  cross- 
examine,4  and  especially  if  these  facts  were  supplied  on  cross- 
examination.  But  where  the  hypothetical  question  embraced 
evidence  of  previous  habits  which  might  tend  to  produce  insanity, 
it  was  not  admissible  in  the  absence  of  other  independent  evidence 
tending  to  show  insanity,5  and  a  question  which  would  not 
admit  of  a  conclusion  indicating  incapacity,  it  has  been  said,  is 
improperly  submitted,6  though  it  would  seem  that  a  question  is 


of  which  there  is  no  evidence,  People 
v.  Tuczkewitz,  149  N.  Y.,  240;  43  N. 
E.  Rep.,  548;  Safe  Dep.  and  T.  Co. 
v.  Berry,  49  Atl.  R.,  401  (Md.); 
Sharkey  v.  State,  2  O.  C.  D.,  443;  or 
upon  hearsay  testimony,  Safe  D.  and 
T.  Co.  v.  Berry  (Md.),  49  Atl.  R.,  401; 
and  the  proper  course  of  defendant's 
counsel,  if  they  think  any  evidence 
in  his  favor  has  been  omitted  from 
the  hypothetical  question,  is  not  to 
rely  upon  an  objection,  but  to  pro- 
pose a  question  containing  the  facts 
claimed  by  them  to  have  been  omit- 
ted, Shirley  v.  State,  37  Tex.  Cr.  App., 
475;  36  S.  W.  Rep.,  267;  Horton  v. 
United  States,  15  App.  D.  C.,  310. 

1  Burt  v.  State,  38  Tex.  Cr.  App., 
397;  43  S.  W.  Rep.,  344;  39  L.  R.  A., 
305.  See  Shirley  v.  State,  Note  7, 
supra.  The  following  cases  illus- 
trate the  law  with  respect  to  the  form 
of  the  question:  It  may  be  based 
upon  all  of  the  testimony,  except 
expert  opinion  evidence,  respecting 
insanity,  though  it  be  elicited  from 
many  witnesses,  if  not  contradictory, 
Cornell  v.  State,  104  Wis.,  527;  80 
N.  W.  Rep.,  745.  It  need  not  em- 
brace all  the  elements  of  insanity, 
but  may  limit  the  inquiry  to  the 
degree  of  intelligence  of  the  defendant 


under  the  circumstances  of  the  act 
under  investigation,  State  v.  Peel, 
23  Mont.,  358;  59  Pac.  R.,  169. 
It  cannot  assume  the  fact  to  be 
proved  by  the  answer,  such,  for 
instance,  as  the  existence  of  an  in- 
sane delusion;  or  express  a  fact  as- 
sumed in  a  word  which  may  include 
the  fact  to  be  proved  by  the  answer; 
for  instance,  a  "misconception," 
which  may  include  "an  insane 
delusion,"  Safe  Dep.  and  T.  Co.  v. 
Berry  (Md.),  49  Atl.  R.,  401.  It 
should  be  sufficiently  explicit  to 
warrant  the  formation  of  an  opinion, 
ibid.  It  should  not  assume  that 
weak  mental  condition  is  a  necessary 
result  of  weak  physical  condition, 
ibid. 

2  State  v.  Peel,  supra. 

3  Williams  v.  State  (Tex.  Cr.  App.), 
53     S.     W.     Rep.,     859.     See    also 
Squires  v.  State  (Tex.  Cr.  App.),  54 
S.  W.  Rep.,  770. 

4  State  v.  Wood  (Iowa),  84  N.  W. 
Rep.,  520;  see  State  v.  Wright  (Iowa), 
84  N.  W.  Rep.,  541. 

5  Bishop  v.  Commonwealth,  22  Ky. 
Law,  760;  58  S.  W.  Rep.,  817;  22  Ky. 
Law,  1161;  60  S.  W.  Rep.,  190. 

6  Safe  Deposit  and  T.  Co.  v.  Berry 
(Md.),  49  Atl.  R.,  401. 


EXPERT   WITNESSES. 


531 


iiot  necessarily  objectionable  because  it  would  not  support  one 
of  two  opposite  opinions  which  might  be  based  on  it.  It  should 
not  by  omission  of  part  of  the  proof  with  respect  to  the  facts 
assumed  improperly  color  the  fact  assumed.1 

TESTIMONY  UPON  THEIE  KNOWLEDGE  OF  THE  FACTS. 

Experts  may  also  give  an  opinion,  not  based  on  a  hypothetical 
question  or  an  assumed  statement  of  facts,  but  derived  from  re- 
peated personal  examinations  of  defendant,2  or  from  personal 
observation  during  the  trial,  where  proof  of  defendant's  man- 
ner, appearance,  and  demeanor  during  the  trial  has  been  offered 
in  his  behalf  as  evidence  of  his  insanity.3  Any  physician  may 
testify  from  personal  acquaintance  and  observation,  even  though 
not  professing  to  be  expert  in  mental  disease,  provided  in  his 
practice  as  physician  he  has  had  a  fair  number  of  such  cases, 
and  is  reasonably  expert.4 

An  attending  physician  may  give  an  opinion  as  to  the  sanity 
of  an  alleged  insane  person.5  Such  evidence  is  subject,  how- 


1  Safe  D.  &  T.  Co.  v.  Berry,  supra. 

2  People  v.  Taylor,  138  N.  Y.,  398; 
405;    Com.  v.  Buccieri,  153  Pa.  St., 
535;    26  Atl.,  228;  Conn.  M.  L.  Ins. 
Co.    v.    Lathrop,    111    U.    S.,    612; 
Dexter  v.  Hall,  15  Wall.  (U.  S.),  9; 
Fairchild  v.  Bascomb,  35   Vt.,  398; 
408;    Tullis  v.  Kidd,   12  Ala.,  648; 
Grant  v.  Thompson,  4  Conn.,  203; 
10  Am.  Dec.,  119;  Rambler  v.  Tryon, 
7  S.  and  R.  (Pa.),  90;    10  Am.  Dec., 
444;    State  v.  Feltes,  51  Iowa,  495; 
McLeod  v.   State,   31  Tex.  Cr.    R., 
331;    20  S.  W.  R.,  749;    Dejarnette 
v.    Com.,    75    Va.,    867;     U.    S.    v. 
Guiteau,    3   Grim.    Law   Mag.,   347; 
State  v.  Barber,  74  Mo.,  292;  Jordan 
v.  People,  19  Col.,  417;   36  Pac.,  218; 
People  v.  Hall,  48  Mich.,  482;    State 
v.    Leehman,   2    S.  D.,  171;    49    N. 
W.  R.,  3;   People  v.    Schuyler,  106 
N.  Y.,  298;    Quaife  v.  Chi.,  etc.,  R. 
Co.,  48  Wis.,  513;   Matter  of  Blakely 
will,    48    Wis.,    294;     Goodwin    v. 
State,  96  Ind.,  550;   Coryell  v.  Stone, 
62  Ind.,  307;  Davis  v.  Since,  35  Ind., 
496;    Boardman  v.  Woodman,  47  N. 
H.,    120;    Buswell    on    "Insanity," 
S  250;  Matter  of  Snelling,  136  N.  Y., 
515;    49   N.   Y.    St.   R.,  695;   Rey- 
nolds v.  Robinson,  64  N.    Y.,    589; 


People  v.  McElvaine,  121  N.  Y.,  250; 
People  v.  Smiler,  125  N.  Y.,  717;  26 
N.  E.  R.,  812;  Link  v.  Sheldon,  136 
N.  Y.,  1;  Murphy  v.  Com.,  92  Ky., 
485;  18  S.  W.  Rep.,  163;  People  v. 
Worthington,  105  Cal.,  166;  38 
Pac.  R.,  689;  State  v.  Crisp  (Mo. 
Sup.),  29  S.  W.  Rep.,  699;  Crockett 
v.  Davis  (Md.),  31  Atl.  Rep.,  710, 
81  Md.,  134;  State  v.  Wright,  35  8. 
W.  R.  (Mo.),  1145. 

3Burt  v.   State,   40  S.   W.   Rep., 
1000,  38  Tex.  Cr.  App.,  397. 

4  Phelps  v.  Commonwealth,  17 
Ky.  LawR.,  706;  32  S.  W.  Rep.,  470; 
In  re  Dolbeer's  Estate,  86  Pac.  (Cal.), 
695;  Davis  v.  State,  35  Ind.,  497;  9 
Am.  Rep.,  760;  12  "Am.  and  Eng. 
Enc.  of  Law"  (2d  ed.),  452. 
.  5  Hastings  v.  Rider,  99  Mass.,  622; 
Townsend  v.  Pepperell,  99  Mass., 
40;  Phelps  v.  Hartwell,  1  Mass.,  71; 
Poole  v.  Richardson,  3  Mass.,  330; 
Needham  v.  Ide,  5  Pick.  (Mass.), 
510;  Com.  v.  Wilson,  1  Gray,  337; 
Com.  v.  Fairbanks,  2  Allen  (Mass.), 
511;  Cowles  v.  Merchants,  140 
Mass.,  377;  May  v.  Bradlee,  127 
Mass.,  414;  Com.  v.  Brayman,  136 
Mass.,  438;  Baxter  v.  Abbott,  7 
Gray  (Mass.),  71;  Wyman  v.  Gould, 


532  MENTAL   UNSOUNDNESS — BECKER  AND   BOSTON. 

ever,  to  being  excluded  as  privileged.1  Observations  of  a  pris- 
oner by  an  expert  are  not  confessions,2  therefore  such  observa- 
tions of  the  prisoner's  conduct  may  be  used  by  an  expert  witness 
as  the  basis  of  his  opinion,  though  the  prisoner  was  not  warned 
that  they  might  be  used  against  him.3 

The  courts  differ  whether  it  must  first  be  shown  on  what  par- 
ticular facts  an  expert,  testifying  from  his  own  knowledge  of  a  per- 
son, bases  his  opinion,  and  whether  he  can  be  asked  his  opinion, 
based  generally  upon  what  he  has  seen  and  known  of  the  accused.4 

In  New  York  it  was  held  that  a  physician  could  not  express 
an  opinion  based  upon  something  the  accused  said  to  him  which 
was  not  in  evidence.5  But  where  the  statements  of  the  accused  as 
to  his  previous  sufferings  are  declared  by  his  physician  to  have 
been  necessary  to  his  diagnosis  of  the  case,  the  physician  when 
testifying  as  an  expert  may  repeat  the  statements  as  the  basis  of 
his  opinion.6  In  Missouri  an  opinion  based  upon  representations 
of  the  accused  as  to  his  previous  history  has  been  deemed  in- 
admissible.7 The  jury  are  entitled  to  the  facts  upon  which  the 
opinion  is  based,  and  on  that  ground  statements  of  the  accused 
to  his  physician  are  admissible  in  connection  with  the  physi- 
cian's opinion  when  he  testifies  as  an  expert.8  Where  a  wit- 

47  Me.,  159;  Heald  v.  Thing,  45  Me.,  "Flanagan  v.  State,  32  S.  E.  R., 

392;    Kearney  v.    State,  68    Miss.,  80;  106  Ga.,  109;  Raub  v.  Carpenter, 

238;    8    So.     R.,   292;    Inhabitants  187     U.    S.,    159;    contra    Jones    v. 

of  Fayette  v.   Chesterville,  77  Me.,  Collins,  94  Md.,  403;  51  Atl.  Rep.,398, 

28;   52  Am.    Rep.,    741;   Gehrke   v.  where  it  was  said  a  physician  may 

State,    13   Texas,  568;     Hickman  v.  give  his  opinion  as  to  mental  capacity 

State,  38  Tex.,  190;   State  v.  Geddis,  of  testator  without  first  stating  the 

42    Iowa,    268;     Reed   v.    State,    62  circumstances     on     which     it     was 

Miss.,   405;     O'Brien   v.    People,   36  founded,  and  though  he  had  never 

N.  Y.,  276;   Real  v.  People,  42  N.  Y.,  attended  testator  professionally  ex- 

270;     St.    Louis,    etc.,    Ry.    Co.    v.  cept   to   prescribe   for   him   on   two 

Bradley,  13  U.  S.   App.,  68;  People  occasions.     Cf.    Regina    v.    Cooper, 

v.  Worthington,  105  Cal.,  166;  38  Pac.  Norwich  Assizes,  1887  (Eng.),  cited  in 

Rep.,  689.     In  Prentis  v.  Bates,  93  J.  Dixon  Mann,  "Forensic Med.," etc., 

Mich.,  234,  53  N.  W.  Rep.,  153,  the  Phila.,    1893,  p.   356,   where  expert 

opinion  of  a  physician,  a  superintend-  testimony  upon  conversations  with 

ent    of  an    insane  asylum,  was  held  accused  was  rejected, 

not  competent,  where  it  was  based  5  People  v.  Stratt,  148  N.  Y.,  566; 

only  upon  the  record  of  the  case  of  an  42  N.  E.  Rep.,  1045. 

inmate  before  he  was  superintendent,  6  People  v.  Shattuck,  109  Cal.,  673; 

and  it  did  not  appear  that  he  had  any  42   Pac.    Rep.,   315.     Cf.   People   v. 

knowledge  of  the  method  of  keeping  Fogelsong  (Mich.),  74  N.  W.  Rep., 

records  at  that  time.  730. 

1  See  this  subject  fully  discussed  in  'State  v.  Soper,  49  S.  W.   Rep., 

vol.  i.,  p.  90  et  seq.,  of  this  work.  1007;  148  Mo.,  217. 

'  See  infra,  p.  545.  8  People  v.  Nino,  149  N.  Y.,  317;  43 

3  Burt  v.  State  (Tex.  Cr.  App.),  40  N.  E.  Rep.,  853. 
S.  W.  Rep.,  1000. 


WHO   MAY    QUALIFY   AS   AN   EXPERT    WITNESS.  533 

ness,  a  qualified  expert,  states  facts  within  his  knowledge,  and 
competent  as  evidence,  he  may  express  his  opinion  as  to  the 
sanity  of  the  accused,  based  on  the  facts  stated,  even  though  the 
opinion  be  that  the  accused  was  simulating  a  fit  or  shamming 
unconsciousness. l 

WHO  MAY  QUALIFY  AS  AN  EXPERT  WITNESS. 

In  a  Pennsylvania  case  a  reputable  physician  of  over  twenty 
years'  experience,  who  saw  defendant  about  an  hour  after  the 
homicide  at  the  station  house  and  treated  his  arm  which  had 
been  inj  ured,  was  held  to  be  competent  to  testify  that  there  were 
no  indications  of  a  recent  epileptic  convulsion,  and  that  if  there 
had  been  one  within  two  or  three  hours  he  did  not  think  it  pos- 
sible that  he  would  not  then  have  seen  some  evidence  of  it.  It 
was  also  held  that  where  a  physician  was  called  as  an  expert  as 
to  the  effect  of  epilepsy  on  the  memory,  and  to  show  that  there 
had  not  been  such  an  impairment  of  defendant's  mind  as  indi- 
cated epileptic  insanity,  it  was  proper  to  allow  him  to  illustrate 
the  soundness  of  defendant's  memory  by  speaking  of  the  quick- 
ness with  which  he  understood  and  answered  questions  put  to 
him  on  the  stand.2 

In  California  it  was  held  that  a  Roman  Catholic  priest  who  is 
required  by  his  priestly  office  to  pass  upon  the  sanity  and  men- 
tal condition  of  invalids  and  dying  persons  under  his  charge,  to 
the  end  that  he  may  administer  the  sacrament  only  to  those 
whose  minds  are  in  a  proper  state  to  reason  or  act  of  their  own 
volition,  is  in  this  respect  an  expert,  and  may  answer  a  hypo- 
thetical question  touching  the  sanity  of  such  individual.8 

But  generally  a  person  who  has  no  medical  knowledge  is  not 
competent  as  an  expert,4  §uch,  for  instance,  as  a  sheriff  who  has 
had  experience  with  insane  prisoners,5  or  a  minister  who  has 
read  books  upon  moral  and  intellectual  science,'  or  a  chaplain 
in  an  insane  asylum.7 

1  People  v.  Koerner,  154  N.  Y.,  355;  •  Hurst  v.  State  (Tex.  Cr.  App.),  40 

48  N.  E.  Rep.,  730.  S.  W.  Rep.,  264. 

'Com.  v.  Buccieri,  153  Pa.  St.,  "Hurt  v.  State,  40  S.  W.  Rep., 

535;  26  Atl.,  228.  1000;  38  Tex.  Cr.  App.,  397. 

3  Estate  of  Toomes,  54  Cal.,  509;  7  Ledwith  v.  Claffy,  18  App.  Div. 
35  Am.  Rep.,  83.  (N.  Y.),  115;  45  N.  Y.  Supp.,  612. 

4  State  v.  Crisp,  29  S.  W.  Rep.,  699; 
126  Mo.,  605. 


534  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

In  Pennsylvania,  however,  the  warden  of  a  prison  for  thirty- 
eight  years,  who  had  had  in  charge  many  prisoners  who  had 
feigned  insanity,  was  deemed  an  expert  competent  to  testify 
whether  a  person  feigned  insanity.1 

Not  every  physician  is  qualified  as  an  expert  on  insanity;  he 
must  have  had  sufficient  acquaintance  with  the  subject,  either 
from  personal  experience  or  from  reading  or  studying  the  sub- 
ject of  diseases  of  the  mind,2  to  satisfy  the  court  that  he  is  com- 
petent therefrom  to  testify  as  an  expert.  If  he  meets  that  re- 
quirement, the  character  and  amount  and  source  of  his  learning 
or  experience  bear  upon  his  credibility.2 

But  where  the  physician  fails  to  show  himself  sufficiently 
familiar,  from  either  experience  or  reading  or  study,  with  the 
subject,  to  satisfy  the  court  that  he  is  competent  to  answer  a 
hypothetical  question  addressed  to  him,  it  is  proper  for  the  court 
to  reject  his  testimony ; 2  for  instance,  where  it  does  not  appear 
that  he  has  ever  treated  an  insane  person.3  The  witness's  mod- 
est disclaimer  that  he  is  not  an  expert  will  not  deprive  his  tes- 
timony of  its  character  as  expert  testimony  if  it  actually  appears 
that  he  is  qualified  as  an  expert  witness.4 

THE  EFFECT  OF  EXPERT  TESTIMONY. 

The  testimony  of  experts,  particularly  so-called  alienists,  has 
become  a  bone  of  contention.  Of  right  it  ought  to  be  a  valued 
adjunct  to  the  enforcement  of  justice.  In  Massachusetts  only  an 
expert  alienist  is  permitted  to  give  his  opinion,  and  he  need  not 
have  seen  the  defendant.  Opinions  of  lay  witnesses  are  not  re- 
ceived.5 In  any  jurisdiction  the  honestly  formed  opinion  of  a 
veritable  expert,  who  is  able  intelligently  to  defend  his  opinion 
upon  cross-examination,  ought  to  be,  and  is,  despite  a  popular 
notion  to  the  contrary,  given  weight  by  courts  and  juries. 

Expert  evidence  is  not  controlling,  and  may  be  overcome  by 
other  competent  evidence.6  On  the  other  hand,  where  the  jury 

1  Commonwealth  v.  Wireback,  190      D.  C.,  310;  State  v.  Boyce,  24  Wash., 
Pa.  St.,  138;  42  Atl.  Rep.,  542;  43      514;   64  Pac.  R.,  719. 

W.  N.  C.,  506.  6Com.  v.  Rogers,  7  Met.   (Mass.), 

2  Abbott  v.  Commonwealth,  21  Ky.       500;      4    Am.    Dec.,  458;    Com.    v. 
Law  R.,  1372;   55  S.  W.  Rep.,  196.         Rich,  14  Gray,  335. 

'Bishop  v.  Commonwealth,  22  'E.g.,  In  re  McKean's  Will,  31 

Ky.  Law  Rep.,  760;  58  S.  W.  Rep.,  Misc.  R.  (N.  Y.),  703;  66  N.  Y.  Supp., 

817;  22  Ky.  Law  Rep.,  1161;  60  S.  44;  Wilsey  v.  Ellis,  89  111.  App.,632, 

W.  Rep.,  190.  where  physician,  witness  to  a  will, 

4  Horton  v.  United  States,  15  App.  testified  against  mental  competency, 


OPINION   EVIDENCE   OP   NON-EXPERT    WITNESSES. 


535 


determine  by  their  verdict  that  the  accused  is  guilty,  expert  evi- 
dence of  sanity  may  sustain  the  verdict,  though  the  remaining 
testimony  tends  to  show  insanity.1 

Expert  opinion  evidence,  based  solely  on  hypothetical  ques- 
tions, is  entitled  to  greater  or  less  weight  according  as  the  facts 
assumed  in  the  questions  may  have  been  established  by  the  tes- 
timony.2 And  where  such  evidence  is  the  only  evidence  tending 
to  show  incapacity,  it  may  not  be  sufficient  to  take  the  case  to 
the  jury.3  But  where  all  of  the  testimony  is  from  experts,  based 
on  observation,  it  cannot  be  properly  disregarded,  and  an  ad- 
judication to  the  contrary  is  error.4 

OPINION  EVIDENCE  OF  NON-EXPEET  WITNESSES. 

In  many,  though  not  in  all  States,  a  non-expert  or  non-pro- 
fessional witness  may,  after  first  testifying  to  facts,  circum- 
stances, or  the  conversation  of  an  alleged  insane  person,  state 
his  opinion  as  to  the  sanity  of  such  person.  The  rules  in  these 
States  differ  as  to  the  extent  of  knowledge  requisite.5 


the  other  testamentary  witness  and 
others  testified  to  the  contrary,  and 
a  finding  of  incapacity  was  overruled 
on  appeal  as  not  sustained  by  the 
evidence.  See  also  Hagan  v.  Sone 
68  App.  Div.,  60;  74  N.  Y.  Supp.,  109 
In  re  Kearney's  Will,  69  App.  Div. 
481;  74  N.  Y.  Supp.,  1045;  In  re 
Wright's  Est.  (Pa.),  51  Atl.  R. 
1031.  Brooks  v.  Pratt,  118  led.  R. 
725  (U.  S.  C.  C.  A.  Mass.),  a  finding  of 
insanity  was  sustained  though  an 
expert  testified  that  after  a  personal 
examination  of  some  length  he 
failed  to  discover  insanity.  In  re 
Conaty's  Will,  26  Misc.  R.,  104;  56 
N.  Y.  Supp.,  854,  where  opinions  of 
experts  that  an  injured  person  could 
not  converse  as  testified,  nor  com- 
prehend the  testamentary  act,  did 
not  rebut  the  evidence  of  subscribing 
witnesses  to  the  contrary. 

In  re  Lawrence's  Will,  27  Misc.  R., 
473;  59  N.  Y.  Supp.,  174,  expert 
evidence  deduced  from  insanity 
three  months  later  overcome  by 
testimony  of  other  witnesses  as  to 
capacity  on  the  day  of  the  execution. 
Affcl..  48  App.  Div.,  83,  62  N.  Y. 
Supp.,  673. 

In  re  Connor's  Will,  61  N.  Y.  Supp., 
910  (Surr.)  (hypothetical  question 


involving  B right's  disease).  Expert 
evidence  respecting  the  effect  of 
drunkenness  on  testamentary  ca- 
pacity cannot  overcome  direct  evi- 
dence of  actual  capacity.  In  re 
Hewitt's  Will,  31  Misc.  R.,  81;  64 
N.  Y.  Supp.,  571. 

1  People  v.  Ferraro,  161  N.  Y.,  365; 
14  N.  Y.  Cr.  R.,  266;  55  N.  E.  Rep., 
931. 

2  State  v.  Miller,  7  Ohio  N.  P.,  458; 
5  Ohio  S.  and  C.  P.  Dec.,  703. 

3  Hagan  v.  Sone,  68  App.  Div.,  60; 
74  N.  Y.  Supp.,  109. 

4  State  v.  Probate  Court,  Ramsey 
Co.,  83  Minn.,  58;  85  N.W.  Rep.,  9 17. 

s  Alabama:  Norris  v.  State,  16 
Ala.,  776;  Powell  v.  State,  25  Ala., 
28;  Burney  v.  Torrey,  14  So.  R.,  685; 
100  Ala.,  157.  Arkansas:  Boiling 
v.  State,  54  Ark.,  588;  16  S.  W.  R., 
658.  California:  People  v.  Wreden, 
59  Cal.,  392;  People  v.  Sanford,  43 
Cal.,  29.  Connecticut:  Traut  v. 
Thompson,  4  Conn.,  203;  Dunham's 
Appeal,  27  Conn.,  193.  Delaware: 
Duffield  v.  Morris,  2  Harr.,  375. 
Florida:  Armstrong  v.  State,  30 
Fla.,  170;  11  So.  R.,  618.  Georgia: 
Walker  v.  Walker,  14  Ga.,  242; 
Choice  v.  State,  31  Cla.,  424;  Patter- 
son v.  State,  86  Ga.,  70;  12  S.  E.  R., 


536 


MENTAL   UNSOUNDNESS — BECKER   AND    BOSTON. 


In  accordance  with  this  rule  a  physician  may,  because  of 
his  acquaintance  with  the  alleged  incompetent,  give  his  opinion 
as  a  non -expert.1 

It  is  a  general  rule  that  the  hypothetical  question  may  not  be 
addressed  to  a  lay  witness,  even  on  cross-examination.2 

Though  non-expert  witnesses  may  state  facts  within  their 
knowledge,  and  state  their  opinion  thereon,  in  general  they  may 
not  state  their  opinion  independently  of  the  facts  and  circum- 


174;  Potts  v.  House,  6  Ga.,  324. 
Idaho:  State  v.  Hurst,  39  Pac.  R., 
554.  Illinois:  Upstone  v.  People, 
109  111.,  169;  Jamison  v.  People,  145 
111.,  357;  34  N.  E.  R.,  486;  Ruther- 
ford v.  Morris,  77  111.,  397.  Indiana: 
State  v.  Newlin,  69  Ind.,  108;  Doe 
v.  Reagan,  5  Blackf.,  217;  33  Am. 
Dec.,  466;  Colee  v.  State,  75  Ind., 
511;  Eggers  v.  Eggers,  57  Ind.,  461; 
Sutherland  v.  Hankins,  56  Ind.,  343; 
Mill  v.  Carr,  5  Ind.  App.,  491;  32  N. 
E.  R.,  591.  Iowa:  Butler  v.  Ins.  Co., 
45  Iowa,  93;  Kosteleckyv.  Scherhart, 
99  Iowa,  120;  68  N.  W.  R.,  591. 
Kansas:  State  v.  Beuerman,  59 
Kan.,  586;  53  Pac.  R.,  874.  Ken- 
tucky: Abbott  v.  Com.,  21  Ky.  L.  R., 
1372;  55  S.  W.  R.,  196;  Kite  v.  Com., 
20  S.  W.  R.,  217;  Massie  v.  Com.,  24 
S.  W.  R.,  611.  Maryland:  Brooke 
v.  Townsend,  7  Gill.,  10.  Michigan: 
Beaubien  v.  Cicot,  12  Mich.,  459; 
People  v.  Borgetto,  99  Mich.,  336;  58 
N.  W.  R.,  328;  Sullivan  v.  Foley,  70 
N.  W.  R.,322.  Minnesota:  Pinney's 
Will,  27  Minn.,  280.  Mississippi: 
Wood  v.  State,  58  Miss.,  741.  Mis- 
souri: State,  v.  Erb,  74  Mo.,  199; 
Baldwin  v.  State,  12  Mo.,  233;  State 
v.  Klinger,  46  Mo.,  224;  State  v. 
Williamson,  106  Mo.,  162;  17  S.  W. 
R.,  172.  Nebraska:  Schlencker  v. 
State,  9  Neb.,  241;  Polin  v.  State, 
14  Neb.,  540;  Schultz  v.  State,  37 
Neb.,  481;  55  N.  W.  R.,  1080.  New 
Hampshire:  Hardy  v.  Merrill,  56 
N.  H.,  227;  cf.  State  v.  Pike,  49  N. 
H.,  399.  New  Jersey:  Vanauken's 
case,  2  Stock.  Ch.,  190;  Genz  v.  State, 
34  Atl.  R.,  816.  North  Carolina: 
Clary  v.  Clary,  2  Ired.  L.,  78.  Ohio: 
Clark  v.  State,  12  Ohio,  483;  40  Am. 
Dec.,  481.  Oregon:  State  v.  Zorn, 
22  Ore.,  591;  30  Pac.  R.,  317;  State 
v.  Hansen,  25  Ore.,  391;  36  Pac. 
R.,  296.  Pennsylvania:  Common- 


wealth v.  Wireback,  190  Pa.  St.,  138; 
42  Atl.  R.,  542;  43  W.  N.  C.,  506; 
Pidcock  v.  Porter,  68  Pa.  St.,  342; 
8  Am.  Dec.,  181;  Wilkinson  v.  Pear- 
son, 23  Pa.  St.,  117;  Com.  v.  Cres- 
singer,  193  Pa.  St.,  326;  44  Atl.  R., 
433.  South  Dakota:  State  v.  Leeh- 
man,  2  S.  D.,  171;  49  N.  W.  R.,  3. 
Tennessee:  Dove  v.  State,  3  Heisk, 
348;  Norton  v.  Moore,  3  Head.,  482. 
Texas:  Webb  v.  State,  5  Tex.  App., 
596  (overruling  previous  decisions); 
Holcomb  v.  State,  4  Tex.,  125; 
McClackey  v.  State,  5  Tex.  App.,  320; 
Garrison  v.  Blauton,  48  Tex.,  299; 
Brown  v.  Mitchell,  26  S.  W.  R.,  1059. 
Utah:  In  re  Christensen's  Estate,  53 
Pac.  R.,  1003;  17  Utah,  412.  Ver- 
mont: State  v.  Hayden,  51  Vt.,  296; 
Cram  v.  Cram,  33  Vt.,  15;  Hatha- 
way v.  Ins.  Co.,  48  Vt.,  335;  Morse 
v.  Crawford,  17  Vt.,  499.  Wash- 
ington: State  v.  Brooks,  30  Pac.  R., 
147.  West  Virginia:  State  v.  Maier, 
36  W.  Va.,  757;  15  S.  E.  R.,  991. 
Wisconsin;  Hempton  v.  State,  111 
Wise.,  127;  86  N.  W.  R.,  596.  U.  S.: 
Charter  Oak  L.  Ins.  Co.  v.  Rodell, 
95  U.  S.,  232;  Conn.  Mut.  L.  Ins.  Co 
v.  Lothrop,  111U.  S.,  612.  England: 
See  Rex  v.  Wright,  R.  and  R.  Grim. 
Cas.,  456.  Cf.  infra,  pp.  545-546, 
New  York  and  Massachusetts  rules. 

1  Commonwealth  v.  Cressinger,  193 
Pa.  St.,  326,  44  Atl.  R.,  433. 

2  In  re  Dolbeer's  Est.,  86  Pac.  R. 
(Cal.),   695;     Rambler  v.   Tryon,   7 
Serg.  and  Rawl.  (Pa.),  90;  10  Am. 
Dec.,   444;     Hogmeir's  Appeal,    108 
Mich.,  410;  66  N.  W.  R.,  327;    Dun- 
ham's Appeal,  27  Conn.,   102;   Pit- 
tard  v.  Foster,  12  111.  App.,  132;  Rag- 
land  v.  State,  125  Ala.,  12;  27  South., 
938;   Appleby  v.  Brock,  76  Mo.,  314; 
Bell  v.  McMaster,  29    Hun  (N.  Y.), 
272;    St.    Louis  Mut.  L.  Ins.  Co.  v. 
Graves,  6  Bush  (Ky.),  268. 


OPINION   EVIDENCE   OF   NON-EXPERT   WITNESSES. 


537 


stances  within  their  own  personal  knowledge,1  and  first  testified 
to  by  them ; 2  or  else,  in  some  States,  until  the  witness  is  shown 
to  have  had  sufficient  knowledge  and  opportunities  of  personal 
observation  to  form  a  correct  conclusion.3  The  opinion  cannot 
be  based  on  what  others  have  told  the  witness.4 

Though  the  rule  is  that  the  facts  should  be  stated  first,  it  has 
been  held  in  a  civil  case  not  reversible  error  if  the  witness  first 
gives  his  opinion  and  subsequently  the  facts  on  which  he  bases 
it  are  elicited.5 

The  failure  to  ask  or  obtain  the  opinion  of  the  witness  does 
not  render  his  testimony  as  to  the  facts  incompetent.8 

Full  cross-examination  of  such  a  witness  should  be  permitted 
to  show  additional  facts  tending  to  shake  the  opinion ;  for  in- 
stance, a  witness  having  expressed  an  opinion  as  to  the  sound- 
ness of  testator's  mind,  may  be  asked  on  cross-examination  re- 
specting his  treatment  of  his  family.7  Or  whether  he  was 
competent  to  make  a  particular  deed,  which  he  is  shown  to  have 
made.8 


>  Armstrong  v.  State,  30  Fla.,  170; 
11  So.  Rep.,  618;  Ellis  v.  State,  24 
S.  W.  Rep.,  894;  33  Tex.  Cr.  App.(  86; 
cf.  Mitchell  v.  State  (Fla.),  31  So.  R., 
242;  Packhain  v.  Ludwig,  103  Md., 
416;  63  Atl.  R.,  1048;  Burney  v. 
Torrey,  100  Ala.,  157;  14  So.  Rep., 
685;  Yarbrough  v.  State,  105  Ala., 
43;  16  So.  Rep.,  758;  Hoover  v.  State, 
48  Neb.,  184;  66  N.  W.  Rep.,  1117; 
Murphree  v.  Term.,  107  Ala.,  424;  18 
So.  Rep.,  264;  In  re  Hoope's  Est., 
174  Pa.  St.,  373;  34  Atl.  Rep.,  603; 
Williams  v.  State,  37  Tex.  Cr.  App., 
348;  39  S.  W.  Rep.,  687;  Hurst  v. 
State  (Tex.  Cr.  App.),  40  S.  W.  Rep., 
264;  Hawley  v.  Griffin  (Iowa),  82 
N.  W.  R.,  905.  The  mere  opinion 
is  said  to  be  entitled  to  little  weight, 
Hudson  v.  Adam's  Adm.,  20  Ky.  Law 
R.,  1267;  49  S.  W.  Rep.,  192,  and 
where  it  is  not  supported  by  the 
facts  upon  which  it  is  based,  or  the 
facts  upon  which  it  is  based  are  not 
sufficient  to  show  the  disappearance 
of  the  degree  of  intelligence  required 
for  the  particular  act  in  question,  the 
evidence  will  not  justify  a  finding  of 


incapacity,   Englert  v.   Englert,  198 
Pa.  St.,  326;   47  Atl.  Rep.,  940. 

2  Sheehan  v.  Kearney  (Miss.),   35 
L.  R.  A.,  102;  21  So.  Rep.,  41;  in  re 
McCabe,  70  Vt.,  155;  40  Atl.  Rep.,  52; 
Roush  v.  Wensel,  15  Ohio  C.  Ct.,  133; 
Crawford  v.  Christian,  102  Wis.,  51; 
78  N.  W.  Rep.,  406;  Lamb  v.  Lynch, 
56  Neb.,  135;  76  N.  W.  Rep.,  428; 
Alvord  v.  Alvord,  109  Iowa,  113;  80 
N.  W.  R.,  306;   Zirkle  v.  Leonard,  61 
Kan.,  636;  60  Pac.  R.,  318;  but  see 
Hewitt  v.  Taunton  St.  Ry.  Co.,  167 
Mass.,  483;  46  N.  E.  Rep.,  106,  where 
a  father  was  permitted  to  state  that 
he  considered   his  child  of  average 
intelligence.     See  also  infra,  p.  542. 

3  Appeal  of  Turner,  72  Conn.,  305; 
44  Atl.  Rep.,  310. 

4  First    Nat.     Bank    v.    McGinty 
(Tex.  Civ.  App.),  69  S.  W.  R.,  495. 

4  Jones  «.-  Galbraith  (Tenn.  Ch. 
App.),  59  S.  W.  Rep.,  350. 

*  Bower  v.  Bower,  142  Ind.,  194;  41 
N.  E.  Rep.,  523. 

7  Petefish  v.  Becker,  176  111.,  448; 
52  N.  E.  Rep.,  71. 

8  Dominick  v.  Randolph,  124  Ala., 
557;  27  So.  Rep.,  481. 


538        MENTAL  UNSOUNDNESS — BECKER  AND  BOSTON. 

WHO  MAY  EXPRESS  AN  OPINION. 

The  Alleged  Incompetent  Himself.  —  The  person 
whose  condition  is  under  consideration,  it  is  said,  is  not  compe- 
tent to  express  an  opinion  on  the  former  unsoundness  of  his  own 
mind,  to  escape  an  agreement  made  by  him.1 

Intimate  Acquaintance. — Though  in  California  only  ex- 
perts and  intimate  acquaintances  may  testify  to  an  opinion,  nev- 
ertheless a  non-expert  witness  who  is  not  an  intimate  acquaint- 
ance may  be  asked  a  grantor's  or  defendant's  appearance  or 
manner  at  a  given  time,2  or  as  to  his  peculiar  conduct  and 
language,3  as  the  question  calls  for  a  fact  and  not  an  opinion  as 
to  mental  condition.4 

The  court  is  to  determine  who  is  an  "  intimate  acquaintance, " 5 
and  the  determination  is  within  the  discretion  of  the  trial  judge.6 
The  witness  may  be  asked  whether  testator  appeared  rational 
or  irrational,7  and  he  may  be  asked  his  opinion  of  testator's 
mental  sanity.7  In  Connecticut  an  intimate  neighbor  may  tell 
whether  a  testator  was  easily  influenced  or  not.8  In  Iowa  it  has 
been  held  that  an  acquaintance  is  necessarily  derived  from  a  series 
of  transactions  or  conversations.9 

Attesting  Witnesses. — Subscribing  or  attesting  witnesses 
to  a  will,10  or  paper  alleged  to  be  a  will,"  are  generally  permitted 
to  express  an  opinion  as  to  testamentary  mental  competency 12  of  a 
testator,  without  other  qualifications,  and  without  first  testifying 
to  the  facts,  circumstances,  or  conversations  on  which  it  is 

1  O'Connell   v.    Beecher,    21    App.       condition  of  testator's  mind,  memory, 
Div.  (N.Y.)  298;  47  N.  Y.  Supp.,  334.      and  judgment. 

C/.,  however,  page  501-2,  supra.  s  In  re  Wax's  Est.,  106  Cal.,  343;  39 

2  Holland  v.  Zollner,  102  Cal.,  633;      Pac.  Rep.,  624. 

36  Pac.   Rep.,  930;    People  v.  Me-  6  People  v.  Hill,  116  Cal.,  562;  48 

Carthy,   115  Cal.,  255;  46  Pac.   R.,  Pac.  Rep.,  711. 

1073.     As    to    "intimate  acquaint-  7  In  re  Keithley's  Est.,  134  Cal.,  9; 

ance"  see  Wheelock  v.  Godfrey,  100  66  Pac.  R.,  5. 

Cal.,  578;  35  Pac.  R.,  3¥f;   People  v.  8  Appeal  of  Vivian,  74  Conn.,  257; 

Barthleman,  52  Pac.    Rep.,  112;  120  50  Atl.  R.,  797. 

Cal.,  7.  9Hertrich  v.  Hertrich,  87  N.  W. 

'Marceau  v.  Travellers'  Ins.  Co.,  Rep.,  689. 

101   Cal.,   338;   35   Pac.    Rep.,   856;  10  Kaufman  v.  Caughman,  49  S.  C., 

People  v.   Ellsworth,  127  Cal.,  595;  159;   27  S.  E.  Rep.,  16. 

60  Pac.  R.,  161.  "  Scott  v.  McKee,  105  Ga.,  256;  31 

4  See  also  Craig  v.  Southard,  148  S.  E.  Rep.,  183. 

111.,  37;  35  N.  E.  Rep.,  361,  where  12  But  not  as  to  mental  competency 

witnesses  were  allowed  to  state  the  generally,  Jones  v.  Collins,  94   Md., 

403;  51  Atl.  R.,  398. 


WHO   MAY   EXPRESS   AN   OPINION.  539 

based.  Such  a  witness  is  subject  to  cross-examination,  but  his 
testimony  as  to  his  opinion  is  competent  without  first  eliciting 
from  him  the  facts  upon  which  lie  bases  it,  other  than  the  fact 
of  the  execution  and  publication  of  the  will  by  the  testator,  and 
the  appearance,  conduct,  and  surroundings  of  the  testator  at  the 
time  of  the  execution  of  the  will.2  But  such  opinion  is  not  enti- 
tled to  any  greater  weight  on  the  subject  of  testator's  mental 
capacity  than  that  of  other  persons  present,3  In  fact,  a  will  has 
been  held  properly  admitted  to  probate  on  the  testimony  of 
other  witnesses  as  to  testamentary  capacity,  though  one 4  or  all 5  of 
the  attesting  witnesses  expressed  the  opinion  that  the  testator 
was  incompetent.6  But  the  testimony  of  subscribing  witnesses 
can  be  overcome  only  by  substantial  testimony.7  The  subscrib- 
ing witness  has  been  allowed  to  say  that  he  observed  no  indica- 
tion of  undue  influence  upon  the  mind  of  the  testator.8  The  sub- 
scribing witness  is  not  precluded  from  expressing  his  opinion 
against  the  competency  of  the  testator.9 

It  has  been  said,  however,  that  a  person  who  signs  as  witness 
to  a  will  impliedly  certifies  to  testamentary  capacity,  and  while 
he  may  testify  to  the  contrary,  his  implied  self -stultification  may 
be  considered  in  weighing  his  testimony.10 

But  where  a  subscribing  witness  has  testified  to  facts,  and 

1  Hertrich  v.  Hertrich  (Iowa),  87  of  the  testator's  capacity  before  at- 
N.  W.  R.,  689.     See   also    Potts   v.  testing  his  will.    The  subscribing  wit- 
House,  6  Ga.,  324;  50  Am.  Dec.,  329;  ness  may  as  matter  of  fact  be  entitled 
Scott  v.  McKee,  105  Ga.,  256;  31  S.  to  greater  credibility.     Safe  Deposit 
E.  R.,  183;    Robinson  v.  Adams,  62  and  Tr.  Co.  v.  Berry  (Md.),  49  Atl. 
Me.,  369;  16  Am.  Rep.,  473;  Williams  R.,  401. 

v.   Lee,  47  Md.,  321;   in  re  Potter,  'Loughney  v.  Loughney,  87  Wis., 

17  App.  Div.,  267;  45  N.  Y.  Supp.,  92;   58  N.  W.   Rep.,    250.     But  as 

563;   Logan  v.  McGinnis,  12  Pa.,  27;  between  the  opinion  of  an  expert  wit- 

Tutow  v.  Tutow,  54  Pa.,  216;  93  Am.  ness    examined    on    a    hypothetical 

Dec.,  691;  Gibson  v.  Gibson,  9  Yerg.,  question  and  the  opinion  of  the  sub- 

329;  VanHussv.Rambolt,2Cold.,  139.  scribing   witnesses,   the    latter    has 

2  Inre  Folt's  Will,  71  Hun  (N.  Y.),  been    suffered     to    prevail.     In    re 
492;  24  N.  Y.  Supp.,  1052.     See  in  re  Conaty's  Will,  26  Misc.  R.,  104;    56 
Barber's  Est.,  63  Conn.,  393;  27  Atl.  N.  Y.  Supp.,  854. 

Rep.,  973;   infra,  p.  551.  8  In  re  Robinson's  Will,  190  111.,  95; 

3  Appeal  of  Crandall,  63  Conn.,  365,      60  N.  E.  R.,  194. 

28  Atl.  Rep.,  531.     It  is  error  to  in-          6  See  infra,  p.  550. 

struct  the  jury  as  matter  of  law  to  the          *  Fulbright  v.  Perry  Co.,  145  Mo., 

effect  that  subscribing  witnesses  are  432;  46  S.  W.  Rep.,  955. 

not  entitled  to  greater  weight  than          8  Taylor  v.  Pegram  (111.  Sup.),  37 

other  witnesses,  since    this  misleads  N.  E.  Rep.,  837. 

them    by  omitting    the    element   of          *  In  re  D'Avignon's  Will,  12  Col., 

individual   credibility,    and   the  cir-  489,  55  Pac.  R.,  936. 

cumstance    that  a   subscribing    wit-          10  Stevens  v.  Leonard,  154  Ind.,  67; 

ness  is  expected   to    inform   himself  56  N.  E.  R.,  27. 


540  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

those  facts  did  not  tend  to  show  incompetency,  it  has  been  held 
improper  to  ask  him  his  opinion  on  the  facts.1  If  this  is  the 
generally  accepted  rule  it  would  be  proper  to  ask  the  opinion  of 
a  subscribing  witness  upon  the  facts  first  testified  to  by  him 
only  in  case  those  facts  tend  to  support  the  opinion  of  mental 
unsoundness;  in  other  words,  while  his  opinion  might  be  ex- 
pressed without  basing  it  on  facts  first  testified  to  except  the 
execution,  publication,  and  circumstances,  if  he  does  testify  to 
other  facts  tending  to  show  the  mental  condition  of  the  testator, 
the  facts  so  testified  take  the  place  of  his  opinion,  and  then  his 
opinion  cannot  be  expressed  on  the  facts,  unless  they  would  tend 
to  support  an  opinion  of  uusoundness. 

A  subscribing  witness  cannot  be  asked  whether  in  his  opinion 
the  testator  had  capacity  to  make  a  will,  for  that  calls  for  the  de- 
cision of  the  whole  issue  of  capacity.2 

It  would  seem  that  the  sanction  accorded  to  the  opinion  of  a 
witness  to  a  will  does  not  extend  to  the  witnesses  to  a  deed  or 
written  instrument  other  than  a  will ;  though  it  has  been  said  as 
to  deeds,  that  the  opinion  of  an  officer  taking  the  acknowledgment 
or  of  a  person  present  at  its  execution  is  entitled  to  peculiar 
weight  in  considering  the  grantor's  capacity.3 

Other  Non-Expert  Witnesses. — Non-expert  opinion  evi- 
dence of  competency  to  execute  a  will  is  not  confined  to  the  wit- 
nesses to  the  will,  for  other  persons  who  had  peculiar  advantages 
in  observing  capacity  are  competent  to  express  an  opinion ;  *  and 
persons  of  long  and  intimate  acquaintance  or  who  have  had  busi- 
ness transactions  writh  the  alleged  incompetent5  may  testify.6 
And  parties  to  the  contest  are  not  incompetent  to  give  their 
opinions  in  jurisdictions  where  statutes  have  removed  the  bar 
caused  at  common  law  by  interest.7 

A  non-expert  witness  sufficiently  qualified  to  testify  on  ordi- 
nary subjects  may  not  be  qualified  to  express  an  opinion  as  to 

1  Furlong  v.  Carraher,    108  Iowa,          4  Whitelaw's  Exr.  v.  Simes,  90  Va., 
492;  79  N.  W.  Rep.,  277;  or  to  permit      588,  19  S.  E.  Rep.,  113. 

him  to  express  an  opinion   that  de-          8  Williams  v.  State  (Tex.  Cr.  App.), 

fendant  was  irrational,  when  the  facts  53  S.  W.  Rep.,  859. 
testified  to  did  not  support  the  opin-          8  Burney  v.  Torrey  (Ala.),  14  So. 

ion,  State  v.  Leehman,  2  S.  D.,  171;  Rep.,  685;   Brown  v.  Mitchell  (Tex.), 

49  S.  W.  R.,  3.  23  S.  W.  Rep.,  1059.     Also  in  homi- 

2  Furlong  v.  Carraher,  supra.  cide  cases,  State  v.  Hurst    (Idaho), 
'  Buckey  v.  Buckey,  38  W.  Va.,  168;  39  Pac.  Rep.,  554. 

18   S.    E.    Rep.,   383;     Delaplain   v.          7  In  re  Goldthorp's  Est..  94  Iowa, 

Grubb,  44  W.  Va.,  612;  30  S.  E.  Rep.,      336;  62  N.  W.  Rep.,  845. 

201. 


EXPRESSION    OF   AN   OPINION   BY    A   NON-EXPERT.          541 

sanity.  The  action  of  a  trial  court  in  excluding  the  opinion  of 
a  thirteen-year-old  child  upon  mental  condition  has  been  sus- 
tained on  appeal.1 

Persons  found  by  the  court  to  be  competent  to  form  opinions 
and  to  have  had  opportunity  to  form  opinions  are  competent  to 
give  their  opinions.2  A  clergyman  who  visited  a  testatrix  during 
her  last  illness  is  competent  to  express  an  opinion  as  to  her  testa- 
mentary capacity  at  that  time.3  The  tendency  of  the  decisions 
is  to  confine  this  sort  of  opinion  evidence  to  those  witnesses 
who  have  had  a  previous  personal  acquaintance  with  the  alleged 
insane  person.4 

In  Texas,  a  judge  before  whom  a  person  had  been  tried  was 
held  not  qualified  to  express  an  opinion  that  accused  was  not 
insane  after  stating  what  he  had  noticed  of  the  accused  during 
his  trial.5  But  in  California  a  jailer  was  permitted  to  testify 
as  to  the  conduct  of  defendant  while  in  jail  and  the  apparent 
condition  of  his  mind  during  that  time;6  and  in  Oregon,  the 
custodian  of  prisoner  for  four  mouths  prior  to  the  trial,  though 
not  previously  acquainted,  was  allowed  to  testify  that  he  saw 
no  indication  of  insanity,  and  that  the  accused  seemed  perfectly 
rational.7 

In  Texas,  an  officer  was  not  allowed  to  testify  that  when  he 
had  heard  accused  testify  in  a  previous  case  he  testified  like  a 
sane  man.8 

In  Illinois,  a  person  who  had  but  a  passing  acquaintance  and 
who  had  not  spoken  with  deceased,  whose  mental  condition  at 
the  time  of  his  death  was  in  question,  for  eight  months  prior 
thereto,  was  deemed  incompetent.9 

But  in  Pennsylvania,  one  who  was  not  personally  acquainted 
with  the  alleged  incompetent,  but  had  seen  him  frequently  and 
observed  him,  was  permitted  to  say  whether  he  believed  him 

'Collins  v.   People,   194  111.,  506;  •  People  v.  McCarthy,  115  Cal.,  255; 

62  N.  E.  Rep.,  902.  46  Pac.  R.,  1073. 

2  Patten  v.  Cilley,  67  N.  H.,  520;  7  State  v.   Feister,   50  Pac.   Rep., 

42  Atl.  Rep.,  47.    '  561. 

3Ethridge   v.    Bennett's   Exrs.,   9  8  Merritt  v.  State,  39  Tex.  Cr.,  70; 

Houst.  (Del.),  295;  31  Atl.  Rep.,  813.  45  S.  W.  Rep.,  21. 

4  See   in  re  Christensen's  Est.,  17  •  Grand  Lodges  Wieting,  168  111., 

Utah,    412;    53    Pac.    Rep.,    1003;  408;  48  N.   E.   Rep.,  59.     See  also 

State  v.  Soper,  148  Mo.,  217;  49  S.  W.  State  v.  Soper,  148  Mo.,  217;  49  S. 

Rep.,  1007.  W.  Rep.,  1007. 

•McLeod    v.    State,   31    Tex.  Cr. 
Rep.,  331;  20  S.  W.  Rep.,  749. 


542          MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

insane.1    The  Pennsylvania  courts  are  liberal  in  admitting  this 
class  of  testimony.2 

In  Alabama  one  who  had  known  the  alleged  incompetent 
slightly  for  several  years,  had  seen  him  occasionally,  and  had  had 
casual  short  conversations  with  him,  but  no  business  transac- 
tions until  a  short  while  previous  to  the  time  in  controversy, 
was  held  incompetent.  In  the  same  case  a  witness  was  held 
competent  who  had  known  the  alleged  incompetent  twelve 
years,  had  had  many  conversations  with  him,  wrote  the  contract 
in  question,  and  saw  him  execute  it.3 

UPON  WHAT   FACTS  OB  KNOWLEDGE  AN   OPINION  MAY  BE 
EXPRESSED  BY  A  NON-EXPERT. 

An  opinion  of  insanity  based  on  an  enumeration  of  acts  and 
declarations  which  were  rational  has  been  excluded.4  A  witness 
cannot  give  his  opinion  that  testator  was  insane  before  testifying 
to  something  said  or  done,  fairly  tending  to  show  insanity.5  Nor 
can  he  express  any  opinion  without  first  having  testified  to  facts 
forming  a  basis  for  such  opinion.6  But  in  Missouri  it  has  been 
said  that  a  witness  may  testify  that  a  person  is  sane  without  giv- 
ing his  reasons.7  The  value  of  such  testimony  will  depend 
largely  on  the  opportunities  for  correct  observation,8  as  well  as 
on  the  appearances  and  conduct  observed ; 9  and  where  there  has 
been  no  opportunity  for  observation  except  at  a  time  remotely 
anterior  to  the  time  in  question  the  opinion  is  incompetent ; 10  and 

'Commonwealth    v.    Brown,    193  'Armstrong  v.  State,  30  Fla.,  170, 

Pa.  St.,  507;  44  Atl.  R.,  497.  11  So.  Rep.,  618. 

2  Com.  v.  Wireback,   190  Pa.  St.,  10  Denning  v. Butcher,  91  Iowa, 425; 
138,  42  Atl.  R.,  542;  43  W.  N.  C.,  506;  59  N.  W.  Rep.,  69;  Buys  v.  Buys,  99 
Com.  v.  Cressinger,  193  Pa.  St..  326;  Mich.,    354;    58   N.    W.    Rep.,'  331; 
44  Atl.  R.,  433.  Grand   Lodge   v.   Wieting,    168   111., 

3  Dominick  v.  Randolph,  124  Ala.,  408;   48   N.    E.    Rep.,   59.     But    in 
557;  27  So.  Rep.,  481.  Merritt  v.  State,  40  Tex.  Cr.,  359; 

4  Commonwealth  v.  Wireback,  190  50  S.  W.  Rep.,  384,  a  witness  was 
Pa.  St.,  138;  42  Atl.  R.,  542;  43  W.  deemed    competent    to    express    an 
N.  C.,  506.  opinion  of  sanity,  though  he  had  not 

8  Lamb  v.  Lippincott,   115  Mich.,  spoken  to  the  alleged  incompetent  for 

611;  73  N.  W.  Rep.,  887.  five  years,  who  had  known  him  well 

6  Roush  v.  Wensel,  15  Ohio  C.  C.  R.,  prior  to  that.     See  State  v.  Soper, 
133;    Snider  v.  State  (Neb.),  76  N.  148  Mo.,  217,  49  S.  W.  Rep.,   1007, 
W.  Rep.,  574.     Supra,  p.  536.  where  a  person  had  seen  accused  only 

7  State  v.  Soper,  148  Mo.,  217;  49  three  times  and  had  no  acquaintance 
S.  W.  Rep.,  1007.  with  him  and  was  not  permitted  to 

8  Clarke  v.  Irwin  (Neb.),  88  N.  W.  express   an  opinion.     In  Safe    Dep. 
R.,  783;   Shark  v.  Merriman  (Mich.),  and  T.  Co.  v.  Berry,  49  Atl.  R.,  401 
66  N.  W.  Rep.,  372.  (Md.),  a  witness  who  based  his  opinion 


EXPRESSION   OP   AN   OPINION  BY   A  NON-EXPERT. 


543 


also  where  it  does  not  appear  how  long  or  how  intimately  the 
witness  had  known  the  insane  person.1 

Where  an  opinion  of  mental  incapacity  was  admitted  without 
facts  to  sustain  it,  the  opinion  was  not  deemed  sufficient  evidence 
to  prove  the  incapacity.2  The  opinion  must  be  based  on  facts 
which  to  some  extent  justify  or  reasonably  tend  to  support  it,8 
but  it  is  not  incompetent  because  of  little  opportunity  to  observe 
or  little  knowledge  if  the  facts  shed  much  light  on  the  alleged 
incompetent's  mental  condition.4  The  question5  and  the  opin- 
ion e  must  be  confined  to  the  facts  stated. 

One  opinion  is  not  a  sufficient  foundation  for  another,  and 
because  a  witness  is  of  the  opinion  tnat  an  accused  person  is  not 


upon  two  interviews  with  testator 
in  which  he  made  mistakes  that  ap- 
peared not  unreasonable  as  to  the 
identity  of  a  watch  and  of  a  person  was 
held  incompetent.  And  in  this  case 
also  where  the  opinion  was  based  on 
physical  change  and  grief,  it  was  in- 
competent because  unimpaired  intel- 
lect is  consistent  with  both;  as  was 
also  an  opinion  based  on  conversations 
showing  physical  weakness  and  loss 
of  memory;  and  an  opinion  based  on 
unwillingness  to  converse  with  wit- 
ness; and  an  opinion  based  on  a 
statement  by  testator,  on  application 
to  him  for  a  loan,  that  he  did  not  have 
a  dollar  in  the  world  and  his  affairs 
were  mixed  up,  when  he  was  actually 
wealthy;  or  on  physical  weakness 
and  depression;  or  on  inability  to 
sign  a  receipt,  and  weakness,  and 
subsequent  refusal  to  talk  to  witness, 
while  weak  and  suffering;  or  on  a 
repeated  mistake  in  calling  a  person's 
name,  after  correction,  or  on  a  state- 
ment by  testator  that  he  could  not 
remember  well  as  his  head  was  not 
the  same  as  it  used  to  be;  or  on 
physical  debility  alone;  or  upon  a 
physical  condition  subsequent  to  the 
execution  of  the  will,  which  was 
different  from  his  condition  at  the 
time  of  executing  the  will;  or  on 
business  transactions  six  years  be- 
fore and  evident  forgetfulness  with 
respect  to  the  condition  of  testator's 
account  with  a  lodge  to  which  he 
always  paid  his  dues  in  advance.  Il 
is  to  be  noted  that  in  this  case 
numerous  criteria  for  qualifying  a 
non-expert  witness  to  give  his  opinion 
were  presented,  and  that  they  all 


failed  to  meet  the  requirement  that 
the  opinion  must  be  based  upon  facts 
which  justify  the  expression  of  an 
opinion  upon  the  question  of  mental 
capacity.  The  court  took  the  view 
that  each  of  these  non-expert  wit- 
nesses was  incompetent,  because  an 
opinion  as  to  mental  capacity  based 
on  any  one  set  of  facts  stated  by  the 
several  witnesses  would  not  justify 
an  opinion  of  incompetency. 

In  contrast  see  Brashears  v.  Orme 
(Md.),  49  Atl.  R.,  620,  where  testator 
grabbed  witness's  horse  in  the  road, 
and  asked  him  what  he  was  doing  for 
hissoul;  subsequently  denied  it;  asked 
witness  to  kill  him  and  drew  up  a 
paper  of  exoneration,  and  cried  when 
witness  refused;  these  acts  were  held 
sufficient  to  qualify  witness  to  ex- 
press an  opinion  on  testamentary 
capacity-.— but  an  opinion  could  not 
be  based  on  testator's  attempt  to 
commit  suicide  twenty-five  years 
before. 

1  Taylor  v.  U.  S.,  7  App.  D.  C.,  27. 

*  St.  Joseph's  Convent  v.  Garner, 
66  Ark.,  623;  53  S.  W.  Rep.,  298. 

'O'Connor  v.  Madison,  98  Mich.. 
183;  57  N.  W.  Rep.,  105;  Alvord  v. 
Alvord,  109  Iowa,  113;  80  N.  W. 
Rep.,  306;  Boorman  v.  N.  W.  Mut. 
Relief  Assn.,  90  Wis.,  144;  62  N.  W. 
Rep.,  924;  Youn  v.  Lamont,  56  Minn., 
216;  57  N.  W.,  478;  Furlong  v. 
Carraher,  108  Iowa,  492. 

1  Kettemann  v.  Metzger,  23  Ohio 
Cir.  Ct.  R.,  61. 

•Furlong  v.  Carraher,  102  Iowa, 
358,  71  N.  W.  Rep.,  210. 

•  Zirkle  v.  Leonard,  61  Kan.,  636, 
60  Pac.  R.,  318. 


544  MENTAL  UNSOUNDNES8— BECKER  AND  BOSTON. 

capable  of  distinguishing  right  from  wrong  that  opinion  is  not  a 
foundation  sufficient  to  render  admissible  his  opinion  whether 
the  accused  would  have  sufficient  mental  power  "to  keep  from 
committing  a  crime. "  * 

In  Kentucky,  a  non-expert  witness  may  give  his  opinion  as 
to  the  mental  condition  of  defendant  when  he  speaks  from  ac- 
quaintance with  and  knowledge  of  him,  though  he  relate  no  par- 
ticular circumstance  in  support  of  his  views.2  Neighbors  who 
testify  to  incidents  showing  mental  unsoundness  of  defendant  at 
different  periods  of  his  life  may  express  their  opinion  thereon.3 
So  in  Missouri,  when  they  show  that  they  observed  his  actions 
and  conversation,  they  may  state  their  opinion  that  he  was  sane.4 

In  Connecticut,  non-expert  witnesses  who  had  frequently  met 
and  conversed  with  testatrix  were  permitted  to  give  their  opin- 
ions, though  they  could  not  give  in  detail  any  conversation.5  In 
Iowa  a  non-expert  may  give  an  opinion  on  mental  condition 
after  giving  facts  showing  an  acquaintance  and  knowledge  of 
the  person.8  In  North  Carolina  an  intimate  acquaintance  who 
has  observed  the  mental  condition  of  the  alleged  incompetent 
may  give  his  opinion  as  to  his  mental  capacity  to  make  such  a 
contract  as  one  in  issue.7 

A  conversation  with  testator  on  the  subject  of  wills,  four 
years  prior  to  the  execution  of  the  will  in  question,  was  in  In- 
diana held  a  sufficient  basis  for  the  opinion  of  a  non-expert.8 

In  Iowa  a  stenographer  who  was  engaged  in  taking  testatrix's 
deposition  for  two  hours  was  permitted  to  give  an  opinion  after 
stating  what  took  place  at  the  examination.9 

In  Michigan  it  has  been  said  that  the  witness,  in  order  to  ex- 
press an  opinion  of  incompetency  based  on  observation,  must 

1  Shaeffer  v.  State,  61  Ark.,  241,  1094;   but   the   witness   must   show 
32  S.  W.  Rep.,  679.  sufficient    knowledge    and  opportu- 

2  Cotrell   v.  Com.  (Ky.),  17   S.  W.  nity  to    form    a    correct    conclusion 
Rep.,     149;      Newcomb's    Exrs.     v.  as  to  testator's  mental  condition,  or 
Newcomb,  16  Ky.  Law  R.,  376;  27  else  must  first   testify   to   sufficient 
S.  W.  Rep.,  997.     See    also  Bulger  facts  on  which  to  base  an  opinion. 
v.  Ross,  98  Ala.,  267;  12  So.  Rep.,  803.  Appeal  of  Turner,  72  Conn.,  305;  44 

*Massie  v.  Commonwealth,  15  Ky.  Atl.  R.,  310. 

Law  R.,  562;  24  S.  W.  Rep.,  611.  8  Kostelecky  v.  Scherhart,  99  Iowa, 

'State  v.  Bronstine,  147  Mo.,  520;  120;  68  N.  W.  Rep.,  591. 

49  S.  W.  Rep.,  512.  '  Whitaker  v.  Hamilton,  126  N.  C., 

*  Appeal  of  Shanley,  62  Conn.,  325;  465;  35  S.  E.  Rep.,  815. 

25  Atl.  Rep.,  245.     See  also  Appeal  *  Bower  v.  Bower,  142  Ind.,  194; 

of  Kimberly,  68  Conn.,  428;  36  Atl.  41  N.  E.  Rep.,  523. 

Rep.,    847.     See    also    Pflueger    v.  9  In  re  Fenton's  Will,  97  Iowa,  192; 

State,  46  Neb.,  493;  64  N.  W.  Rep.,  66  N.  W.  Rep.,  99. 


THE   NEW    YORK   RULE.  545 

show  that  there  was  something  in  the  appearance  of  the  person 
to  justify  the  inference,  though  it  may  be  sufficient  that  there 
were  acts  and  appearances  which  the  witness  cannot  describe, 
but  which  produced  an  impression  on  his  mind.1 

A  witness,  in  Texas,  was  not  permitted  to  say  that  he  saw 
accused  on  the  day  of  the  homicide,  and  he  thought  the  accused 
was  pale  and  haggard,  and  it  seemed  there  was  some  trouble ; 
the  court  regarded  this  as  opinion  evidence,  not  based  upon  a 
statement  of  facts.2  But,  where  a  non-expert  witness  had  known 
a  pei-sou  several  years  and  had  associated  with  him  almost  daily, 
he  was  permitted,  not  only  to  state  the  facts  that  the  person  was 
simple-minded  and  had  no  memory  of  time  or  place,  but  to  ex- 
press the  opinion  that  he  was  not  of  sufficient  intelligence  to 
distinguish  between  alcohol,  whiskey,  and  wine.3 

The  opinion  may  be  based  on  any  sufficient  observation  to 
justify  it;  accordingly  it  is  not  necessary  that  the  observation 
should  include  the  transaction  of  business,4  though  a  business 
transaction  is  in  question  in  the  suit. 

The  opinion  of  a  11011  -expert  witness  who  has  testified  to 
facts  must  be  based  upon  the  facts  stated ;  accordingly,  having 
testified  to  facts,  he  cannot  be  asked  his  opinion  on  what  he 
knows,  but  has  not  stated,5  nor  on  what  he  knows  and  what  he 
has  heard.8 

Conduct  and  conversation  observed  by  a  non-expert  witness, 
even  though  while  the  accused  was  in  prison,  are  not  regarded  as 
confessions;  they  can,  therefore,  be  stated  by  the  witness  and 
used  as  the  basis  of  his  opinion,  though  the  accused  was  not  cau- 
tioned that  they  might  be  used  against  him.7  And  certainly 
where  the  prisoner  has  been  warned  that  what  he  says  may  be 
used  against  him,  his  statements  to  the  sheriff  who  has  him  in 
custody  may  be  introduced  in  evidence  as  the  basis  of  the  sheriff's 
opinion  as  to  his  sanity.8 

The  New  York  Rule. — In  New  York  a  non-expert  wit- 

1  Prentis  v.  Bates,  93  Mich.,  234;  twice  removed,  Jones  v.  Collins,  94 
53  N.  W.  Rep.,  153.  Md.,  403,  51  Atl.  R.,  398. 

2  Spangler  v.  State,  55  S.  W.  Rep.,  8  State  v.  Robbins  (Iowa),  80  N.  W. 
326.  Rep.,  1061. 

3  Johnson  v.  State  (Tex.  Cr.  App.),  •  State  v.  Peel,  23  Mont.,  358;  59 
62  S.  W.  Rep.,  756.  Pac.  R.,  169. 

4  Ring  v.  Lawless,  190  111.,  520;  60  7  Adams  v.  State,  34  Tex.  Cr.,  470; 
N.  E.   Rep.,  881;  e.g.,  observation  of  31  S.  W.  Rep..  372. 

conduct  toward  wife,  and  knowledge          8  Hurt  v.  State,  38  Tex.  Cr.    397; 
that  a  cancer  in  the  head  had  been      40  S.  W.  Rep.,  1000. 
III.— 35 


546  MENTAL  UNSOUNDNESS— BECKER  AND  BOSTON. 

ness  may  not  give  his  opinion  as  to  "  sanity  or  insanity  "  but  may 
characterize  as  "rational  or  irrational,"1  or  as  the  acts  and  con- 
versation "of  a  rational  person,"2  the  acts  and  conversation  of  a 
defendant  on  trial  under  an  indictment,  or  of  any  person  whose 
sanity  is  in  question  in  a  civil  case,  which  he  observed  and  has 
previously  detailed.1  In  New  York  it  has  been  strictly  held 
that  a  lay  witness  may  not  express  his  general  opinion,  but  only 
whether  the  particular  words  or  acts  were  rational.3  He  must 
state,  it  is  said,  not  his  opinion  on  the  subject  of  sanity  or  in- 
sanity, but  the  impression  that  the  acts  and  declarations  pro- 
duced on  his  own  mind  at  the  time.4 

The  Massachusetts  Rule. — In  Massachusetts  non-expert 
witnesses  are  not  permitted  to  testify  to  their  opinion  as  to  the 
sanity  of  a  person  or  the  rationality  of  his  acts.5  A  lay  witness 
may  be  asked  whether  a  person  has  during  a  stated  period  of 
time  "failed  mentally,"  but  that  seems  to  be  about  the  limit  of 
such  questioning.6 

THE  FUNCTION  OF  JUDGE  AND  JURY  WITH  EESPECT  TO  COM- 
PETENCY AND  WEIGHT  OF  NON-EXPERT  OPINION  EVI- 
DENCE. 

It  is  the  province  of  the  court  to  say  whether  the  opinion  of 
a  non-expert  witness  is  based  on  sufficient  observation,7  and  by 
preliminary  examination  of  the  witness  to  determine  whether  he 
is  a  competent  witness.8  The  court  may  exclude  the  witness's 
conclusion  as  to  what  a  person  had  capacity  to  know,  when 
he  has  testified  in  detail  as  to  the  facts  within  his  knowledge 

1  Holcomb  v.  Holcomb,  95  N.  Y.,  Am.  Dec.,  458;  Com.  v.  Rich,  14  Gray, 
316;    People  v.  Taylor,  138  N.  Y.,  335;  Smith  v.  Smith,  157  Mass.,  389; 
398,  409;    52  N.  Y.    St.  Rep.,  914;  32  N.  E.  R.,  348;    May  v.  Bradlee, 
People  v.  Strait,  148  N.  Y.,  566;  42  127  Mass.,  414,  421. 

N.  E.  Rep.,  1045.     Followed  in  New  6  Clark  v.  Clark,   168  Mass.,  523; 

Mexico,  Territory  v.  Padilla,  8  N.  M.,  47  N.  E.  R.,  510;  Com.  v.  Brayman, 

510;  46  Pac.  R.,  346.  136  Mass.,  148. 

2  Johnson  v.  Cochrane,  159  N.  Y.,  7  Hite  v.  Commonwealth,  14  Ky. 
555;  54  N.   E.  R.,   1092;    Paine  v.  Law  R.,  308;  20  S.  W.  Rep.,  217; 
Aldrich,  133  N.  Y.,  544;  30  N.  E.  R.,  Denning  v.  Butcher  (Iowa),  59  N.  W. 
725;  but  see  Carpenter  v.  Bailey,  94  Rep.,  69;    O'Connor  v.  Madison,  98 
Cal.,  406.  Mich.,    183;    57    N.    W.    Rep.,    105; 

3  White  v.   Davis,  62    Hun,    622;  Crawford  v.  Christian,  102  Wis.,  51; 
17  N.  Y.  Supp.,  548.  78  N.  W.   Rep.,  406;    Hempton  v. 

4  People  v.  Youngs,  151  N.  Y.,  210;  State,  111  Wis.,  127;  86  N.  W.  Rep., 
45  N.  E.  Rep.,  460;    Wyse  v.  Wyse,  596. 

155  N.  Y.,  367;  49  N.  E.  Rep.,  942.  8  Grand  Lodge  v.  Wieting,  168  111., 

5 Com.  v.  Rogers,  7  Mete.,  500;  4      408;  48  N.  E.  Rep.,  59. 


LIMITS  OF  OPINION  EVIDENCE  OF  NON-EXPERT  WITNESSES.    547 

showing  what  the  person  knew.1  In  Washington  it  was  held  not 
to  be  an  abuse  of  the  court's  discretion  to  refuse  to  allow  a  non- 
expert witness  to  express  an  opinion  after  he  had  stated  all  of 
the  facts  known  to  him.2  And  in  Iowa,  to  exclude  an  opinion 
on  the  facts,  where  the  facts  would  not  tend  to  support  an  opin- 
ion of  mental  unsoundness,3  on  the  theory,  doubtless,  that  the 
speculations  of  non -expert  witnesses  will  not  be  permitted, 
where  the  evidence  gives  no  ground  for  such  speculation.  It 
will  thus  be  seen  that  the  court  has  considerable  latitude  of  dis- 
cretion as  to  what  it  will  submit  to  the  jury.  The  weight  of  the 
evidence  is,  of  course,  for  the  jury  to  decide.4 

The  Limits  of  Opinion  Evidence  of  Non-Expert 
Witnesses. — "While  a  witness  may  state  his  opinion  as  to  men- 
tal uusoundness  or  manifestations,  he  may  not  state  whether  in 
his  opinion  the  degree  of  incapacity  has  been  reached  which  ren- 
ders one  incapable  of  managing  his  estate,  that  being  the  prov- 
ince of  the  jury.5  Nor  that  the  accused  knew  the  difference 
between  the  right  and  wrong  of  his  act.8  Nor  can  he  give  his 
opinion  as  to  the  existence  of  a  specific  mental  disease  such  as 
paresis.7  But  he  may  express  the  opinion  that  accused  was  sane 8 
and  capable  of  making  a  deed.9  The  witness's  mere  opinion  as 
to  what  a  person  knew  or  must  have  known  with  respect  to  a 
deed,  after  the  witness  has  testified  to  all  the  facts  within  his 
own  knowledge  tending  to  show  what  the  person  actually  knew 
of  the  deed,  is  inadmissible.10 

While  a  witness  has  been  permitted  to  express  his  opinion 
as  to  the  mental  capacity  of  a  grantor  to  execute  a  particular 

1  Gress  Lumber  Co.  v.  Coody  (Ga.),  7  In  re  McCabe,  70  Vt.,  155;  40  Atl. 

27  S.  E.  Rep.,  169.  Rep.,  52. 

2Clum  v.  Barkley,  20  Wash.,  103;  •  State  v.  Soper,  148  Mo.,  217;  49 

54  Pac.  Rep.,  962.  Contra:  Error  S.  \V.  Rep.,  1007.  Contra,  Jones  v. 

to  refuse  to  allow  expression  of  opin-  Collins,  94  Md.,  403;  51  Atl.  R.,  398, 

ion  on  facts  testified  to  by  witness,  where  it  was  said  that  a  witness  in  a 

State  v.  Wright  (Iowa),  84  N.  W.  will  contest  cannot  express  opinion  as 

Rep.,  541.  to  whether  testator  was  entirely  sane, 

3  Furlong  v.  Carraher,  108  Iowa,  but  his  opinion  must  be  confined  to 

492;  79  N.W.  Rep.,  277.  Cf.  supra,  the  question  whether  he  had  a  dis- 

note  3,  p.  543.  posing  mind. 

'Genzv.  State  (N.  J.),  34  Atl.  Rep.,  'Hayes  v.  Candee  (Conn.),  52 

816;  Clarke  v.  Irwm  (Iowa),  88  N.  Atl.  R.,  826;  such  a  question  refers 

W.  R.,  783.  to  mental  condition,  not  to  legal  ca- 

5  Hannick  v.  State,  134  Ind.,  324,  pacity,  and  is  therefore  the  proper 
34  N.  E.  Rep.,  3.  subject  of  opinion  evidence. 

6  Shults  v.  State,  37  Neb.,  481;  55  10  Gress  Lumber  Co.  v.  Coody  (Ga.), 
N.W.  Rep.,  1080.     But  see  Pflueger  v.  27  S.  E.  Rep.,  169. 

State,  46  Neb.,  493;  64  N.W.  R.,  493. 


548  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

contract  in  issue, 1  it  has  been  held  improper  to  permit  him  to 
express  an  opinion  as  to  capacity  to  appreciate  and  understand 
contracts.2  But,  on  the  other  hand,  it  has  been  deemed  proper 
to  allow  an  opinion  as  to  competency  to  transact  legal  busi- 
ness3 or  business.4  A  witness  may  not  state  his  opinion  that 
the  deceased  had  capacity5  or  was  in  a  condition6  to  make  a 
will. 

It  is  competent  for  a  witness  who  has  laid  the  foundation 
for  his  opinion  to  express  the  opinion  that  a  testator  was  "child- 
ish"7 or  acted  in  a  childish  manner  (a  contrary  view  has  been 
expressed  in  Maryland)  ; 8  that  his  expression  was  "  simple  "  ;9  and 
that  he  acted  like  a  rational  man ; 10  and  that  he  seemed  "weak " 
and  "weak-minded";11  or  of  average  intelligence ; 12  or  did  not 
seem  to  know  what  he  did.13  But  a  question  calling  for  an  opin- 
ion whether  testator  was  of  sound  mind,  as  he  had  been  "in  prior 
years, "  without  fixing  the  time,  was  inadmissible.14  A  witness 
was  permitted  to  express  an  opinion  whether  a  person  had 
failed  in  her  mental  capacity  in  the  last  five  years,15  but  not  to 
make  the  comparison  that  a  grantor  was  no  more  competent 
to  make  contracts  than  a  child  of  immature  age  and  under- 
standing.16 

It  is  proper  to  ask,  after  a  witness  has  stated  in  detail  his 
observations,  whether  there  was  anything  else  "strange  or  un- 
usual "in  the  conduct  of  the  alleged  incompetent.17  Such  wit- 
nesses have  been  permitted  to  express  an  opinion  whether  an 

1  Whitaker  v.  Hamilton,  126  N.  C.,  49  Atl.  R.,  401,  the  phrase  being  re- 
465,  35  S.  E.  Rep.,  815.  garded  as  ambiguous  and  indefinite. 

2  Mills  v.  Cook  (Tex.  Civ.  App.),56          10  In  re  Wax's  Est.,  106  Cal.,  343; 
S.  W.  Rep.,  697.  39  Pac.  Rep.,  624. 

3  Hepler  v.   Hosack,   197  Pa.  St.,          "  In  re  Goldthorp's  Est.,  94  Iowa, 
631;  47  Atl.  R.,  847.  336;  62  N.  W.  Rep.,  845. 

4  Hayes  v.  Candee  (Conn.),  52  Atl.  "  Hewitt  v.  Taunton  St.  Ry.  Co., 
R.,  826.  167  Mass.,  483;  46  N.  E.  Rep.,  106. 

s  Brown  v.  Mitchell  (Tex.),  31  S.  13  Green  v.  State,  64  Ark.,  523;  43 

W.  Rep.,  621.     Cf.  Jones  v.  Collins,  S.    W.    Rep.,   973.     Cf.    Messner   v. 

supra,  p.    545.     But  see,   contra,   in  Elliott,  184  Pa.  St.,  41;  39  Atl.  Rep., 

case    of    a    physician,    McHugh    v.  46,     where     such     comparison    was 

FitzGerald  (Mich.),  61  N.  W.  Rep.,  deemed  immaterial. 

354.  u  Denning  v.  Butcher,91  Iowa,425; 

6  Hopkins  v.  Wheeler,  21  R.  I.,  533;  59  N.  W.  Rep.,  69.     Cf.  Cicero,  etc., 

45  Atl.  Rep.,  551.  v.  Richter,  85  111.  App.,  591. 

'Burney  v.  Torrey,  100  Ala.,  157;  15  Clark  v.  Clark,   168  Mass.,  523; 

14  So.  Rep.,  685.  47  N.  E.  Rep.,  510. 

8  Cicero,    etc.,  v.    Richter,    85  111.  10  Mills  v.  Cook  (Tex.  Civ.  App.), 

App.,  591.  57  S.  W.  Rep.,  81. 

"Safe  Dep.  and  T.  Co.  v.  Berry,  "  Petefish  v.  Becker,  176  111.,  448; 

52  N.  E.  Rep.,  71. 


PRESUMPTIONS.  549 

infant  was  possessed  of  sufficient  discretion  to  be  guilty  of  con- 
tributory negligence.1 

Opinions  on  the  issue  of  mental  competency  are  not  per- 
mitted to  extend  beyond  the  issue ;  therefore,  a  witness  may  not 
express  an  opinion  as  to  the  cause  of  ill-feeling  between  testator 
and  another;2  such  a  matter  is  not  the  subject  of  opinion  evi- 
dence. 

But  opinions  as  to  the  tone  and  manner  of  a  person  are  ad- 
missible,3 or  rather,  one  who  observes  the  tone  and  manner,  in 
testifying  as  to  the  fact,  may  characterize  the  tone  and  manner ; 
a  witness  may  say  that  another  "seemed  to  be  angry." 4 

A  witness  may  express  his  opinion  whether  testator  possessed 
sufficient  understanding  to  transact  ordinary  business  incident  to 
the  management  of  his  household  affairs  and  property  ;5  though 
that  ability  is  not  the  measure  of  testamentary  capacity  ;8  or  that 
a  person  was  simple-minded  and  had  no  memory  of  time  or 
place.7 

PRESCRIPTIONS. 

A  KESUME  OF  THE  PRESUMPTIONS  BESPECTING  INSANITY. 

The  Presumption  of  Sanity. — The  effect,  and,  to  some 
extent,  the  nature  of  the  presumption  of  sanity,  are  treated  be- 
low in  connection  with  the  burden  of  proof  in  cases  involving 
the  issue  of  mental  competency. 8  At  this  place  oul y  some  special 
aspects  of  the  presumption  require  consideration. 

The  presumption  of  sanity  may  be  defined  in  its  application 
to  criminal  prosecutions  as  that  generalization  of  experience 
which  requires  a  court  and  jury  to  assume  at  the  outset,  in  the 
absence  of  proof  of  the  actual  condition  of  the  accused's  mind,9 
that  he  had  the  mental  capacity  to  form  a  criminal  purpose, 
and  to  deliberate  and  premeditate  on  an  act  which  malice,  anger, 

1  St.  Louis,  etc.,  Ry.  Co.  v.  Shifflet,          *  Appeal  of  Turner,  72  Conn.,  305; 
56     S.    W.     Rep.,   697    (Tex.     Civ.      44  Atl.  R.,  310. 

App.).  "See  as  to  measure  of  testamen- 

2  Miller  v.  Miller,  187  Pa.  St.,  572,      tary  capacity,  sujrra,  p.  385. 

41  Atl.  Rep.,  277;   43  W.  N.  C.,  84.  7  Johnson  v.  State  (Tex.  Cr.  App.), 

3  Logan  v.  State  (Tex.  Cr.  App.),      62  S.  W.  Rep.,  756. 

53  S.  W.,  694.  "  Infra,  p.  556.    See  also  supra,  p. 

4Catlett  v.  State  (Tex.  Cr.  App.),      385. 

61  S.  W.  Rep.,  485.  •  Davis  r.  United  States.  160  U.  S., 

469;    16  Supr.  Ct.  Rep.,  353. 


550  MENTAL.  UNSOUNDNESS — BECKER  AND   BOSTON. 

hatred,  revenge,  or  evil  disposition  might  impel;1  or  had  the 
mental  capacity  to  understand  the  nature  and  quality  of  his  act 
and  to  know  that  it  was  wrong.2  And,  whatever  may  be  the 
local  rule  of  criminal  responsibility,  the  presumption  in  any  event 
requires  the  court  and  jury  to  assume  prima  facie  that  the  ac- 
cused enjoyed  freedom  of  will,  in  the  sense  of  the  power  to  make 
a  conscious  choice  between  right  and  wrong.3  To  these  may  be 
added  a  further  assumption,  that  the  accused  made  his  choice  of 
action  upon  premises  of  fact  gained  by  the  exercise  of  normal 
faculties  of  perception,  not  upon  premises  of  insane  delusion.4 
In  civil  cases  substantially  the  same  definitions  apply.5 

To  a  degree,  the  presumption  of  sanity  is,  we  think,  of  only 
prima  facie  force,  and  vanishes  as  an  element  in  the  case  when 
its  place  is  taken  by  direct  evidence ;  but  still  it  remains,  as  some 
courts  hold,  a  rnle  to  judge  the  proved  facts  by,  and  the  court 
and  jury  will  until  the  end  of  the  trial  bear  in  mind  that  when 
two  conclusions  may  equally  well  be  drawn  from  an  item  of 
proof,  one  of  sanity  and  the  other  of  insanity,  the  presumption 
requires  the  inference  of  sanity  to  be  chosen.8 

Presumption  of  Consciousness. — There  is  a  presumption  of  con- 
sciousness allied  to  that  of  sanity,7  and  this  presumption  extends 
to  a  consciousness  of  the  character  of  an  act,  for  instance,  an  act 
of  self-destruction.8 

Presumption  Against  Presumption.  — The  presumption  of  sanity 
yields  to  the  stronger  presumption  of  continuance  of  insanity  of 
a  permanent  character.9  But  when  the  proof  is  that  the  insanity 
was  of  an  intermittent  character,  with  lucid  intervals,  the  pre- 
sumption of  insanity  does  not  yield  to  any  presumption  of  the 
continuance  of  an  unsound  mental  state.10 

The  Presumption  of  Testamentary  Capacity.11 — In 
probate  proceedings  it  is  generally  provided  by  statute  how  the 

1  State  v.  Miller,  7  OhioN.  P.,  458;  7  State  v.  Hill  (N.  J.),  47  Atl.  R., 
5  Ohio  S.  &  C.  P.  Dec.,  703.  814  (a  confession). 

2  Supra,  p.  431.  8  Dickerson  v.  Northwestern  Mut. 

3  Supra,  p.  448.  L.  Ins.  Co.,  200  111.,  270;  65  N.  E.  R., 

4  Supra,  p.  462.  694. 

5  See  Snodgrass  v.  Knight,  43  W.  9  In  re  Lapham's  Will,  .19  Misc.  R. 
Va.,  294;  27  S.  E.  R.,  233;  Delaplain  (N.  Y.  Surrogate),  71;  44  Supp.,  597; 
v.  CJrubb,  44  W.  Va.,  612;  30  S.  E.  R.,  for  the  latter  presumption,  see  infra, 
201.  p.  551. 

"Cy.    infra,    p.    558;     Appeal    of          10  Pike  v.  Pike,  104  Ala.,  642;    16 
Sturdevant,   71   Conn.,  392;   42  Atl.       So.  R.,  689. 

R.,  70.  u  See  alsoin/ra,  p.  565,  for  burden 

of  proof  in  will  controversies. 


PRESUMPTION  OP   CONTINUANCE  OF  INSANITY.  551 

will  shall  be  proved,  and  usually  the  subscribing  witnesses  are 
required  to  testify  as  to  the  mental  capacity  of  the  testator ;  *  in 
such  cases,  in  the  absence  of  any  proof  of  sound  mind,  it  is  im- 
proper to  admit  the  will  to  probate ;  it  has  therefore  been  said 
that  the  presumption  of  sanity  does  not  extend  to  probate  pro- 
ceedings.2 But  this  is  not  the  law  in  all  States.  In  Delaware 
a  person  over  twenty-one  is  presumed  to  have  testamentary 
capacity.3  And  in  Pennsylvania  it  has  been  said  that  testa- 
mentary capacity  is  always  presumed  unless  the  contrary  is 
shown.4  In  Iowa  and  Indiana  also  the  presumption  of  sanity 
exists  in  probate  proceedings.5  In  Pennsylvania,  where  the 
making  and  execution  are  not  denied,  testamentary  capacity  is 
presumed." 

The  presumption  of  testamentary  capacity  arises  upon  proof 
that  testator  was  capable  of  understanding  and  transacting  the 
ordinary  business  of  life.7 

The  Presumption  of  Continuance  of  Insanity. — The 
presumption  of  continuance  when  it  applies  to  insanity  over- 
comes the  presumption  of  sanity.8 

After  an  adjudication  of  insanity  the  presumption  of  continu- 
ance is  said  to  be  conclusive,  until  there  is  a  direct  adjudication 
of  restoration ; 9  but  this  general  rule  has  been  subjected  to 
exceptions.10 

No  legal  presumption  of  absolute  recovery  from  a  state  of 
acknowledged  insanity  arises  from  the  lapse  of  time  alone.11 

And  generally  there  is  a  presumption  of  the  indefiuitecon&ntt- 
ance  of  insanity  or  mental  unsoundness,12  of  a  character  deemed 

1  But  not  always;  for  instance,  in  9  Wallace  v.  Frey,  27  Misc.  R.,  29; 

Maine  such  testimony  is  not  required.  56  N.  Y.  Supp.,  1051. 

In  re  Wells,  96  Me.,  161;   51  Atl.  R.,  See  supra,  p.  525,    "Adjudications 

868.  as  evidence." 

*  In  re  Baldwin's  Est.,  13  Wash.,  10  See  supra,  pp.  525-527. 

666;  43  Pac.,  934.  Hoyt,  C.  J.,  dis-  "  Shelford  on  Lunatics,  275;  1 

senting.  See  infra,  p.  565.  In  re  Greenleaf  on  Evidence,  sec.  42; 

Thomson,  92  Me.,  563;  43  Atl.  Rep.,  People  ex  rel.  Norton  v.  N.  Y.  Hos- 

511.  pital,  3  Abb.  N.  C.,  229. 

'Steele  v.  Helm,  2  Marv.  (Del.),  12  Lantes  v.  Davidson,  60  Kan.,  389; 

237;  43  Atl.  R.,  153.  56  Pac.  R.,  745.  See  note  to  Ford 

4  In  re  Hoyt's  Est.,  10  Kulp.,  166.  v.  State  (Miss.),  35  L.    R.   A.,    117. 

5 See  infra,  p.  566.  Herndon  v.  Vick,  18  Tex.  Civ.  App., 

•Messnerv.  Elliott,  184  Pa.  St.,  41;  583;  45  S.  W.  Rep.,  852,  infra, 

39  Atl.  Rep.,  46.  p.  563;  State  v.  Robbins  (Iowa),  80 

7  Harp  v.  Parr,  168  111.,  459;  48  N.  W.  Rep.,  1061  (see  this  case  for 

N.  E.  Rep.,  113.  facts  entitling  to  instruction  on  this 

*  Supra,  p.  550.  point). 


552  MENTAL   UNSOUNDNESS — BECKER  AND  BOSTON. 

continuous1  or  liable  to  be  permanent.1  But  that  presumption 
does  not  apply  to  mental  unsoimdness  of  a  temporary 3  or  spas- 
modic4  character ;  nor  to  drunkenness,5  though  it  be  habitual 
drunkenness.6  It  does  not  apply  to  delirium  tremens.7  It  does 
not  apply  to  incapacity  produced  by  the  violence  of  disease  and 
the  inordinate  use  of  drugs,  though  coupled  with  infirmity  of 
age,  where  the  actual  producing  cause  is  temporary.8  But  it 
does  apply  to  incapacity  due  to  old  age.  * 

Where  the  insanity  is  of  a  temporary  character,  it  has  been 
held  that  because  there  is  no  presumption  of  its  continuance 
there  is  no  presumption  of  incompetence  at  the  time  of  the  exe- 
cution of  a  codicil  by  a  person  incompetent  by  reason  of  tem- 
porary insanity  at  the  time  of  making  his  will,  though  the  codi- 
cil was  made  only  three  days  later.9  But  in  New  York,  where 
the  grantor  in  a  deed  was  shown  to  be  mentally  incompetent  on 
the  day  of  the  execution  of  a  deed,  it  was  said  to  be  a  question 
of  fact  whether  he  was  in  the  same  mental  condition  at  the  time 
of  its  delivery  several  days  afterward. 10 

The  presumption  of  continuance  does  not  render  an  adjudica- 
tion of  insanity  admissible  to  prove  insanity  prior  to  the  adjudi- 
cation.11 

Presumption  of  Insanity. — In  North  Carolina  it  was  said  that 
no  presumption  of  incompeteucy  to  execute  a  deed  arose  from  a 
combination  of  age  and  long  continued  physical  disease,  increas- 

1  Infra,  p.  563.  475;    37    Tex.  Cr.    App.,  494,  even 

*  Hcmpton  v.  State,  111  Wis.,  127;  though  it  was  only  four  or  five  hours 

86  N.  W.  Rep.,  596.  previous.     State  v.  Alcom,    137  Mo., 

3  Infra,  p.  564,  Murphree  v.  Senn  121;  38  S.  W.  Rep.,  548.    See  supra, 
(Ala.),  18  So.  Rep.,  264;    Kellogg  v.  p.  524,  Evidence  of  Intoxication. 

U.  S.,  43  C.  C.  A.,  179;    103  Fed.  R.,  8  Koegel  v.  Egner,  54  N.  J.  En.,  623; 

200.  35  All.  Rep.,  394;    but  the  habit,  as 

4  People  r.  Findley,  132  Cal.,  301;  distinguished  from  the  intoxication, 
64  Pac.    R.,  472;  Ford  v.   State,  71  may  be  presumed  to  continue,  Mc- 
Ala.,  385;  People  v.  Francis,  38  Cal.,  graw  v.  McGraw,  50  N.  E.   R.,  526. 
183;    Armstrong    v.    State,  30    Fla.,  '  Kellogg  v.  U.  S..  103  Fed.  Rep., 
170;  17  L.  R,  A.,  484;  11  So.  R.,  618;  290;    43  C.  C.  A.,  179.     Von  de  Veld 
Langdon  v.  People,  133  111.,  382;  24  v.  Judy,  143  Mo.,  348;  44  S.  W.  R., 
N.  E.    R.,  874;  State   t>.   Reddiok,  7  1117. 

Kan.,  143;   Ford  v.  State,  73  Miss.,  "Raymond  v.   Wathen,    142  Ind., 

734;    35  L.   R.   A.,   117;    19  So.  R.,  367;   41  N.  E.  Rep.,  815. 

660;  State  v.  Sewell,  48  N.  C.,  245;  •  In  re  Nelson's  Est.,  132  Cal.,  182; 

Leache  r.  State,  22  Tex.   App.,  279;  64  Pac.  R.,  294. 

58  Am.   Rep.,  638;  3  S.  W.  R.,  539;  10  Jones  v.  Jones  (N.  Y.),  63  Hun, 

State  ?'.  Wilner,  40  Wis.,  304;  Contra,  630;    17  N.  Y.  Supp.,  905. 

see  Overall  v.  State,  15  Lea,  672.  "  Small  v.Champeny,  102  Wis.,  61; 

'Howard  v.  State,  36  S.  W.  Rep.,  78  N.W.  Rep.,  407.     See   supra,  p. 

527. 


PRESUMPTIONS   AS   TO    UNDUE    INFLUENCE.  553 

ing  in  virulence  and  resulting  in  death  within  three  mouths  after 
its  execution,  notwithstanding  the  deed  was  a  bounty.1 

Presumption  of  Continuance  of  Sanity.— The  pre- 
sumption of  continuance  applies  as  well  to  sanity  as  to  insanity ; 
therefore  a  court  was  held  justified  in  charging  as  matter  of  law 
that,  if  accused  was  sane  up  to  within  a  short  time  of  the  homi- 
cide, was  sane  afterward,  and  remained  sane  thereafter  till  the 
trial,  they  should  find  he  was  sane  at  the  time  of  the  homicide.2 
But  such  an  instruction  would  seem  a  little  too  strong  to  be  given 
in  every  case  where  temporary  insanity  may  be  asserted.3 

Undue  Influence.  — As  a  general  rule,  it  is  doubtless  true  that 
there  is  no  presumption  of  a  continuance  of  undue  influence 
shown  to  have  once  existed.* 

PRESUMPTIONS  AS  TO  UNDUE  INFLUENCE. 

When,  in  litigations  respecting  gifts  between  the  living  or  con- 
tracts based  upon  grossly  inadequate  consideration,  a  confidential 
relation  is  established,  involving  more  or  less  dependence  by  one 
upon  the  other,  a  presumption  of  fraud  and  undue  influence 
straightway  arises  against  the  one  benefiting  thereby,  which 
he  is  absolutely  bound  to  overcome.5  This  is  an  essentially 
arbitrary  presumption,  enforced  by  the  courts  partly  be- 
cause of  the  difficulty  of  proving  fraud  and  undue  in- 
fluence, and  partly  because  of  the  inherent  suspiciousness  of 
gifts,  or  virtual  gifts  under  the  guise  of  contracts  between  the 
living. 

"A  court  of  equity  interposes  its  benign  jurisdiction  to  set 
aside  instruments  executed  between  persons  standing  in  the  re- 
lations of  parent  and  child,  guardian  and  ward,  physician  and 
patient,  solicitor  and  client,  and  in  various  other  relations  in 
which  one  party  is  so  situated  as  to  exercise  a  controlling  iuflu- 

1  Williams  v.  Haid,  118  N.  C.,  481;  making  will,  Johnson  v.  Johnson,  187 

24  S.  E.  Rep.,  217.      This    was,    it  III.,  86;  58  N.  E.  Rep.,  237. 

may   be   remarked,  an    instance   of  *  See  supra,  p.  461. 

a  common  misuse  of  the  word  "pre-  4See  in  re  Shell's  Est.  (Colo.)  63  Pac. 

sumption."     What  the  court  meant  R.,413. 

was  merely    that    the  evidence  did  8  Smith  i>.  Kay  (Eng.),  7  H.  L.  Gas., 

not    prove,    raised    no    inference    of,  771;  Towson  r.  Moore,  11  App.  Dist. 

insanity.  Col.,  377;  Green  r.  Roworth,  113 

'Taylor  v.  U.  S.,  7  App.  D.  C.,  27.  N.  Y.,  470;  Ten  Eyck  r.  Whitbeck, 

See  as  to  presumption  of  continu-  156  N.  Y.,  341,  353;  Doheny  v.  Lacy, 

ance  of  a  state  of  sanity  shown  to  168  N.  Y.,  213;    and  cases  cited  m 

have    existed    one    month    prior    to  these  cases. 


554  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

ence  over  the  will  and  conduct  and  interests  of  another.  In  some 
cases  undue  influence  will  be  inferred  from  the  nature  of  the 
transaction  alone ;  in  others  from  the  nature  of  the  transaction 
and  the  exercise  of  occasional  or  habitual  influence."1 

This  presumption  applies  with  especial  force  where  one  party 
is  weaker  mentally  than  the  other. 

Gifts  by  Will. — As  to  gifts  from  the  dead  by  will,  in- 
volved in  testamentary  litigation,  it  seems  to  be  settled  in  prac- 
tically all  the  States  that  this  presumption  does  not  exist  with 
full  force.  It  is  then  not  wholly  inoperative,  but  exercised  in- 
directly rather  than  directly.  It  has  been  held  that  a  confiden- 
tial relation  between  testator  and  beneficiary  imposes  upon  the 
latter  the  onus  of  offering  further  testimony,  additional  explana- 
tion.2 Such  relation  increases  the  weight  of  other  more  direct 
evidence  of  fraud  and  undue  influence ;  fraud  may  then  be  in- 
ferred and  regarded  as  established  with  less  proof  from  the  party 
alleging  it  than  he  otherwise  would  be  required  to  furnish.  In  a 
word,  confidential  relationship  is  a  circumstance  to  be  considered 
when  a  testator  has  made  gifts  otherwise  than  impartially  to  the 
natural  objects  of  his  bounty.3 

In  fact,  it  may  be  questioned  whether  in  testamentary  litiga- 
tions there  is  any  presumption  at  all,  in  the  true  legal  sense  of  a 
rule  of  law  by  which  an  unproved  fact  may  be  assumed.4  Confi- 
dential relations  are  merely  a  matter  of  circumstantial  evidence. 
Taken  with  other  affirmative  evidence  of  imposition,  they  may 
require  a  conclusion  against  the  will. 

"  Fraud  is  never  to  be  presumed  from  the  mere  concurrence 
of  temptation  and  opportunity,  or  from  the  mere  fact  that  the 
chief  actor  is  also  the  principal  beneficiary.  It  must  be  estab- 
lished by  affirmative  evidence.  It  is  thus  established,  however, 
when  facts  are  proved  from  which  it  results  as  an  unavoidable 
inference.  When  such  evidence  is  furnished,  the  burden  of  re- 
pelling the  presumption  to  which  it  leads  is  cast  upon  the  party 
to  whom  the  fraud  is  imputed. ' ' 5 

In  general,  unless  there  is  evidence  tending  to  show  or  raise 

1  Sears  v.  Shafer,  6  N.  Y.,  268,  272;  Matter  of  Smith,  95  N.  Y.,  516;   Post 
Story's  Eq.  Jur.,  §§  308-324.  v.   Mason,   91   N.    Y,,   539;    Coit  v. 

2  Tyler  v.  Gardiner,  35  N.  Y.,  559,  Patchen,  77  N.  Y.,  539;    cases  cited 
574.  below. 

3  Tyler  v.  Gardiner,  35  N.  Y.,  559.  8  Tyler  v.  Gardiner,  35  N.  Y.,  554, 

4  Matter  of  Peck,  6  Dem.  (N.  Y.),  594. 
299;    Will  of  Martin,  98  N.  Y.,  196; 


PBB8UMPTIONS  AS   TO   UNDUE   INFLUENCE. 


555 


an  inference  or  presumption  of  undue  influence,  the  absence  of 
such  influence  must  be  presumed.1 

Among  the  elements,  "the  familiar  indicia  of  undue  influ- 
ence, "  which  when  proved  concurrently  may  cast  the  burden  on 
the  beneficiary  of  proving  the  absence  of  improper  influence, 
may  be  mentioned :  superiority  of  mental  power  and  capacity  of 
the  beneficiary ;  confidential  relations,  with  opportunity  or  power 
to  influence;  and  an  unnatural  or  unjust  division  of  property.2 
One  or  two  of  these  circumstances  will  not  alone  be  sufficient  to 
raise  any  presumption  of  undue  influence  that  will  cast  the  bur- 
den on  the  beneficiary  to  show  the  fairness  of  the  will.3 


1  Messner  v.  Elliott,  184  Pa.  St.,  41; 
39  Atl.  R.,  46. 

2  Whitelaw's  Exr.  v.  Sims,  90  Va., 
588;    19  S.  E.  R.,  113;    Robinson  v. 
Robinson,  203  Pa.  St.,  400;    53  Atl. 
R.,  253;  Coghill  v.  Kennedy,  119  Ala., 
641;    24  So.   R.,  459;.  McQueen  v. 
Wilson,  31  So.  R.  (Ala.),  94;   Patten 
v.  Cilley,  67  N.  H.,  520;   42  Atl.  R., 
47;    In  re  Brush's  Will,  35  Misc.  R., 
689;    72  N.   Y.   Supp.,   421;    In  re 
Wheeler's  Will,  5  Misc.   R.   (N.   Y. 
Surr.),  279;   25  Supp.,  313;   Scatter- 
good  v.  Kirk,  192  Pa.  St.,  263;    43 
Atl.  R.,  1030;  44  W.  N.  C.,  313. 

3  The  following  have  been  held  in- 
sufficient, in  recent  cases: 

Weakness  of  a  testator  in  mind  and 
body  coupled  with  mere  opportunity 
to  influence;  In  re  Bedlow's  Will, 
67  Hun  (N.  Y.),  408;  22  N.  Y.  Supp., 
290;  In  re  Pitt's  Est.  (Wis.),  55  N. 
W.  Rep.,  149;  Maddox  v.  Maddox, 
114  Mo.,  35;  21  S.  W.  Rep.,  499; 
Interest  and  opportunity, — In  re 
Clark's  Will,  5  Misc.  Rep.  (N.  Y.),  68; 
25  N.  Y.  Supp.,  712;  in  re  Nelson's 
Est.,  132  Cat,  182;  64  Pac.  R.,  294; 
Inequality  and  opportunity, — McFa- 
din  v.  Catron,  138  Mo.,  197;  38  S. 
W.  Rep.,  932. 

Relationship  of  husband  and  wife, — 
Bulger  v.  Ross,  98  Ala.,  26;  12  So.  R., 
803;  in  re  Green's  Will,  20  N.  Y. 
Supp.,  538;  id.,  67  Hun,  527;  22 
Supp.,  1112;  Orth  v.  Orth  (Ind.), 
44  N.  E.  R.,  17. 

Though  coupled  with  a  sudden 
reconciliation, — in  re  Cruger's  Will, 
31  Misc.  (N.  Y.),  272;  23  Supp.,  412. 

Filial  relation, — in  re  Logan's  Est., 
195  Pa.  St.,  282;  45  Atl.  R.,  729;  in 


re  Bonner,  33  Misc.  (N.  Y.),  9;  67 
Supp.,  1117;  in  re  Hurlburt's  Will, 
48  App.  Div.,  91;  62  N.  Y.  Supp., 
698;  or  exclusion  of  son, — in  re 
Loennecker's  Will,  112  Wis.,  461;  88 
N.  W.  R.,  215;  Heath  v.  Koch,  74  App. 
Div.  (N.  Y.),  338;  77  Supp.,  513. 

Beneficiary  attorney  or  draughts- 
man of  will  or  relative  of  draughtsman, 
—in  re  Yorke's  Est.,  6  Pa.  Dist.  R., 
321;  in  re  Adams's  Est.,  201  Pa.  St., 
502;  51  Atl.  R.,  368;  Clarke  v. 
Schell,  84  Hun,  28;  31  Supp.,  1053; 
in  re  Suydam's  Will,  84  Hun,  514; 
23  Supp.,  449;  Contrary  intimation 
in  Donovan  v.  Bromley,  71  N.  W.  R., 
523  (Mich.);  in  re  Logan's  Est.,  195 
Pa.  St.,  282;  45  Atl.  R.,  729. 

Beneficiary  nurse,  housekeeper,  and 
friend, — Richardson  v.  Ely  (Mass.), 
63  N.  E.  R.,3. 

Beneficiary  testator's  physician, — 
in  re  Cornell's  Will,  163  N.  Y  608; 
57  N.  E.  R.,  1107;  in  re  Adams's 
Est.,  201  Pa.  St.,  502;  51  Atl.  R.,  368. 

Beneficiary  testator's  partner, — 
Goodbar  v.  Lidikay,  136  Ind.,  1;  35 
N.  E.  R.,  691;  Koegel  v.  Egner,  54 
N.  J.  Eq.,  623;  35  Atl.  R.,  394. 

Beneficiary  a  stranger,  and  rela- 
tives excluded, — Chandler  v.  .lost,  96 
Ala.,  596;  11  So.  Rep.,  636;  Sullivan 
v.  Foley,  112  Mich.,  1 ;  70  N.  W.  Rep., 
322;  Miles  v.  Treanor,  194  Pa.  St., 
430;  45  Atl.  R.,  368;  Henry  v.  Hall, 
106  Ala.,  84;  17  So.  Rep.,  187;  Clarke 
v.  Schell,  84  Hun  (N.  Y.),  28;  31  N. 
Y.  Supp.,  1053. 

Illicit  relations  between  testator 
and  beneficiary, — in  re  Gordon's  Est., 
28  Pittsb.  L.  J.  (N.  S.),  78;  in  re 
Rand's  Will,  28  Misc.  (N.  Y.),  465; 


556          MENTAL  UNSOUNDNESS — BECKER   AND   BOSTON. 

Iii  fact  it  may  be  stated  as  a  general  rule  that  the  courts  do 
not  set  aside  wills  on  the  ground  of  undue  influence  upon  slen- 
der proof ;  do  not  indulge  in  merely  speculative  presumptions. 

Where  the  facts  themselves  were  such  as  to  raise  a  presumption 
of  undue  influence,  that  presumption  will  in  time  be  overcome  by 
the  event  that,  with  an  opportunity  to  revoke,  the  testator  by  his 
declarations  showed  that  his  will  conformed  to  his  wishes.1  But 
the  presumption  was  said  not  to  be  overcome  by  lapse  of  time, 
where  the  will  meanwhile  remained  in  the  custody  of  beneficiary's 
husband,  and  it  did  not  appear  that  testator's  attention  was 
called  to  it,  or  that  he  remembered  it.2  Where,  however,  the 
alleged  undue  influence  was  that  of  a  wife,  since  deceased,  failure 
to  revoke  or  change  after  her  death  was  accorded  weight  in  de- 
termining that  there  was  no  undue  influence.3 


BURDEN  OF  PROOF  OF  INSANITY ;     WHERE  IT    LIES  AND 
HOW  IT  IS  MET. 

Every  act  is  presumed  to  have  been  sanely  done  until  the 
contrary  appears  by  evidence.4  And  the  contrary  is  not  made 
to  appear  by  merely  showing  the  possibility  of  an  unsound  mental 
condition.5 

Even  in  criminal  cases,  according  to  the  rule  in  many  States, 

59  Supp.,  1082;    in  re  Westerman's  making  greater  provision  for  the  same 

Will,  29  Misc.  (N.  Y.),  409;  61  Supp.,  attorney;    held  that  undue  influence 

106.5;    in    re  Welford's  Will   (N.    J.  was  not  shown  by  the  facts. 

Pre.),  51  Atl.  R.,  501;  though  in  con-  Undue  influence  is  not  established 

nection  with  other  circumstances  such  by  showing  that  one  of  the  executors, 

relations  may  be  a  strong  indication  who  was  also    residuary  legatee    in 

of  undue  influence, — Waters  v.  Reed,  case  certain  doubtful  trusts  should 

SDetr.  Leg.N.  (Mich.),  899;  88  N.  W.  fail,  drew   the    will,    was   testatrix's 

R.,  394.  personal    friend,  advised    her   about 

Beneficiary  priest  of  testator, — in  her  business  and  investments,  where 

re  Sparks's  Will,  51  Atl.  R.,  118  (N.  it  also  was  shown  that  she  was  a  per- 

J.  Pre.).  son  of  strong  mind  and    frequently 

Beneficiary     a     distant     relative,  refused  to  follow  his  advice.     In   re 

though   heirs   excluded, — Hegney   v.  Edson's  Will,  24  N.  Y.  Supp.,   711, 

Head,  126  Mo.,  619;  29  S.  W.  R.,  587.  see  also  supra,  p.  419  et  seq. 

Beneficiary  a  religious  or  eleemo-  l  Inre  Reed's  Will,  20  N.  Y.  Supp.. 

synary  institution,  where  testator  per-  91;  2  Con.  Surr.,  403. 

suaded  by  one  interested  in  it, — ibid.;  2  Barbour  v.  Moore,  10  App.  D.  C., 

Barkley  v.  Barkley  Cemetery  Assn.,  30. 

153  Mo.,  300;    54  S.  W.  R.,  482.  3  Deck  v.  Deck,  106  Wis.,  470;    82 

In  re  Spellier's  Est.  (Pa.  Orph.  Ct.),  N.  W.  R.,  293. 

2  Pa.  Dist.  Rep.,  513,  the  will  was  Commonwealth  v.  Woodley,   166 

drawn  by  an  attorney,  personal  friend  Pa.  St.,  463;   31  Atl.  Rep.,  202. 

of  testator,  and  made  provision  for  5  State  v.  Novak  (Iowa),  79  N.  W. 

the  attorney,  but  revoked  a  prior  will  R.,  465. 


BURDEN   OP  PROOF  IN   CRIMINAL  CASES.  557 

the  burden  is  not  met  except  by  fairly  preponderating  evidence ! 
of  a  reliable  character,2  or  sufficient  to  establish  insanity  to  the 
reasonable  satisfaction  of  the  jury.3  It  is  not  enough  to  raise  a 
reasonable  doubt  as  to  the  sanity  of  the  accused.  In  other  States 
it  is  said  that  if,  after  the  defence  has  ottered  its  proof  of  insanity, 
and  the  prosecution  has  offered  its  proof  in  rebuttal,  a  reason- 
able doubt  remains  as  to  the  sanity  of  the  accused,  he  is  entitled 
to  an  acquittal.4 

BURDEN  OF  PEOOF  IN  CRIMINAL  CASES. 

In  criminal  cases  the  burden  of  proving  the  accused  insane, 
if  insanity  is  a  defence,  rests  upon  the  defence,  owing  to  the  pre- 
sumption of  fact,  drawn  from  human  experience,  that  any  man 
is  sane.  Theoretically,  the  burden  of  proving  that  the  offence 
charged  was  committed  by  a  person  responsible  for  his  acts  is 
upon  the  prosecution.  The  prosecution  may  rest,  however,  upon 
the  presumption  of  sanity  without  offering  proof,  and  in  case 
the  defence  of  insanity  is  interposed  the  burden  is  on  the  de- 
fendant to  establish  it.5 

In  some  States,  as  in  New  York,  it  is  said  that  the  affirmative 
remains  with  the  prosecution  until  the  end  of  the  trial,  and  that 
the  prosecution  must  satisfy  the  jury  of  the  guilt  of  the  prisoner, 
which  includes  his  capacity  to  commit  crime,  upon  the  whole 
evidence.6  In  Mississippi  it  has  been  said  that  the  burden  of 
proving  insanity  is  not  on  the  accused,  but  the  burden  of  proving 

1  State  v.  Novak  (Iowa),  79  N.  W.  v.  Hand,  1  Marv.  (Del.),  545;  41 

Rep.,  465;  Commonwealth  v.  Heidler,  Atl.  R.,  192;  Armstrong  v.  State, 

191  Pa.  St.,  375;  43  Atl.  R.,  211;  44  30  Fla.,  170;  11  So.  R.,  618;  Jami- 

W.  N.  C.,  310;  Commonwealth  v.  son  v.  People,  145  111.,  357;  34  N.  E. 

Wireback,  190  Pa.  St.,  138;  42  Atl.  R.,  486;  State  v.  Clements,  47  La. 

Rep.,  542;  43  W.  N.  C.,  506;  Common-  Ann.,  1088;  17  So.  R.,  502;  State  v. 

wealth  v.  Berchine,  168  Pa.  St.,  603;  Scott,  49  La.  Ann.,  253;  21  So.  R., 

32  Atl.  Rep.,  109;  contra  Knights  v.  271;  State  v.  Schaefer,  116  Mo.,  96; 

State,  78  N.  W.  Rep..  508;  58  Neb.,  22  S.  W.  R.,  449;  State  v.  Agnew,  10 

225.  But  see  further  discussion  of  N.  J.  Law  J.,  165;  State  v.  Graves, 

this  question  infra,  p.  558.  5  N.  J.  Law  J.,  54;  Faulkner  v.  Ty., 

'See  p.  559.  6  New  Mex.,  464;    30  Pac.  R.,  905; 

3  See     infra,     p.     560.     State     v.  Commonwealth  v.  Gerade,  23  Pittsb. 
Brooks  (Mont.),  57  Pac.  R.,  1038.  L.  J.,    117;    Commonwealth  v.   Kil- 

4  Infra,  p.  559.  patrick    (Pa.),  53  Atl.  R.,  774;    and 
4  People  v.  Ward,  105  Cal.,  335;  38      cases  cited  below. 

Pac.   R.,  945;    People  v.  McCarthy,  •  Brotherton  v.   People,  75  N.  Y., 

115  Cal.,    255;     46   Pac.    R.,    1073;  159;    O'Connell  v.  People,  87  N.  Y., 

People  v.  Hettick,  126  Cal.,  425;    58  377;  cf.  Ford  v.  State,  73  Miss.,  734; 

Pac.  R.,  918;   State  v.  Cole,  2  Penne.  19  So.  R.,  665;    Knights  r.  State,  58 

(Del.),  344;    45  Atl.  R.,  391;    State  Neb.,  225;    78  N.  W.  It.,  508. 


558  MENTAL  UNSOUNDNESS — BECKER  AND  BOSTON. 

sanity  is  on  the  prosecution ;  but  that  in  the  absence  of  any  evi- 
dence the  prosecution's  burden  is  met  by  the  presumption  of 
sanity.1  These  distinctions  seem  to  be  of  words  rather  than  of 
substance ;  the  fact  remains  that  the  defence  has  the  affirmative 
of  the  issue  of  insanity. 

In  Missouri  a  distinction  has  been  attempted  between  the 
burden  of  proof  in  cases  of  imbecility  and  in  cases  of  chronic  in- 
sanity, in  respect  to  the  proof  of  a  lucid  interval.  In  the  case 
of  imbecility  the  burden  of  proof  is  not  on  the  State  to  prove  a 
lucid  interval,  but  it  seems  it  would  be  in  a  case  of  chronic 
insanity.  This  theory  appears  to  belong  to  the  pseudo-scientific 
class.2 

Confusion  has  arisen,  however,  from  the  failure  to  distinguish 
the  burden  of  proof  from  the  method  of  meeting  it.  We  believe 
the  sound  theory  to  be  that  the  burden  of  proving  the  commis- 
sion of  the  offence,  including  mental  capacity  to  commit  it,  rests 
upon  the  prosecution  throughout.  The  presumption  of  sanity 
is  in  a  way  evidence,  but  only  prima  facie  evidence,  of  sanity; 
and  although  it  suffices  in  the  absence  of  any  proof  to  the  con- 
trary, yet  upon  substantial,  credible  evidence  of  irresponsibility 
being  offered,  the  presumption  should  vanish  and  not  be  again 
heard  of  on  the  trial.  If  the  prosecution  succeeds,  it  does  so  be- 
cause it  produces  direct  evidence  of  sanity.  Nevertheless,  many 
judicial  opinions  have  given  countenance  to  the  theory  that  the 
effect  of  the  presumption  of  sanity  is  to  shift  permanently  the 
burden  of  proof ;  and  this  theory  has  had  an  indirect,  but  con- 
siderable influence  upon  the  determination  of  a  more  vital  ques- 
tion :  How  strong  must  the  proof  of  irresponsibility  be  to  entitle 
the  prisoner  to  an  acquittal  ? 

Quantum  of  Evidence  of  Insanity.— The  decisions 
greatly  differ  as  to  the  weight  of  evidence  sufficient  to  estab- 
lish the  defence  of  insanity.  When  the  issue  of  insanity  has 
been  tried,  and  both  sides,  or  the  prisoner  alone,  has  offered 
evidence  on  the  issue,  what  rule  shall  be  applied  to  determine 
whether  the  defence  has  been  made  out? 

It  is  a  rule  of  the  common  law  of  England,  adopted  through- 
out the  United  States,  that  the  burden  is  on  the  prosecution  to 
establish  the  guilt  of  the  accused  beyond  a  reasonable  doubt. 

%  Ford  v.  State,  73  Miss.,  734;    19          2  State  v.  Palmer,   161  Mo.,   152- 
So.  R.,  665  61  S.  W.  R.,  651. 


QUANTUM   OF  EVIDENCE  OF  INSANITY. 


559 


In  some  States,  however,  it  has  been  held  that  the  rule  of  reason- 
able doubt  has  110  application  to  the  defence  of  insanity.1 

Eule  of  Reasonable  Doubt  as  to  Sanity.  — It  is  quite  generally 
held  that  if  from  all  the  proof  there  is  reasonable  doubt  as  to 
defendant's  sanity  he  is  entitled  to  the  benefit  of  the  doubt,  and 
consequently  to  an  acquittal.  But  there  are  conflicting  expres- 
sions even  by  the  same  court  in  the  same  State.2 

The  rule  is  sometimes  stated  with  qualifications.  In  Florida, 
if  evidence  is  given  tending  to  show  insanity,  this  must  be  con- 
sidered in  connection  with  the  presumption  of  sanity  by  the  jury ; 
the  State  holds  the  affirmative,  and  if  there  is  a  reasonable  doubt 
of  sanity  accused  should  be  acquitted.3  But,  nevertheless,  the 


1  California:    the  doctrine  of  rea- 
sonable doubt  has  no  application  to 
an  issue  of  sanity  of  the  accused; 
People  v.  Ward,   105  Cal.:  335;    38 
Pac.  R.,  945;    People  v.  Barthleman, 
120  Cal.,  7;  52  Pac.  R.,  112.     Texas: 
the  burden  is  not  on  the  State  to 
prove  defendant's  sanity  beyond  a 
reasonable  doubt;    Burt  v.  State,  38 
Tex.  Cr.,  397;    40  S.  W.  R.,   1000; 
Williams  v.  State,  37  Tex.  Cr.,  348; 
39  S.  W.  R.,  687;  Wheatly  v.  State, 
39  S.  W.  R.,  67;  cf.  Hurst  v.  State, 
50  S.  W.  R.,  719.     Kentucky:   Port- 
wood  v.  Commonwealth,  20  Ky.  L. 
R.,  680;  47  S.  W.  R.,  339.     Pennsyl- 
vania:    Commonwealth    v.    Heidler, 
191  Pa.  St.,  375;    43  Atl.  R.,  211; 
44  W.  N.  C.,  310.     Alabama:  Martin 
v.  State,  119  Ala.,  1;   25  So.  R.,  255. 
Ohio:     It    is    not    enough    to    show 
merely  that  insanity  is  a  possibility; 
State  v.  Miller,  7  Ohio  N.  P.,  458;  5 
Ohio  S.  and  C.  P.  Dec.,  703. 

2  Davis  v.  U.  S.,  160  U.  S.  469;   16 
Sup.  Ct.  Dec.,  353;    Irving  Stuart  v. 
State,  1  Baxt.,  178;  Kingv.  State,  91 
Tenn.,    617;    20   S.    W.    Rep.,    169; 
Faulkner  v.  Territory  (N.  M.),  30  Pac. 
Rep.,  905;  6  N.M.,  464;  State  v.  Schae- 
fer,  116  Mo.,  96;  22  S.  W.  Rep.,  447; 
Com.  v.  Gerade,  145  Pa.  St.,  289  (Pa. 
O.  and  T.);    22  Atl.  Rep.,  464;    23 
Pittsb.  L.  J.,  117;    People  v.  Bem- 
merly,  98  Cal.,  299;    33  Pac.   Rep., 
263;  Armstrong  v  State,  30  Fla.,  170; 
11  So.  Rep.,  618;    and  27  Fla.,  366; 
9  So.  Rep.,  1;    State  v.  Davis,   109 
N.  C.,  780;  14  S.  E.  Rep.,  55;  Moore 
v.  Com.,  92  Ky.,  630;  18  S.  W.  Rep., 
833;    Montag  v.  People,  141  111.,  75; 
30  N.  E.  Rep.,  887;   Fischer  v.  State, 


30  Tex.  App.,  502;  18  S.  W.  Rep., 
90;  Hunt  v.  State  (Tex.  Cr.  App.), 
26  S.  W.  Rep.,  206;  People  v.  Dillon, 
8  Utah,  92;  30  Pac.  Rep.,  150;  Smith 
v.  State,  31  Tex.  Cr.  Ap.,  14;  19  S.  W. 
Rep.,  252;  Miller  v.  State  (Wyo.),  29 
Pac.  Rep.,  186;  State  v.  Zorn,  22 
Ore.,  591;  30  Pac.  Rep.,  317;  Revoir 
v.  State,  82  Wis.,  295;  52  N.  W.  Rep., 
84;  Smith  v.  Com.,  93  Ky.,  318;  17 
S.  W.  Rep.,  868;  People  v.  McNulty, 
93  Cal.,  437;  36  Pac.  Rep.,  597; 
People  v.  Bawden,  90  Cal.,  195;  27 
Pac.  Rep.,  204;  People  v.  Eubanks, 
86  Cal.,  295;  24  Pac.  Rep.,  1014; 
State  v.  Hill,  46  La.  Ann.,  27;  14  So. 
Rep.,  294;  State  v.  Hansen,  25  Ore., 
391;  36  Pac.  Rep.,  296;  Kearney  v. 
State,  68  Miss.,  233;  9  So.  Rep.,  292; 
Hunt  v.  State  (Tex.  Cr.  App.),  28 
S.  W.  Rep.,  206;  Blummer  v.  State 
(Ind.),  34  N.  E.  Rep.,  968;  Jamison 
v.  People,  145  111.,  357;  34  N.  E  Rep., 
486;  Boiling  v.  State,  54  Ark.,  588; 
16  S.  W.  Rep.,  658;  Lovegrove  v. 
State,  31  Tex.  Cr.  R.,  491;  21  S.  W. 
Rep.,  191;  People  v.  Taylor,  138  N. 
Y.,  398;  34  N.  E.  Rep.,  275;  People 
v.  Nino,  149  N.  Y.,  317;  43  N.  E.  Rep., 
853;  Stuart  v.  State,  1  Baxt.  (Tenn.), 
178;  Kingv.  State,  91  Tenn.,  617;  20 
S.  W.  Rep.,  169;  State  v.  Larkins 
(Idaho),  47  Pac.  Rep.,  945;  Ryder  v. 
State,  100  Ga.,  528;  38  L.  R.  A.,  721; 
28  S.  E.  Rep.,  246;  Brown  v.  State, 
25  So.  Rep.,  63;  40  Fla.,  459;  Caffey 
v.  State  (Miss.),  24  So.  Rep.,  315; 
State  v.  Brooks,  57  Pac.  Rep.,  1038; 
23  Mont.,  146. 

3  Brown  v.  State,  40  Fla.,  459;  25 
So.  Rep.,  63. 


560  MENTAL   UNSOUNDNESS — BECKER   AND   BOSTON. 

commission  of  a  revolting  crime  is  not  alone  sufficient  to  over- 
come the  presumption  of  sanity.1 

In  Oklahoma  the  burden  is  on  the  defendant  to  raise  a 
reasonable  doubt,  and  then  the  prosecution  must  prove  his  sanity 
beyond  a  reasonable  doubt.2 

Rule  of  Preponderance  of  Evidence. — The  cases  cited  in  the 
note3  hold  that  insanity  must  be  shown  by  the  defence  by  a  pre- 
ponderance of  evidence.  Evidence  sufficient  to  show  a  probabil- 
ity of  insanity  meets  the  requirement  of  a  preponderance.4 

In  Montana,  it  has  been  held,  that  the  prosecution  must  prove 
sanity  by  a  preponderance  of  evidence,  if  the  defence  offers  evi- 
dence tending  to  prove  insanity.5  The  same  rule  obtains  in  Ne- 
braska.6 

Insanity  when  established  as  a  fact,  and  of  the  character  to 
excuse  responsibility,  is  not  a  partial,  but  a  complete  defence  and 
requires  an  acquittal.7  Therefore,  in  States  where  the  defence 
must  do  more  than  raise  a  reasonable  doubt  as  to  sanity,  a  mere 
reasonable  doubt  of  sanity  does  not  reduce  the  degree  of  the 
crime.8 

Rule  of  Satisfaction  of  Jury. — In  Delaware,  by  the  statute, 
unless  insanity  is  established  by  the  State's  evidence,  the  accused 
must  establish  it  by  direct  evidence,  to  the  satisfaction  of  the 
jury.9 

1  Davis  v.  State  (Fla.),  32  So.  R.,  Ga.,  388;  Phelps  v.  Commonwealth, 
822.  17  Ky.  Law  R.,  706;  32  S.  W.  Rep., 

2  Maas  v.  Territory,  10  Okl.,  714;  470.     A     preponderance     does     not 
63  Pac.  R.,  960.  necessarily  follow  from  mere  number 

3Kelchv.  State  (Ohio),  45  N.  E.  R.,  of  witnesses,    Wade  v.   State    (Tex. 

6;   Cottell  v.  State,  12  Ohio  C.  C.  R.,  Cr.  App.),  63  S.  W.  R.,  878;  though 

467;   1  Ohio  C.  D.,  472;    People  v.  this  may  be  a  controlling  element, 

Allender,  48  Pac.  Rep.,  1014;  117  Cal.,  where  the  witnesses  are  of  like  credi- 

81;    State  v.  Bell,    136  Mo.  120;  37  bility,  Ketteman  v.  Metzger,  23  Ohio 

S.  W.  Rep.,  823;  Commonwealth  v.  C.  C.,  61. 

Heidler,  191  Pa.  St.,  375;  43  Atl.  R.,  4  Sharkey   v.    State,    2   O.  C.   D., 

211;    44    W.   N.  C.,  310;     State    v.  443. 

Robbins  (Iowa),  80  N.  W.  R.,  1061;  5  State  v.  Peel,  23  Mont.,  358;  59 

State  v.  Parks,  93  Me.,  208;  44  Atl.  Pac.  R.,  169. 

R.,  899;    State  v.  Del  Bello,  8  Oh.  6  Snider  v.  State,  56  Neb.,  309;  76 

S.  and  C.  P.  Dec.,  455;    People  v.  N.  W.  Rep.,  574. 

Travers,  88  Cal.,  238;  26  Pac.  Rep.,  7  Commonwealth  v.  Hollinger,  190 

88;     People  v.   Bemmerly,    33   Pac.  Pa.  St.,  155;  42  Atl.  Rep.,  548. 

Rep.,  26.3;  98  Cal.,  299;    Fischer  v.  B  Commonwealth  v.  Wireback,  196 

State,    30    Tex.  App.,    502;     Love-  Pa.  St.,  138;  43  W.  N.  C.,  506;  42  Atl. 

grove  v.  State,  31  Tex.  Cr.  R.,  491;  Rep.,  542. 

21  S.  W.  Rep.,  191;  People  v.  Ward,  9  State  v.  Cole,  2  Penne.,  344;  45 

105   Cal.,    335;    38    Pac.    Rep.,  945;  Atl.  R.,  391. 
Keener  v.  State,  24  S.  E.  Rep.,  28;  97 


ILLUSTRATIVE  CASES — CONFLICT   OF  EVIDENCE.          561 

And  iii  Iowa  the  presumption  of  sanity  is  not  overcome  unless 
the  evidence  clearly  establishes  the  fact.1 

In  New  Jersey  the  evidence  must  satisfy  the  jury,  but  any 
satisfactory  evidence  will  suffice.2 

In  Texas  the  insanity  of  defendant  need  not  be  established 
beyond  a  reasonable  doubt,  but  only  to  the  reasonable  satisfaction 
of  the  jury.3 

In  Iowa  an  instruction  was  approved,  perhaps  with  some 
hesitation,  which  told  the  jury  that  they  were  not  required  to 
find  insanity  except  upon  reliable  evidence  which  convinced  them 
that  the  fact  was  proven  by  a  fair  preponderance  of  all  the  evi- 
dence in  the  case  bearing  thereon.4 

In  Louisiana  it  is  said  that  the  proof  of  insanity  should  satisfy 
the  jury  that  the  accused  was  not  sane  at  the  time  of  the  act 
charged.5 

In  Missouri  a  distinction  has  been  made  between  proof  beyond 
a  reasonable  doubt  and  proof  to  the  reasonable  satisfaction  of  the 
jury,  and  the  latter  adopted  as  the  proof  sufficient  to  establish 
insanity.6 

In  Georgia  the  phrase  "  reasonable  certainty"  has  been  applied 
to  indicate  the  measure  of  the  burden  upon  defendant  of  proving 
insanity,  such  reasonable  certainty,  however,  being  produced  by 
a  preponderance  of  evidence.7 

Where  the  defence  was  intoxication,  it  was  held,  if  the  jury 
were  satisfied  beyond  a  reasonable  doubt  that  the  accused  had 
committed  the  act  charged  (larceny)  then  the  burden  was  on  the 
accused  to  show  that  the  intoxication  was  so  complete  as  to  ren- 
der him  irresponsible.8 

Illustrative  Cases — Conflict  of  Evidence.9— In  a 
murder  case  in  Texas,  the  evidence  showed  that  relatives  of 
the  accused  were  insane ;  physicians  who  had  attended  the  ac- 

1  State  v.  Novak,  79  N.  W.  R.,  4G5.  «  State  v.  Novak,  79  N.  W.  Rep., 

*Genz  v.  State,  34  Atl.   R.,  816;  -465. 

58  N.  J.  Law,  482;    37  Atl.  R.,  69;  5  State  v.  Scott,  49  La.  Ann.,  253; 

59  N.  J.  Law,  488.  21  So.  Rep.,  271. 

3  Williams   v.  State,  37  Tex.   Cr.,  8  State  v.  Duestrow,   137  Mo.,  44; 

348;  39  S.  W.  Rep.,  687.     See  also  38  S.  W.  Rep.,  554. 

Burt  v.  State  (Tex.  Cr.  Ap.),  38  Tex.  7  Minder  v.  State,  113  Ga.,  772;  39 

Cr.,  397;  40  S.  W.  Rep.,  1000;  Hurst  S.  E.  R.,  284. 

v.  State    (Tex.  Cr.  Ap.),  50  S.  W.  8  See  supra,  p.  481,  for  intoxication 

Rep.,  719;    State  v.   Miller,  7  Ohio  as  a  defence  to  crime.    Davis  v.  State, 

N.  P.,  458;  5  Ohio  S.  and  C.  P.  Dec.,  74  N.  W.  Rep.,  599;  54  Neb.,  177. 

703.  *  For  further  illustrations  see  civil 

cases,  infra,  p.  564. 
III.— 36 


562  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

cused  testified  to  acts  tending  to  show  insanity,  and  gave  their 
opinions  that  he  was  insane;  there  was  no  evidence  to  show  mo- 
tive ;  on  the  other  hand,  other  acquaintances  expressed  the  opinion 
that  he  was  sane,  without  giving  substantial  reasons,  and  two 
physicians,  not  specially  qualified  as  experts  in  insanity,  gave 
opinions  that  he  was  sane,  based  on  their  observations  during  the 
trial  and  on  the  testimony ;  held,  that  there  was  a  preponderance 
of  evidence  that  he  was  insane,  and  that  the  verdict  of  guilty  was 
not  supported  by  the  evidence.1 

In  People  v.  Taylor 2  the  court  refused  to  set  aside  a  verdict 
of  guilty  as  against  the  evidence.  The  accused  had  been  a  con- 
vict, but  of  exemplary  character  for  several  years ;  had  then  as- 
saulted his  keeper  with  a  hatchet  without  provocation ;  and  was 
pronounced  by  the  prison  physician  after  six  months'  observation 
to  be  suffering  from  melancholia  with  homicidal  tendencies.  He 
was  then  transferred  to  an  asylum  for  insane  criminals,  detained 
there  for  a  year,  and  retransferred  as  not  insane.  In  prison  he 
became  friendly  with  a  convict,  then  showed  hostility  to  him 
under  the  delusion  that  he  had  divulged  a  plan  of  escape,  and 
frequently  threatened  to  kill  this  fellow-convict.  Afterward  he 
became  apparently  reconciled  to  him,  but  on  the  next  day  killed 
him.  He  showed  no  emotion  and  expressed  a  desire  to  be  "elec- 
trocuted." He  had  practised  a  pernicious  habit  which  he  be- 
lieved had  wrecked  him  physically  and  morally.  Two  physicians 
after  examination  pronounced  him  insane,  and  five  experts 
after  examination  pronounced  him  sane.  It  was  held  that  the 
verdict  of  the  jury  should  stand,  even  though  a  reasonable  doubt 
of  sanity  was  sufficient  to  require  acquittal. 

In  New  York  it  was  held  insufficient  to  establish  a  reasonable 
doubt  of  insanity,  that  the  defendant  testified  his  mind  was  a 
blank  from  just  before  the  killing,  and  others  testified  that  he 
was  nervous,  irritable,  and  excited  over  the  behavior  of  his  wife, 
who  for  months  had  had  improper  relations  with  another  to  his 

'McLeodv.  State,  31  Tex.  Cr.  Rep.,  295;    Lacy  v.  State,  30  Tex.  App. 

331;  20  S.  W.  Rep.,  749.  119;  Taylor  v.  Commonwealth  (Va.), 

2  138  N.  Y.,  398;  34  N.  E.  Rep.,  275.  19  S.  E.  Rep.,  739;   State  v.  Dreher 

See  also  People  v.  Ferraro,  161  N.  Y.,  (Mo.),  38  S.  W.  Rep.,  567, 137  Mo.,  1 1 ; 

365;  55  N.  E.  Rep.,  931;  14  N.  Y.  Cr.  Commonwealth    v.    Wireback,     190 

R.,  266;  Miller  v.  State,  3  Wyo.,  657;  Pa.  St.,  138;  42  Atl.  Rep.,  542;  43  W. 

Fisher  v.  State,  30  Tex.  App.,  502;  N.  C.,  506;  People  v.  Crest,  168  N.  Y., 

State  v.  Brooks,  4  Wash.  St.,  328;  30  19;  15  N.  Y.  Cr.  R.,532;  60  N.  E.  R., 

Pac.,  147;  State  v.  Zorn,  22  Or.,  591;  1057. 
30Pac.,317;  Revoir  v.  State,  82  Wis., 


PRESUMPTION   OF  CONTINUANCE  OF   INSANITY.  563 

knowledge,  without  any  attempt  on  his  part  to  punish  them 
during  that  time.1 

In  Pennsylvania  the  accused  introduced  evidence  that  he  was 
an  epileptic  and  that  the  tendency  of  that  disease  in  an  aggra- 
vated form  is  to  weaken  the  intellectual  powers.  It  did  not  show 
that  his  intellect  was  seriously  impaired  nor  that  he  was  affected 
on  the  day  of  the  homicide.  It  was  shown  that  he  had  had  an 
attack  of  epilepsy  about  five  weeks  before.  A  witness  who  had 
known  him  five  years  had  only  twice  seen  him  act  irrationally. 
Held,  insufficient  to  prove  insanity.2 

In  Illinois  it  was  held  not  sufficient  to  rebut  the  presumption 
of  sanity,  that  defendant  was  queer  in  his  ways,  very  nervous 
and  excitable,  and  felt  as  if  he  was  going  crazy.3  And  evidence 
that  he  had  been  in  an  insane  asylum  and  that  some  witnesses, 
both  expert  and  non-expert,  were  of  the  opinion  that  he  was  still 
insane  was  not  sufficient  to  reverse  a  conviction  where  there  was 
evidence  that  he  earned  regular  wages,  invested  them,  and 
attended  to  his  affairs  properly.4 

Burden  of  Proof  of  Continuance  of  Insanity.5 — The 
courts  of  many  States  hold  that  where  the  evidence  shows 
that  defendant  was  at  any  time  previous  to  the  crime  affected 
with  insanity  of  a  chronic  character,  the  presumption  is  that  he 
continued  so  and  had  no  lucid  intervals,  and  the  burden  of  proof 
is  then  upon  the  State  to  show  that  the  crime  was  committed  dur- 
ing a  lucid  interval.6  But  in  Missouri  a  distinction  is  made 
between  imbecility  and  chronic  insanity,  the  burden  of  proving 
a  lucid  interval  being  on  the  State  in  the  latter  case,  and  not  in 
the  former.7 

In  Texas,  however,  it  was  said  that  an  adjudication  of  insan- 
ity, though  conclusive  that  defendant  was  then  insane,  does  not 
raise  any  presumption  that  the  insanity  was  permanent,  but  is 
simply  to  be  considered  with  the  other  evidence  on  the  question 
whether  the  accused  was  insane  at  the  time  of  the  crime,  and 

1  People  v.  Osmond,  138  N.  Y.,  80;          4  Meyer  v.  People,  156  111.,  126;  40 
33  N.  E.  Rep.,  739.  N.  E.  Rep.,  490. 

2  Commonwealth  v.    Buccieri,   153          5  See  also  supra,  p.  551. 

Pa.  St.,  535;  26  Atl.  Rep.,  228;  32          'State  v.  Schaefer,  116  Mo.,  96;  22 

W.  N.  C.,  113.     Cf.  Commonwealth  S.  W.  R.,  447;    Armstrong  v.  State, 

v.  Preston,  188  Pa.  St.,  429;  41  Atl.  30Fla.,  170;  11  So.  Rep.,  618;  People 

Rep.,  534.  v.  Lane,  100  Cal.,37(J;  34  Pac.  Rep., 

3  Lilly  v.  People,  148  111.,  467;  36  856. 

N.  E.  Rep.,  95.  '  State  v.  Palmer,    161   Mo.,  152; 

61  S.  W.  R.,  651. 


5G4          MENTAL    UNSOUNDNESS — BECKER    AND    BOSTON. 

therefore  that  an  instruction  was  properly  refused  that  "unless 
the  evidence  shows  beyond  a  reasonable  doubt  that  the  insanity 
was  temporary  and  that  defendant  has  been  cured,  it  is  presumed 
to  have  continued  until  now." l 

Where  the  evidence  shows  merely  temporary  insanity  prior 
to  a  homicide,  without  other  facts  to  create  a  reasonable  doubt 
whether  the  accused  was  sane  at  the  time  of  the  homicide,  the 
State  may  rely  upon  the  presumption  of  sanity  without  proving 
a  lucid  interval,  though  it  would  be  otherwise  if  the  insanity 
were  of  an  habitual  character.2  And  it  was  said  in  Missouri 
that  though  the  accused  shows  that  he  was  insane  prior  to  a 
homicide,  still  the  burden  is  upon  him  to  prove  his  insanity  at 
the  time  of  the  killing.3 

BURDEN   OF   PEOOF   OF  INSANITY  IN  CIVIL  CASES. 

Upon  the  question  of  insanity,  though  the  burden  of  proof  of 
all  issues  may  be  upon  the  plaintiff  or  moving  party,  the  pre- 
sumption of  sanity4  aids  the  person  who  relies  upon  it  to  the  ex- 
tent that  the  burden  of  proving  insanity  is  upon  the  party  who 
asserts  it.5 

Inquisitions  of  Lunacy. — The  presumption  of  sanity 
is  applied  in  such  inquiries,  and  the  burden  is  on  him  who  alleges 
incompeteucy.8  But  one  who  attacks  for  fraud  the  validity  of 

1  Hunt  v.  State,  33  Tex.  Cr.,  252;  set    aside   judgment    on   ground    of 
26    S.     W.     Rep.,     206.     See    also  insanity  of  judgment  debtor,  burden 
People  v.  Schmitt,   106  Cal.,  48;  39  on  judgment  debtor  seeking  to  set 
Pac.  Rep.,  204.  judgment  aside);   Butters  v.  Comyns, 

2  Ford  v.  State,  73  Miss.,  734;  19  81  111.  App.,  418  (on  conservator  seek- 
So.   Rep.,  665.  ing  to  set  aside  judgment  entered 

3  State  v.  Wright,  134  Mo.,  404;  35  against  his  ward  before  his  appoint- 
S.     W.     Rep.,    1145.     Cf.    State    v.  ment);     Clarke  v.    Irwin  (Neb.),   88 
Palmer,  161  Mo.,  152;  61  S.  W.  R.,  N.   W.   R.,  783   (burden  of  proving 
651.  insanity  of  true  owner  is  on  him  who 

4  Presumption   of   sanity,    Buckey  seeks  to  recover  in  ejectment  against 
v.  Buckey,  38  W.  Va.,  168;  18  S.  E.  him  who  claims  by  adverse  possession 
Rep.,  383.  against    him);     Carter     v.     Stewart 

5  Youn  v.  Lamont,  56  Minn.,  216;  (Tenn.   Ch.    App.),    43   S.  W.   Rep., 
57  N.  W.  Rep.,  478    (mortgage — in-  366    (burden   of  proving  suspension 
sanity    of    mortgagor,     burden     on  of  statute  of  limitation  on  him  who 
person    disputing  validity   of   mort-  asserts  it). 

gage) ;      Nonnemacher     v.      Nonne-  *  In  re  Shelleig,  1 1  Ohio  S.  and  C. 

macher,  159  Pa.  St.,  634;  28  Atl.  Rep.,  P.  Dec.,  81.     See  in  re  Welch,  108 

439    (marriage — burden    on    person  Wis.,  387;  84  N.  W.  Rep.,  550,  rent 

asserting  insanity  at  time    of  mar-  of  farm  for  less  than  value  does  not 

riage);    Smith  v.  McClure,  146  Ind.,  prove  incompetency  of  owner. 
123;  44  N.  E.  Rep.,  1004    (action  to 


WILLS.  565 

an  adjudication  of  lunacy  against  him  has  the  burden  of  proof.1 
And  one  who  attempts  to  supersede  an  adjudication  of  incom- 
petency  has  the  burden  of  proof  of  a  changed  or  restored  con- 
dition of  mind.2 

WILLS. 

Burden  of  Proving  Sanity  by  the  Prevailing  Rule 
Prima  Facie  on  Proponents. — Contrary  to  the  usual  rule  in 
other  legal  contests  (that  the  presumption  of  sanity  casts  the  bur- 
den of  proof  throughout  a  trial  on  those  who  allege  insanity),  in 
proving  a  will,  the  burden  of  showing  testamentary  capacity 
and  an  intelligent  knowledge  of  the  contents  of  the  will3  is, 
in  most  States,  upon  the  proponents  of  the  will4  in  the  first 
instance,  or  upon  those  alleging  its  validity.5  This  is  so  held, 
because  the  right  to  make  a  testamentary  disposition  of 
property  is  regarded  as  a  privilege  accorded  by  the  State  to  those 
competent  only,  and  hence,  from  considerations  of  public  policy 
the  statutes  or  the  practice  usually  require  the  proponents  to 
prove  by  actual  evidence  at  least  a  prima  facie  case  of  mental 
competency,  before  probate  can  be  allowed. 

Shifting  of  the  Burden  of  Proof  to  Contestants. — Generally  where 
the  burden  of  proving  competency  is  prima  facie  on  the  propo- 
nents, it  is  met  in  the  first  instance  by  the  testimony  of  the  attest- 
ing witnesses  to  the  will ; 8  their  testimony  being  at  most  confined 

1  McCormick  v.  McCormick  (Iowa),  ing  the  will   had  already  been  ad- 
81  N.  W.  Rep.,  172.  mitted  to  probate,  that  in  a  contest 

2  Appeal  of  Thompson,  16  Montg.  of   its  validity  its  previous  probate 
Co.  Law  Rep.  (Pa.),  102.  did   not  cast   upon   contestants  the 

3  In  re  De  Castro's  Will,  32  Misc.  burden  of  proving  mental  incapacity, 
R.,  193;  66  N.  Y.  Supp.,  239.  Clements  v.  McGinn,  33  Pac.   Rep., 

4  Johnson  v.  Stevens,  15  Ky.  Law  920.     In  New  York  in  an  action  to 
R.,  477;  23  S.  W.  Rep.,  957;   Prather  establish  the  validity  or  invalidity  of 
v.   McClelland    (Tex.   Civ.  App.),  26  a  will  after  probate,  the  probate  is 
S.  W.   Rep.,  657;  Murry  v.  Hennessy  given  prima  facie  effect  in  an  action 
(Neb.).  67  N.  W.  Rep  ,  470;  Sheehan  under    sec.    2653a,    Code  Civ.  Pro., 
v.  Kearney  (Miss.),  21  So.  Rep,  41;  and   in  such   action   the   burden   of 
35  L   R.  A.,   102;  in  re  Thomson,  92  establishing  incompetency  is  on  the 
Me.,  563;   43  Atl.    Rep.,  511;    in  re  contestant,  Dobie  v.   Armstrong,   27 
Baldwin's  Est.,    13   Wash.,   666;  43  App.  Div.,  520;  50  N.  Y.  Supp.,  801. 
Pac.  Rep.,  934;  in  re  Oiffin's  Est.,  9  See  in  re  Rintelen.  37  Misc    R.,  462 
Pa.  Dist.  R.,  248;  23  Pa.  Co.  Ct.  R.,  (N.  Y.  Surr.);  75  N.  Y.  Supp.,  935, 
559;     Bacon   v.    Bacon    (Mass.),    62  where  testator  was  a  confirmed  in- 
N.  E.  R.,  990;    Delafield  v.  Parish,  ebriate,  there  was  no  evidence  that 
25  N.    Y.,  29;  In   re   Widmayer,  74  he  dictated    the  will  or    understood 
App.  Div.    (N.    Y.),  336;  77   N.    Y.  its    contents,    and    probate    was  re- 
Supp.,  663.  /used. 

*  Held  in  California,  notwithstand-          *  Or,  under  a  special  practice,  by 


566          MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

to  the  appearance,  conduct,  and  surroundings  of  the  testator  at 
the  time  of  the  execution  of  the  will  and  their  opinions  based 
thereon.  A  presumption  then  arises  in  proponent's  favor,  which 
controls  unless  overcome  by  a  preponderance  of  evidence  in 
favor  of  the  contestants. 1  The  burden,  having  been  thus  shifted, 
remains  to  the  end,  in  most  States,  upon  the  contestants. 

In  Ohio  a,  prima  facie  case  of  testamentary  capacity  entitles 
the  will  to  probate  unless  the  contestants  sustain  their  con- 
tention by  a  preponderance  of  proof.2  And  in  Illinois  it  is  said 
that  when  the  proponents  have  made  a  prima  facie  case  by  statu- 
tory proof  of  due  execution  and  of  testator's  mental  capacity, 
the  legal  presumption  of  testator's  sanity  casts  on  contestants  the 
burden  of  proving  the  contrary.3 

In  Some  States  Burden  Prima  Facie  on  Contestants. 
—In  some  States  it  is  said  that  the  proponents  need  not 
make  any  proof  of  the  testator's  mental  capacity,  that  is,  none 
other  than  follows  as  an  inference  from  the  presumption  of 
capacity  and  the  proof  of  due  compliance  with  the  formalities  of 
execution.  The  issue  of  incompetency  must  be  tendered  by  the 
contestants.  In  these  States  the  situation  is  the  same,  so  far  as 
the  contestants  are  concerned,  as  in  those  States  where  the  burden 
shifts  after  prima  facie  proof  by  the  proponents,  the  only  im- 

the  production  of  the  will,  with  the  3  Craig  v.  Southard,  162  111.,  209; 

certificate  of  oaths  of  the  subscrib-  44  N.  E.  R.,  393;    Huggins  v.  Drury, 

ing  witnesses,  and  the  testimony  in  192    111.,    528;    61    N.    E.    R.,   652; 

court   of  one    witness.     Johnson  v.  Thompson   v.  Bennett,   194  111.,  57; 

Johnson,   187  111.,  86;   58  N.  E.  R.,  62  N.  E.  R.,  321.     Though  some  of 

237.  the    Illinois    decisions    mention    the 

1  In  re  Barber's  Estate,  63  Conn.,  shifting    of    the    burden    after    the 

393;   27  Atl.    R.,    973;     Perkins    v.  production  of  certain  evidence,  others 

Perkins,   39   N.   H.,    163;     Elliot  v.  remark  that  it  is  technically  inaccu- 

Welby,    13  Mp.   App.,    19;     Taff  v.  rate  to  say  that  the  burden  is  shifted 

Hosmer,  14  Mich.,  309;   McGinnis  v.  during  the  trial;  the  burden  remains 

Dempsey,  27  id.,  363;  Dean  v.  Dean,  where  it  is  at  the  start,  though  at 

27  Vt.,  746;  Turner  v.  Cook,  36  Ind.,  various  stages  of  the  trial  it  may 

129;    Irish  v.  Newell,   62   111.,    196;  appear,  by  reason  of  the  testimony, 

Carpenter    v.    Calvert,    83    id.,    62;  to  have  been  more  or  less  fully  met, 

Hawkins  v.   Grimes,    13  B.   Monroe  accordingly  as   the    evidence  for  or 

(Ky.),    257;     Brooks   v.   Barrett,    7  against  the  proponents  or  contestants 

Pick.  (Mass.),  94;   Mayo  v.  Jones,  78  preponderates  at  the  moment.     It  is, 

N.  C.,  402;    Kingsley  v.  Blanchard,  therefore,  inaccurate  to  instruct  the 

66  Barb.,  317;  Banker  v.  Banker,  63  jury  that  after  certain  evidence  the 

N.  Y.,  409.     And  so  is  the  English  burden  shifts;    but  such  instruction 

rule:   Smee  v.  Smee,  L.  R.,  5  P.  D.,  is  not  necessarily  misleading.     Sling- 

84,  and  cases  cited.  loff  v.  Bruner,  174  111.,  561;  51  N.  E. 

'Beresford  v.  Stanley,  6  Ohio  N.  R.,  772. 
P.,  38;   in  re  Ludlow's  Will,  6  Ohio 
Dec.,  344;  4  Ohio  N.  P.,  155. 


BURDEN   PRIMA   FACIE   ON  WHOM.  567 

portant  difference  being  that  in  the  latter  the  proponents  of  any 
will,  whether  there  is  a  contest  or  not,  must  offer  some  direct 
proof  of  competency.  Thereafter  the  contestants  must  sustain 
their  case  by  a  preponderance  of  proof.1 

In  the  States  where  the  proponents  need  not  offer  even  prima 
fade  proof  of  the  testator's  sanity,  emphasis  is  laid  upon  the 
presumption  of  sanity,  which,  it  is  said,  applies  in  probate  pro- 
ceedings as  well  as  in  other  controversies.2 

The  presumption  of  sanity  may  be  of  sufficient  probative 
force  to  turn  the  scale,  when  the  evidence  is  evenly  balanced.3 

In  Alabama  it  is  said  that  all  presumptions  are  in  favor  of 
the  validity  of  the  will,  after  the  proponents  have  shown  merely 
jurisdiction,  testamentary  age,  and  due  execution.4  And  in 
Iowa,  that  on  proof  by  proponent  of  due  execution,  the  burden  is 
on  the  contestants  to  show  incompetency  or  undue  influence.5 

Effect  of  Unreasonableness  of  Will  on  Burden  of  Proof. — In 
Kentucky  it  seems  to  be  indicated  that  the  "burden"  remains 
with  the  proponents  until  they  have  proved,  prima  facie,  due 
execution  merely,  but  is  then  shifted  to  the  contestants  to  prove 
incapacity,  unless  the  will  presents  internal  evidence  of  irration- 
ality, such  as  inconsistency  in  structure,  language,  or  details.8 
In  California  precisely  the  contrary  has  been  held :  that  the  fact 
that  the  will  is  unreasonable  does  not  so  create  a  presumption  of 
incapacity  as  to  devolve  upon  the  proponents  the  burden  of  ex- 
plaining away  the  unreasonableness.7 

Instructions  to  the  Jury. — The  jury  on  the  issue  of  mental 

1  And  the  fact  that  the  proponents      Motz's  Est.,  69  Pac.  R.,  294.     Penn- 
do  offer  proof  of  capacity  does  not      sylvania:  Messner  v.  Elliott,  184  Pa. 
according  to  either  rule   affect  the      St.,  41;   39  Atl.  R.,  46. 

burden  of  proof.     Proponents  do  not  3  Appeal  of  Sturdevant,  71  Conn., 

assume  the  burden  by  offering  the  392;    42  Atl.  R.,  70. 

evidence,  Woodford  v.  Buckner,  32  4  Barnewall  v.  Murrell,  18  So.  R., 

Ky.  L.  R.,  627;   63  S.  W.  R.,  617.  831. 

2  Alabama:  Barnewall  v.  Murrell,  18  8  In  re  Allison's  Est.,   104   Iowa, 
So.  Rep.,  831.     Iowa:  In  re  Allison's  130;  73    N.   W.   R.,  489;    Howe  v. 
Est.,  73  N.  W.   R.,  489;  104  Iowa,  Richards,  83  N.  W.  R.,  909;    in  re 
130;  in   re  Goldthorp's  Est.,  88   N.  Goldthorp's  Est.,  88  N.  W.  R.,  944; 
W.  R.,  944;    Howe  v.  Richards,  83  in  re  Hull's  Est.,  89  N.  W.  R.,  979. 
N.  W.  R.,  909;   in  re  Hull's  Will,  89  •  King  v.  King  (Ky.),  42  S.  W.  R., 
N.  W.  R.,  979.     Indiana:   Blough  v.  317;    Woodford  v.  Buckner,  23  Ky. 
Parry,  144  Ind.,  463;    43  N.  E.  R.,  L.  R.,  623;  63   S.  W.  R.,  617;    but 
560;    Roller  v.  Kling,  150  Ind.,  159;  see  Boone  v.  Ritchie  (Ky.),  53  S.  W. 
49  N.  E.  R.,  948.     Delaware:   Smith  R.,  518. 

v.    Day    (Del.),    45    Atl.    R.,    396.          7  In  re  Black's  Est.,  132  CaL,  392; 
North  Carolina:  In  re  Burns's  Will,      64  Pac.  R.,  695. 
28  S.  E.  R.,  519.     California:    In  re 


568  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

incompetency  iu  a  case  where  the  burden  is  on  contestants  should 
be  instructed  rather  that  they  must  find  the  paper  the  will  of 
testator,  unless  he  was  of  unsound  mind  when  it  was  executed, 
than  that  they  must  believe  deceased  of  sound  mind  before  they 
can  find  the  paper  to  be  his  will,1  and  care  should  be  taken  in 
such  cases  not  so  to  phrase  the  instruction  as  to  lead  to  the  im- 
pression that  the  burden  is  on  proponents.2 

Presumption  of  Continuance  of  Insanity  as  Affecting  Burden  of 
Proof. — The  rule  as  to  burden  of  proof  is  so  strictly  applied  in 
Indiana  that  where  the  testator  was  prior  to  making  the  will  in 
a  state  of  mental  unsounduess  apparently  permanent,  it  was  held 
that  such  proof  did  not  cast  upon  the  proponents  the  burden  of 
proving  that  the  will  was*  executed  during  a  lucid  interval ;  the 
burden  was  on  the  contestants  to  show  that  the  insanity  persisted 
at  the  time  of  the  execution  of  the  will.3 

In  Alabama  and  elsewhere  the  rule  has  been  more  conserva- 
tively stated.  It  is  not  incumbent  on  proponents  to  show  that  a 
will  was  made  in  a  lucid  interval  until  contestants  show  mental 
incapacity  of  the  testator.4  When  contestants  show  chronic  im- 
becility or  permanent  insanity  preceding  the  execution,  the  pro- 
ponents must  then  prove  an  interval  of  competency.5 

In  any  event,  though  it  be  found  that  a  testator  was  insane 
prior  to  making  a  will,  his  insanity  will  not  be  presumed  to  have 
continued,  unless  it  be  found  that  it  was  habitual  and  fixed.6 
The  continuance  of  insanity  is  not  a  presumption  of  law,  but  an 
inference  of  fact,  and  to  warrant  the  inference,  the  insanity 
must  be  permanent  in  character.7 

1  Layer  v.  Layer,  22  Ky.  Law  Rep.,  Smart,  2  Mo.  App.  Repr.,  1107.     See 

1936;  62  S.  W.  R.,  15.  VanOsdellv.  Hyce(La.),  15  So.  Rep., 

•  See    Woodford    v.    Buckner,    23  19;  46  La.  Ann.,  387.     In  Rogers  v. 
Ky.  Law  Rep.,  627;  63  S.  W.  R.,  617.  Armstrong  Co.  (Tex.  Civ.  App.),  30 

3  Merriman  v.  Merriman,  153  Ind.,  S.  W.  Rep.,  848,  it  was  held  error  to 
631;   55  N.  E.  R.,  734.  instruct  the  jury  that  the  law  pre- 

4  Murphree  v.  Senn,  107  Ala.,  424;  sumes  that  the  grantor  of  a  deed  was 
18  So.  Rep.,  264.  sane,  when  there  was  evidence  that 

s  Von  de  Veld  v.  Judy,  143  Mo.,  he  was  insane  at  the  time  of  its  exe- 
348;  44  S.  W.  Rep.,  1117;  Jones  v.  cution,  for,  it  is  said,  his  mental  con- 
Collins,  94  Md.,  403;  51  Atl.  R.,  398;  dition  is  then  a  question  of  fact, 
but  cf.  Merriman  v.  Merriman,  153  Where  a  grantor  was  proved  to  be 
Ind.,  631;  55  N.  E.  Rep.,  734.  mentally  incompetent  on  the  day 

*  Johnson  v.  Armstrong  (Ala.),  12  of  the  execution  of  a  deed,  it  was 
So.  Rep.,  72.     See  Nonnemacher  v.  said  to  be  a  question  of  fact  whether 
Nonnemacher,   159  Pa.  St.,  634;  28  he  was  in  the  same  mental  condition 
Atl.  Rep.,  439.  several    days    afterward    when    the 

7Manley's  Exrs.  v.  Staples  (Vt.),  deed  was  delivered,  Baxter  v.  Baxter, 
26  Atl.  Rep.,  630;  Richardson  v.  76  Hun,  98;  27  N.  Y.  Supp.,  834; 


THE   MASSACHUSETTS   RULE. 


569 


Partial  Insanity,  as  Affecting  Burden  of  Proof. — Where  the 
contestants  show  monomania,  it  is  not  incumbent  on  the  defend- 
ants to  show  by  a  preponderance  of  evidence  that  the  mono- 
mania did  not  relate  to  matters  which  would  affect  testamentary 
capacity;1  it  merely  behooves  defendants  to  adduce  sufficient 
evidence  to  prevent  the  preponderance  from  being  in  favor 
of  the  contention  that  it  did  relate  to  matters  affecting  ca- 
pacity.2 

Where  the  contestants  rely  on  insane  delusions  to  defeat  the 
will,  the  burden  is  upon  them  on  that  issue,3  and  to  prove  that 
the  will  was  the  direct  product  of  the  delusions.4 

Effect  of  Adjudication  of  Insanity  is  to  Shift  Burden  of  Proof  to 
Proponents. — One  under  guardianship 'is  presumed  incapable  of 
making  a  will.5  But  where  a  person  had  been  adjudged  insane 
and  committed  to  an  asylum  from  which  he  was  subsequently 
discharged,  it  was  held  that  the  adjudication  did  not  create  a 
conclusive  presumption  of  the  continuance  of  the  insanity.8 

The  Massachusetts  Rule. — In  Massachusetts  the  pre- 
sumption of  sanity  applies  until  rebutted  by  contestants,  but 


and  proof  of  temporary  incapacity 
to  make  a  will  caused  by  bodily  pain 
and  physical  weakness  creates  no 
presumption  of  the  continuance  of 
such  incapacity;  Taylor  v.  Pegram, 
37  N.  E.  Rep.,  837;  151  111.,  106. 
In  Louisiana  it  was  held  that  where 
a  will  was  made  by  the  testator  him- 
self unaided  by  others,  and  its  pro- 
visions were  judicious,  there  follows 
a  presumption  that  it  was  made  in  a 
lucid  interval,  though  the  testator 
was  a  person  afflicted  with  insanity; 
and  that  the  subsequent  suicide  of 
the  testator,  due  to  insanity,  raises 
no  presumption  of  insanity  when 
the  will  was  made.  Succession  of 
Bey,  15  So.  Rep.,  297;  46  La.  Ann., 
773.  But,  on  the  other  hand,  where 
in  a  suit  to  recover  on  promissory 
notes  executed  by  maker  claimed  to 
have  been  insane  at  the  time  of  the 
execution,  it  was  shown  that  he  was 
insane  prior  to  the  execution  of  the 
notes,  the  burden  was  on  the  plain- 
tiff to  show  his  capacity  at  the  time 
of  the  execution,  Ducker  v.  Whitson, 
112N.  C.,44;  16S.  E.  Rep.,854.  See 
also  supra,  p.  563.  And  proof  of 
a  previous  and  subsequent  lucid 


interval  was  insufficient  to  prove 
that  grantor  was  sane  at  the  time  of 
the  execution  by  him  of  a  deed  in 
dispute,  Pike  v.  Pike,  104  Ala.,  642; 
16  So.  Rep.,  689.  The  transaction 
was  itself  not  in  accordance  with 
the  conduct  of  men  of  ordinary 
.  prudence  and  intelligence;  it  was 
held  that  the  transaction  was  dis- 
proof of  lucidity.  Ibid. 

1  See  supra,  p.  396. 

2  Young  v.  Miller,   145  Ind.,  652; 
44  N.  E.  Rep.,  757. 

» In  re  Scott's  Est.,  128  Cal.,  57; 
60  Pac.  R.,  527. 

4  Jones  v.  Collins,  94  Md.,  403;  51 
Atl.  R.,  398. 

8  In  re  Lapham's  Will,  19  Misc. 
(N.  Y.),  71;  44  N.  Y:  Supp.,  90; 
in  re  Hoope's  Est.,  174  Pa.  St.,  373; 
34  Atl  R.,  603  (containing  a  learned 
discussion  of  the  weight  of  the  pre- 
sumption and  the  collusiveness  of 
proof  necessary  to  overcome  it); 
see  also  in  re  Widmayer,  74  App. 
Div.  (N.  Y.),  336;  77  N.  Y.  Supp., 
663. 

6  Mutual  Life  Ins.  Co.  v.  Wiswell, 
56  Kans.,  765;  44  Pac.  Rep.,  996. 


570  MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 

then  the  burden  of  showing  capacity  upon  the  whole  evidence,1 
by  a  fair  preponderance, 2  is  on  the  proponents. 

Propositions  Respecting  the  Burden  of  Proof  to  Establish  a  Will, 
Announced  in  the  Parish  Will  Case,3  a  Celebrated  and  Leading  Casein 
New  York.- — A  majority  of  the  court  concurred  in  the  following 
legal  propositions  set  forth  in  the  opinion  of  Davies,  J. : 

"  1.  That  in  all  cases  the  party  propounding  the  will  is  bound 
to  prove  to  the  satisfaction  of  the  court  that  the  paper  in  ques- 
tion does  declare  the  will  of  the  deceased,  and  that  the  supposed 
testator  was,  at  the  time  of  making  and  publishing  the  docu- 
ment propounded  as  his  will,  of  sound  and  disposing  mind 
and  memory. 

"2.  That  this  burden  is  not  shifted  during  the  progress  of  the 
trial,  and  is  not  removed  by  proof  of  the  factum  of  the  will,  and 
the  testamentary  competency,  by  the  attesting  witnesses,  but  re- 
mains with  the  party  setting  up  the  will. 

"  3.  That  if,  upon  a  careful  and  accurate  consideration  of  all 
the  evidence  on  both  sides,  the  conscience  of  the  court  is  not 
judicially  satisfied  that  the  paper  in  question  does  contain  the 
last  will  of  the  deceased,  the  court  is  bound  to  pronounce  its 
opinion  that  the  instrument  is  not  entitled  to  probate. 

"  4.  That  when  it  is  sought  to  establish  a  posterior  will,  to 
overthrow  a  prior  one  made  by  the  testator  in  health,  and  under 
circumstances  of  deliberation  and  care,  and  which  is  free  from 
all  suspicion,  and  when  the  subsequent  will  was  made  in  en- 
feebled health  and  in  hostility  to  the  provisions  of  the  first  one ; 
in  such  case  the  prior  will  is  to  prevail,  unless  he  who  sets  up  the 
subsequent  one  can  satisfy  the  conscience  of  the  Court  of  Pro- 
bate that  he  has  established  a  will.  And  also  the  prior  will  is  to 
prevail  unless  the  subsequent  one  is  so  proven  to  speak  the  tes- 
tator's intentions  as  to  leave  no  doubt  that  it  does  so  speak  them. 

"  5.  That  it  is  not  the  duty  of  the  court  to  strain  after  probate 
nor  in  any  case  to  grant  it,  where  grave  doubts  remain  unre- 
moved,  and  great  difficulties  oppose  themselves  to  so  doing. 

"  6.  That  the  heirs  of  a  deceased  person  can  rest  securely 
upon  the  statutes  of  descents  and  distributions,  and  that  the 
rights  thus  secured  to  them  can  only  be  divested  by  those  claiming 
under  the  will  and  in  hostility  to  them,  by  showing  that  the  will 

1  Richardson    v.    Ely    (Mass.),    63          2  Fulton  v.  Umbehend  (Mass.),  65 
N.  E.  R.,  3.  N.  E.  R.,  829. 

3  Delafield  v.  Parish,  25  N.  Y.,  9. 


THE   MASSACHUSETTS  RULE. 


571 


was  executed  with  the  formalities  required  by  law,  and  by  a  tes- 
tator possessing  a  sound  and  disposing  mind  and  memory." 

The  court  also  said : 

"  The  maxim,  qui  se  scripsit  hceredem,  has  imposed  by  law  an 
additional  burden  on  those  claiming  to  establish  a  will  under  cir- 
cumstances which  call  for  the  applicactiou  of  that  rule,  and  the 
court  in  such  a  case  justly  requires  proof  of  a  more  clear  and 
satisfactory  character.  Such  a  condition  is  exhibited  by  the  tes- 
timony in  the  present  case.  The  two  codicils  under  consideration 
were  exclusively  for  the  benefit  of  Mrs.  Parish,  with  the  excep- 
tion of  the  charitable  gifts,  and  although  they  were  not  actually 
written  by  her,  yet  they  were  drawn  up  at  her  suggestion,  upon 
her  procurement,  and  by  counsel  employed  by  her.  She  pre- 
pared and  gave  the  instructions  for  them,  and  in  judgment  of  law 
they  must  be  regarded  as  written  by  herself — Facit  per  alium, 
facit  per  se. " l 


1  In  that  case  it  appeared  that  the 
testator,  Henry  Parish,  who  was  pos- 
sessed of  a  large  estate  and  had  been 
a  cultivated  and  refined  gentleman, 
was  in  July,  1849,  while  in  the  appar- 
ent enjoyment  of  full  health,  stricken 
with  an  attack  of  paralysis,  described 
by  the  physicians  as  "  hemiplegia. " 
He  had  made  one  will  in  1842,  while 
in  full  health,  by  which  he  practi- 
cally divided  his  estate  between  his 
wife  and  her  relatives  and  his  own 
brothers  and  sisters.  After  the  at- 
tack of  paralysis  in  1849,  his  wife 
was  hardly  ever  absent  from  his 
presence,  and  she  and  her  relatives 
were  his  constant  attendants,  to  the 
exclusion  almost  wholly  of  his  own 
relatives,  with  whom  he  to  this  pe- 
riod he  had  always  lived  on  terms  of 
intimacy  and  cordiality.  In  Au- 
gust, 1849,  in  September,  1853,  and 
in  June,  1854,  codicils  were  prepared 
and  executed  by  which  the  provi- 
sions of  the  original  will  of  1842  were 
changed  so  as  to  revoke  the  legacies 
and  devises  to  his  brothers  and  sis- 
ters and  leave  the  bulk  of  the  estate 
to  his  wife.  It  was  claimed  that 
during  all  the  period  after  his  attack 
of  paralysis  down  to  his  death  in 
March,  1856,  he  was  unable  to  speak 
intelligibly  or  coherently,  or  to  read 
or  write,  and  that  he  frequently  in- 
decently exposed  his  person  and  was 


guilty  of  ungentlemanly  and  violent 
conduct,  and  could  only  indicate  his 
wishes  by  gestures  and  peculiar 
sounds. 

The  court,  in  the  prevailing  opin- 
ion, by  Davies,  J.,  reviewed  the  evi- 
dence at  length  and  laid  great  stress 
upon  the  significance  of  the  entire 
change  in  the  personal  habits  and 
character  of  the  testator.  It  said: 
"The  conviction  on  our  mind  is  clear 
that  these  facts  and  circumstances 
show  unerringly  that  the  attack  of 
July  19th  obliterated  the  mental 
powers,  the  moral  perceptions,  the 
refined  and  gentle  susceptibilities  of 
Henry  Parish;  that  after  that  period 
he  ceased  to  be  the  mild,  intelligent, 
and  unruffled  man  he  had  been  there- 
tofore, and  that  thereafter  he  was 
not  morally  responsible  for  the  un- 
becoming and  ungentlemanly  con- 
duct he  so  frequently  exhibited.  He 
then  ceased  to  be  Henry  Parish,  and 
was  no  longer  an  accountable  being. 

"We  find  much  less  difficulty  in 
reconciling  our  minds  to  this  view 
of  the  case  than  to  adopt  the  theory 
of  the  proponents,  that  Mr.  Parish, 
up  to  the  period  of  his  death,  pos- 
sessed an  unclouded  intellect,  retain- 
ing its  pristine  vigor  and  activity, 
was  conscious  of  all  that  was  trans- 
piring around  him,  and  understood 
all  that  was  said  to  him;  compre- 


572          MENTAL  UNSOUNDNESS — BECKER  AND   BOSTON. 


bended  the  minute  details  of  the 
complicated  and  important  business 
transacted  for  seven  years  in  his 
name,  and  often  in  his  presence,  and 
was  capable  of  communicating  and 
did  communicate  his  thoughts  and 
wishes  to  others.  It  is  much  easier 
for  us  to  believe  that  those  who,  we 
doubt  not  honestly,  think  that  Mr. 
Parish  understood  what  was  said  to 
him,  and  that  they  comprehended 
the  operations  of  his  mind,  and  the 
expression  of  his  wishes,  are  mis- 
taken in  their  suppositions,  than  to 
reconcile  his  actions  after  his  attack 
with  the  fact  that  he.  was  still  in  pos- 
session of  all  his  mental  faculties. 

"When  the  means  of  arriving  at 
the  knowledge  whether  Mr.  Parish 
was  understood  or  not  are  examined, 
it  will  be  found  that  they  were  very 
imperfect  and  very  liable  to  misap- 
prehension. It  is  to  be  observed 
also  that  all  who  speak  on  this  sub- 
ject applied  no  test  to  determine  the 
accuracy  of  their  impressions.  They 
saw  Mr.  Parish  mainly  when  in  ap- 
parent good  physical  health,  and 
visited  him  under  the  impression  and 
with  the  preconceived  idea  that  he 
understood  what  was  said  to  him,  and 
they  naturally  construed  the  signs 
and  gestures  made  by  him  as  indica- 
tions of  intelligence  and  responsive 
to  suggestions  made  by  them. 

"But  the  accustomed  mode  of 
conveying  thought  by  speech  was 
denied  to  Mr.  Parish.  Some  of  the 
witnesses  think  he  made  use  of  the 
words  '  yes '  and  '  no  '  and  one  or  two 
other  words;  but  the  weight  of  the 
testimony  greatly  preponderates  in 
favor  of  the  position  that,  after  his 
attack,  he  never  uttered  an  intelli- 
gible word.  This  is  the  testimony 
of  Mr.  Kernochan,  who  saw  him  more 
frequently  than  any  other  person 
other  than  members  of  the  family. 
Mr.  John  Ward,  whose  intercourse 
with  him  was  very  frequent,  says 
distinctly  that  he  never  heard  him 
utter  a  distinct  and  intelligible  word 
after  his  attack.  He  was  therefore 
denied  the  usual  manner  of  commu- 
nicating his  thoughts  and  wishes. 
What  remained  were  signs  and  gest- 
ures and  the  expression  of  his  face, 
to  communicate  with  those  around 
him.  Some  of  the  witnesses  suppose 
that  they  obtained  his  meaning  by 


the  expression  of  his  face.  Now,  it 
is  to  be  remembered  that  the  only 
agents  conveying  such  expressions 
are  the  mouth  and  eyes.  Mr.  Parish 
had  no  use  whatever  of  the  former 
organ  for  this  purpose.  His  face 
was  always  peculiarly  unimpressive 
and  undemonstrative,  but  after  his 
attacks  the  muscles  of  his  mouth 
became  firm  and  rigid.  His  eyes  af- 
forded but  little  aid  in  this  particu- 
lar. He  had  nearly  lost  the  sight  of 
one  of  them,  and  the  other  was 
opaque  by  the  operation  of  cataract, 
and  both  were  generally  covered  by 
spectacles  of  great  convexity.  He 
could,  therefore,  neither  speak  nor 
use  the  muscles  of  his  face  to  give 
expression  to  his  thoughts,  and  the 
gestures  made  by  him  with  the  left 
hand  and  its  fingers  were  irregular, 
unmeaning,  and  contradictory,  and 
often  conceded  to  be  misunderstood. 

"With  these  imperfect  and  uncer- 
tain media  for  ascertaining  the 
thoughts  of  Mr.  Parish,  it  is  doing  no 
injustice  to  any  one  to  assume  that 
they  have  been  mistaken  in  suppos- 
ing that  they  correctly  understood 
him.  We  more  naturally  and  read- 
ily come  to  this  result,  because  we 
find  that  all  who  had  any  intercourse 
with  Mr.  Parish,  on  many  occasions, 
found  great  difficulty  in  understand- 
ing his  wishes  and  thoughts,  if  they 
even  understood  them  at  all;  and 
the  instances  are  frequent  and  clearly 
established  where  he  often  made  af- 
firmative and  negative  motion  of  his 
head  immediately  succeeding  each 
other  to  the  same  question,  leaving 
the  inquirer  in  perplexity  which  he 
really  intended.  The  testimony  is 
conclusive  that  Mrs.  Parish  herself 
frequently  acknowledged  that  she 
could  not  understand  him,  and  there 
is  some  testimony  tending  to  show 
that  on  some  occasions  at  least  she 
thought  he  did  not  at  all  understand 
what  was  said  to  him,  and  that,  in 
her  opinion,  the  effort  would  be  use- 
less to  make  him  understand.  ..." 

"All  the  testimony  shows  that  he 
could  only  indicate  with  his  fingers 
and  hands,  or  by  sounds,  that  he 
wanted  something,  or  that  some- 
thing was  the  matter,  and  which 
motions  or  sounds  were  construed 
by  those  around  him  as  evidences  of 
his  wish  to  put  a  question,  whereupon 


BURDEN   OF   PROOF   AS   TO   INTOXICATION. 


573 


BURDEN  OF  PROOF  AS  TO  INTOXICATION. 

Where  the  defendant  relies  on  intoxication  to  rebut  malice, 
the  burden,  of  proof  of  such  intoxication  is  upon  him.     And 


they  began  to  suggest  various  topics, 
arm  when  they  thought  they  per- 
ceived that  they  had  hit  upon  the 
subject  in  his  mind  they  supposed  he 
wished  to  inquire  about,  they  put 
such  questions  as  suggested  them- 
selves to  them,  and  to  which  they 
supposed  they  had  received  affirma- 
tive or  negative  answers.  If  Mr. 
Parish  had  no  power  to  express  a 
wish  to  destroy  a  will,  it  follows  he 
had  none  to  create  one,  and  the 
manifestations  of  his  wishes  de- 
pended entirely  upon  the  interpreter 
and  the  integrity  of  the  interpreta- 
tion. .  .  ." 

"It  is  thus  seen  that  great  diffi- 
culties and  uncertainty,  to  say  the 
least  of  it,  attended  any  expression 
of  the  thoughts  or  wishes  of  Mr.  Par- 
ish, and  that  a  large  number  of  those 
having  business  or  intercourse  with 
him  utterly  failed  to  attach  or  ob- 
tain any  meaning  to  his  signs,  sounds, 
motions,  or  gestures.  The  natural 
and  obvious  deductions  to  be  made 
from  all  these  facts  and  circumstances 
are  that  Mr.  Parish  had  no  ideas  to 
communicate,  or,  if  he  had  any,  that 
the  means  of  doing  so,  with  certainty 
and  beyond  all  cavil  or  doubt,  were 
denied  to  him.  If  some,  with  the 
aid  of  an  interpreter,  and  always  the 
same,  indulged  the  charitable  thought 
that  they  correctly  apprehended  his 
wishes,  it  is  clear  that  others,  equally 
intelligent,  with  adequate  and  equal 
opportunities  of  judging,  and  with 
the  same  aids,  utterly  failed  to  com- 
prehend him. 

"The  facts  testified  to  are  of  such 
a  character,  giving  full  and  proper 
weight  to  all  the  evidence,  regarding 
it  in  the  most  favorable  light  to  the 
proponents,  as  to  leave  great  doubt 
on  the  mind  that  Mr.  Parish,  after 
his  attack,  was  anything  more  than 
the  creature  of  habit,  the  reflex  of 
the  opinions  and  wishes  of  others, 
the  clay  in  the  hands  of  the  potter, 
to  be  moulded  into  any  shape  or 
form  desired.  His  hearing  was  good; 
the  sight  of  one  of  his  eyes,  although 
impaired,  was  not  seriously  affected, 


and  he  had  the  perfect  use  of  his  left 
hand  and  arm.  Nothing  was  more 
natural,  therefore,  than  that  those 
who  entertained  the  idea  that  he 
possessed  intellect  would  resort  to  the 
obvious  facilities  and  aids  to  enable 
him  to  give  it  expression.  The  power 
of  speech,  it  is  manifest,  was  denied 
to  him;  if  he  possessed  any,  it  was 
exercised  most  imperfectly  and  with 
no  practical  advantage.  This,  the 
obvious  and  usual  method  of  com- 
municating thought,  he  had  not. 
None  could  fail  to  know  that,  if  Mr. 
Parish  had  thoughts,  the  great  and 
controlling  anxiety  of  his  life  would 
be  to  give  them  expression  and  to 
manifest  them  to  his  friends.  Inde- 
pendently of  the  social  gratification 
attendant  upon  such  successful  ef- 
fort, he  had  great  interests  to  man- 
age, a  large  property  to  look  after, 
and  the  accumulation  and  manage- 
ment of  which  had  been  the  absorb- 
ing object  of  his  life.  A  large  estate 
had  accumulated  and  was  accumu- 
lating, which,  if  he  knew  anything, 
he  must  have  known  was  taking  a 
direction,  as  the  proponents  allege, 
hostile  to  his  wishes,  to  those  from 
whom  he  was  alienated,  and  away 
from  the  cherished  objects  of  his 
regard  and  affections.  Every  con- 
ceivable motive  and  consideration 
pressed  upon  him,  therefore,  to  keep 
up  intercourse  with  his  family  and 
friends,  if  the  thing  was  possible. 
No  man  having  the  power  thus  to 
communicate,  and  having  thoughts 
and  wishes  to  express,  thus  circum- 
stanced, would  remain  in  a  living 
grave  for  seven  years  without  mak- 
ing superhuman  efforts  to  be  under- 
stood by  those  around  him.  Those 
friends  rightly  assumed,  therefore, 
that  Mr.  Parish  would  be  most  so- 
licitous to  maintain  intercourse  with 
them,  if  it  were  possible  to  do  so. 
The  first  attempt,  and  the  most  ob- 
vious one,  was  to  have  Mr.  Parish 
write  with  his  left  hand.  He  had 
the  perfect  use  of  it;  could  write 
well;  had  done  it  all  his  life.  We 
all  know  from  experience  how  sim- 


574  MENTAL,  UNSOUNDNKSS— BECKER  AND  BOSTON. 


where  defendant  relies  on  delirium  tremens  as  a  defense,  the  bur- 
den is  on  him  to  show  that  it  existed  at  the  time  of  the  act 


pie  this  process  is,  and  how  easy  of 
execution.  We  can  see  how  effect- 
ual it  would  have  been  in  enabling 
Mr.  Parish  to  express  his  wishes  and 
keep  up  his  intercourse  with  his 
friends,  and  retain  the  management 
and  control  of  his  affairs,  and  make 
such  disposition  of  his  estate  as  he 
then  desired.  This  expedient,  though 
effectually  tried  and  persistently 
urged  upon  Mr.  Parish,  utterly  failed 
of  accomplishing  any  satisfactory 
result.  One  of  the  witnesses  thinks 
that,  on  one  occasion,  he  succeeded 
in  writing  the  word  'horse,'  and  the 
same  witness  says  he  wrote  several 
times  the  word  'wills.'  The  latter 
efforts  were  preserved,  and  are  pro- 
duced and  made  exhibits  in  the  cause. 
An  inspection  of  them  will  show  that 
there  is  no  propriety  in  interpreting 
them  as  'wills'  or  any  other  word. 
They  are  nothing  but  imperfect,  un- 
meaning scrawls,  such  as  any  child 
might  make  who  had  strength  to  hold 
a  pen.  They  unmistakably  show 
that  there  was  no  mind  to  guide  the 
hand,  or,  if  there  was  any,  not  of 
sufficient  force  to  control  the  will  and 
second  its  determinations.  If  Mr. 
Parish  had  any  mind  capable  of  op- 
eration or  of  forming  conclusions,  his 
faculty  of  hearing  remaining  unim- 
paired, it  would  have  been  the  easi- 
est thing  imaginable  for  him  to  have 
written  the  word  'ves'  in  response 
to  any  question  he  desired  to  answer 
in  the  affirmative,  and  the  word  'no' 
to  any  he  desired  to  answer  in  the 
negative.  This  could  have  been 
done  with  much  less  effort  than  was 
required  to  write  the  words  'horse' 
and  'wills.' 

"This  attempt  to  have  Mr.  Parish 
communicate     by     writing     having 

E roved  fruitless,  resort  was  had  to 
lock  letters,  a  very  simple  and  facile 
mode  of  communicating  thought  by 
those  who  are  deprived  of  the  nat- 
ural use  of  doing  so  by  speech.  If 
he  had  any  thoughts  to  communi- 
cate, he  had  thus  at  hand  an  easy, 
certain,  and  effective  means  of  do- 
ing so  with  accuracy  and  beyond  the 
perad  venture  of  mistake.  The  slight- 
est exertion  only  was  required — no 


fatigue  could  ensue.  This  attempt 
also  produced  no  results.  Another 
effort  was  also  made  with  the  letters 
of  the  alphabet  in  another  form,  and 
it  also  was  unsuccessful. 

"A  further  and  different  mode  was 
suggested  by  some  of  his  friends, 
which,  if  the  theory  of  some  of  the 
witnesses  for  the  proponents  is  cor- 
rect, afforded  a  safe,  sure,  and  easy 
method  of  communication.  It  was 
the  use  of  a  dictionary  by  Mr.  Par- 
ish. This  process  had  two  advan- 
tages; it  would  have  enabled  him  to 
suggest  topics  of  inquiry,  and  in- 
sured intelligent  and  certain  answers 
to  the  questions  put  to  him.  A  mo- 
ment's reflection  will  satisfy  any 
mind  that  no  process  could  have  been 
devised  more  certain  and  satisfactory 
than  this  for  holding  intercourse  with 
an  intelligent  mind,  denied  to  it  the 
power  of  giving  expressions  to  its 
emotions  and  thoughts  in  the  form 
of  speech.  No  results  were  obtained 
from  this  source,  and  the  inference 
from  the  testimony  is  that  no  efforts 
were  made  to  afford  Mr.  Parish  the 
opportunity  of  trying  this  method  of 
communicating  his  thoughts. 

"And  this  omission  greatly 
strengthens  the  impression  conveyed 
by  the  testimony  that  he  did  not  and 
could  not  read  at  all  after  his  attack. 
It  is  true  that  he  was  seen  to  look  at 
newspapers,  accounts,  ledgers,  check- 
books, notes,  etc.;  but  that  his  mind 
took  in  and  comprehended  what  his 
visual  organs  discerned,  the  evidence 
in  this  case  will  not  warrant  us  in  as- 
suming. It  is  natural  to  suppose 
that,  if  Mr.  Parish  could  read,  he 
would  have  desired  himself  to  peruse 
these  codicils,  and  they  would  have 
been  placed  before  him  for  that  pur- 
pose; and  on  the  assumption  that  he 
could,  the  inquiry  presses  upon  us, 
Why  were  they  not  given  him  for 
perusal?  If  it  had  been  established 
that  he  could  read  intelligently,  and 
it  had  appeared  that  these  codicils 
had  been  read  over  by  him,  it  would 
have  furnished  much  more  satisfac- 
tory evidence  than  any  we  now  have 
that  they  expressed  his  wishes.  If 
he  could  read,  and  had  intellect  to 


BURDEN  OF  PROOF  AS  TO  INTOXICATION. 


575 


charged.1  Where  a  testatrix  was  intemperate  and  was  very 
stupid  on  the  day  she  made  her  will,  before  making  it,  but  the 
peraon  who  drew  it  testified  that  she  was  competent  and  con- 
scious, and  subsequently  she  ratified  the  will  by  a  codicil,  and 


understand  what  his  eyes  beheld, 
why  is  it  that  there  is  an  entire  ab- 
sence of  evidence  that  he  was  ever 
seen  reading,  with  apparent  under- 
standing, a  letter?  of  his  ever  having 
been  seen,  on  any  one  occasion  dur- 
ing his  long  confinement,  with  a  book 
in  his  hand  perusing  it?  Is  it  to  be 
believed  that,  if  Mr.  Parish  could 
read,  that  he  would  not,  during  those 
whole  seven  years,  when  he  was  al- 
most entirely  excluded  from  inter- 
course with  the  world,  have  once  re- 
sorted to  books  for  amusement  and 
instruction?  It  is  incredible.  We 
all  know  that  no  greater  solace  is 
available  to  an  invalid,  and  none 
more  universally  sought  after.  They 
are  companions  always  at  hand,  of 
the  most  soothing,  agreeable,  and 
entertaining  character,  and  it  can- 
not be  doubted  that,  if  Mr.  Parish 
could  read  and  had  intellecutal  capac- 
ity sufficient  to  understand  what  he 
read,  that  books  would  have  been  his 
daily  and  constant  companions. 

"These  views  press  themselves  on 
us  with  great  force,  if  we  concur  in 
the  opinion  of  Dr.  Taylor  that  Mr. 
Parish  after  his  attack  became  a  de- 
vout and  sincere  Christian,  and  was 
anxiously  and  inquiringly  seeking  to 
make  his  peace  with  his  Maker,  whom 
he  must  nave  expected  soon  to  meet. 
Where  would  an  intelligent  Christian 
sooner  turn  for  advice,  direction,  and 
consolation  than  to  the  Bible?  This 
book,  we  all  know,  is  printed  in  type, 
so  that  all,  of  any  degree  of  vision, 
can  peruse  it.  Nay,  those  totally  de- 
prived of  sight  are  not  precluded 
from  resorting  to  it  for  comfort  and 
direction.  We  have  looked  in  vain 
through  the  testimony  in  this  case 
to  find  any  evidence  that  Mr.  Parish 
ever  read  his  Bible,  that  one  was  ever 
procured  for  him,  or  that  any  effort 
was  ever  made  to  induce  him  to 
peruse  it,  or  that  he  ever  indicated 
a  wish  to  do  so. 

"To  what  result  does  this  view  of 
the  facts  and  circumstances  in  this 
case,  diverted  to  and  commented  on, 


lead  the  mind?  On  a  careful  con- 
sideration of  them  all,  with  a  most 
anxious  desire  to  arrive  at  a  just  and 
correct  conclusion,  we  are  clearly  of 
the  opinion  that  the  attack  of  Mr. 
Parish  on  the  19th  of  July,  1849,  ex- 
tinguished his  intellectual  powers, 
so  obliterated  and  blotted  out  his 
mental  faculties  that  after  that  pe- 
riod he  was  not  a  man  of  sound  mind 
and  memory  within  the  meaning  and 
language  of  the  statutes,  and  was 
therefore  incompetent  to  make  a 
will,  and  that  the  codicils  of  Septem- 
ber, 1853,  and  of  June,  1854,  were 
not  his  will,  and  formed  no  part 
thereof." 

Compare  with  the  Parish  case 
Mendenhall  v.  Tungate,  15  Ky.  Law 
R.,  639;  24  S.  W.  Rep.,  431,  where 
the  incompetent  testatrix  was  para- 
lyzed, bedridden,  and  speechless  ex- 
cept to  say  "yes,"  "no  and  "well." 

1  Gate  v.  Hill,  46  La.  Ann.  27,  14 
So.  Rep.  294;  Commonwealth  v. 
Woodley,  166  Pa.  St.  463,  31  Atl. 
Rep.  202. 

See  Lang  v.  Ingalls  Zinc  Co. 
(Term.  Civ.  Ap.),  49  S.W.  Rep.  288; 
Fidelity  &  Casualty  Co.  v.  Chambers 
(Va.).  24  S.  E.  Rep.  896,  for  cases 
where  there  was  a  conflict  of  evi- 
dence upon  the  fact  of  intoxication. 

See  Maynard  v.  State  (Tex.  Cr. 
App.),  39  S.  W.  Rep.  667,  for  illus- 
tration of  instruction  where  there 
was  merely  evidence  that  accused 
had  been  drinking  and  subsequently 
failed  to  remember. 

See  People  v.  Kloss,  115  Cal.  567, 
47  Pac.  459,  to  effect  that  evidence 
of  drinking  the  day  previous  to  of- 
fence does  not  call  for  instruction  on 
legal  effect  of  intoxication. 

See  In  re  Woolsey's  Will  (Surr.),  17 
Misc.  Rep.  547,  41  N.  Y.  Supp.  263 
— that  testator  drank  on  day  he 
made  will  and  that  witness  delivered 
to  him  three  bottles  of  whiskey  a 
few  hours  before  he  executed  the 
will  does  not  overcome  testimony  of 
other  witnesses  that  he  was  sober 
when  he  made  the  will. 


576          MENTAL  UNSOUNDNESS — BECKER  AND  BOSTON. 

there  was  no  evidence  of  her  condition  when  she  made  the  codi- 
cil, it  was  held  that  there  was  not  in  the  evidence  sufficient  to 
rebut  the  presumptions  arising  from  evidence  of  due  attestation 
and  execution,  or  to  warrant  sending  the  issue  to  the  jury.1 

1  Cook  v.  White,  167  N.  Y.  588,  See  also  Baxter  v.  Baxter  (N.  Y.), 

60  N.  E.  R.  1109.  76  Hun,  98,  27  N.  Y.  S.,  834  (1894); 

State  v.  Kavanaugh  (Del.),  53  Buckey  v.  Buckey,  38  W.  Va.  168, 

Atl.  R.  335.  18  S.  E.  383. 


CARE  AND  CUSTODY 


OF 


INCOMPETENT  PERSONS 

AND  THEIR  ESTATES. 


BY 

GOODWIN  BROWN, 

Formerly  New   York  State  Commissioner  in  Lunacy. 


SECOND   EDITION 
REVISED   BY 

ALFRED  L.   BECKER, 

Of  the  Buffalo,  N.  I'.,  Bar. 


nr— 37 


CARE  AND  CUSTODY  OF  INCOMPETENT 
PERSONS  AND  THEIR  ESTATES. 

THE  common  law  recognizes  four  forms  of  insanity,  viz.: 
lunacy,  idiocy,  accidental  loss  of  understanding,  and  deprivation 
of  understanding  by  the  subject's  voluntary  acts,  as  habitual 
drunkenness.  Persons  suffering  from  insanity  are  deemed  by 
the  law  incapable  of  managing  their  own  affairs.  When  a  per- 
son becomes  mentally  disabled,  from  whatever  cause  the  disabil- 
ity may  arise,  whether  from  sickness,  vice,  casualty,  or  old  age, 
he  is  a  fit  and  necessary  subject  of  guardianship  and  protection.1 

It  may  safely  be  assumed  that  madness  subsists  in  every  vari- 
ety of  shape  and  degree.  It  subsists  in  the  maniac  chained  to 
the  floor ;  in  the  patient  afflicted  with  mental  aberration  on  cer- 
tain subjects,  or  on  a  certain  subject  only,  and  in  respect  to  such 
even  never  betraying  himself  in  violence  or  outrage.  The  afflic- 
tion is  the  same  in  species  in  both  cases,  the  difference  being 
only  in  degree.2  "What  constitutes  such  a  degree  of  insanity  as  to 
justify  the  intervention  of  the  law  in  protecting  the  property  and 
person  of  the  subject  and  in  restraining  his  liberty,  is  to  be  deter- 
mined by  the  legislature  and  the  courts  in  their  wise  discretion. 

The  term  non  compos  mentis  is  generic  and  was  regarded  as  of 
absolute  significance,  denoting  a  total  deprivation  of  sense.  The 
court  of  chancery  in  England  applying  this  meaning  would  not 
issue  commissions  de  lunatico  inquirendo  unless  the  subject  was 
insane  within  the  technical  definition  prescribed  by  law.3  This 
restricted  meaning  was  followed  in  the  earlier  cases  in  the  United 
States.4  In  the  more  modern  cases  these  words  are  held  to  in- 
clude not  only  cases  of  idiocy  and  lunacy,  as  defined  at  common 
law,  but  all  cases  of  imbecility  where  the  subject  is  incapable  of 
conducting  the  ordinary  affairs  of  life  and  liable  to  suffer  in  per- 
son and  property  from  his  own  weaknesses.5 

1  In  re  Barker,  2  Johns.  Ch.  (N.  Y.),          '  Case   of   Beaumont,    1    Wharton 
232.  (Pa.),  52. 

*  Deer  v.  Clark,  3  Add.  Ecc.,  79.  6  Hamrick  v.  State,  34  N.  E.,3;  134 

*Case  of  Barmley,  3  Atk.,  173.  Ind.,  324. 

579 


580 


INCOMPETENT  PERSONS — BROWN  AND  BECKER. 


Who  Are  Subject  to  Adjudication  as  Incompetent. 

— The  legal  test  is  the  capacity  to  understand  the  nature  and 
effect  of  ordinary  transactions.1  In  McElroy's  case 2  the  Supreme 
Court  of  Pennsylvania  held  that  the  question  for  the  jury  on  a 
traverse  of  an  inquisition  finding  the  party  non  compos  mentis  was 
whether  the  inind  is  deranged  to  such  an  extent  as  to  disqualify 
the  traverser  from  conducting  himself  with  personal  safety  to 
himself  and  others,  and  from  managing  his  own  affairs  and  dis- 
charging his  relative  duties.  This  rule  has  been  generally 
adopted  in  the  more  recent  cases  in  the  United  States.3  In  New 


1  Ex  parte  Cranmer,  12  Vesey,  Jr., 
454. 

'  6  W.  and  S.  (Pa.),  451. 

3  See  Carmichael,  in  re,  36  Ala.,  514; 
Rowden  v.  Rowden,  28  Ala.,  565; 
Hovey  v.  Chase,  52  Maine,  304;  Blan- 
chard  v.  Nestle,  3  Denio  (N.  Y.),  47; 
Stanton  v.  Wetherwax,  16  Barb.  (N. 
Y.),  259;  Rodgers,  in  re,  9  Abb.  N. 
C.  (N.  Y.),  141;  Greenwadev.  Green- 
wade,  4.3  Md.,  313;  Ken  worth  v.  Will- 
iams, 5  Ind.,  375;  Cochran  v.  Ams- 
den,  104  Md.,  282;  Snyder  v.  Snyder 
(111.),  31  N.  E.,  303;  Hamrick  v. 
State,  34  N.  E.  (Ind.),  3;  134  Ind., 
324;  Emerick  v.  Ernerick,  49  N.  W. 
(Iowa),  1,017;  Owings'  case,  1  Bland, 
386;  17  Am.  Dec.,  311;  Johnson  v. 
Safe  Dep.  &  Tr.  Co.,  104  Md.,  460; 
65  Atl.,  333;  Gray  v.  Obear,  59  Ga., 
675;  Re  Lindsey,  43  N.  J.  Eq.,  9; 
10  Atl.,  549;  Green  wade  v.  Green- 
wade,  43  Md.,  315;  McCamman  v. 
Cunningham,  108  Ind.,  545;  9  N.  E., 
455. 

Mere  weakness  of  mind,  not 
amounting  to  lunacy,  idiocy,  or  im- 
becility, will  not  justify  an  adjudica- 
tion of  incompetency.  In  re  Rush, 
53  N.  Y.  Supp.,  581;  in  re  Smith,  12 
Pa.  Super.  Ct.,  649;  in  re  Wells,  67 
N.  Y.  Supp.,  631.  But  where  the 
statute  provides  for  the  appointment 
of  a  conservator  of  one  insane  and 
incapable  to  manage  his  affairs  prop- 
erly, a  case  is  made  out  if  one  be  so 
unsound  mentally  as  to  be  unable  to 
manage  his  property,  even  though  he 
be  not  absolutely  demented.  Shapter 
v.  Pillar,  63  Pac.  R.  (Colo.),  302. 
And  where  a  statute  authorizes  the 
appointment  of  a  guardian  for  an  im- 
becile, the  appointment  may  be  made 


where  one  has  become  so  infirm 
mentally  that  he  cannot  manage  his 
affairs  with  sufficient  capacity  to  pre- 
serve his  property.  In  re  Emswiler, 
8  Ohio  N.  P.,  132;  11  Ohio  S.  & 
C.  P.  Dec.,  10.  The  evidence  is 
sufficient  to  authorize  the  appoint- 
ment of  a  committee  when  it  shows 
timidity,  weakness  of  mind,  inar- 
ticulateness of  utterance,  inability  to 
multiply  simple  numbers,  waste  of 
estate.  Calderon  v.  Martin,  50  La. 
Ann.,  1153;  23  So.  R.,  909;  France  v. 
Frantz,  4  Ohio  N.  P.,  278.  See  also 
Commonwealth  v.  Hays,  195  Pa.  St., 
270;  45  Atl.  R.,  728;  in  re  Smith,  12 
Pa.  Super.  Ct.,  649;  Taylor  v.  Moore, 
23  Ky.  L.  R.,  1572;  65  S.  W.  R.,  612; 
"  What  Should  Be  the  Legal  Require- 
ments for  the  Commitment  of  Insane 
Persons  to  Hospitals  for  the  Care  of 
the  Insane?  "  63  Albany  Law  Jour., 
441. 

HABITUAL  INTEMPERANCE. —  The 
statutes  usually  provide  also  for  the 
adjudication  and  guardianship  of 
habitually  intemperate  persons.  See 
Tome  v.  Stump,  42  Atl.  R.,  902;  89 
Md.,  264;  in  re  Tarr's  Estate,  10  Pa. 
Super.  Ct.,  554.  In  some  States  pro- 
vision is  made  for  the  commitment  of 
inebriates  for  treatment.  E.g.,  Mas- 
sachusetts Pub.  Stats.,  c.  87,  §§12, 
13;  St.  1889,  c.  414,  §  7.  Commit- 
ment of  female  inebriates  to  refor- 
matory. New  York  City  Consol.  Act, 
§  1,466,  subd.  1.  In  such  cases  the 
method  of  conducting  the  inquiry  is 
a  matter  of  local  practice.  See  Niven 
v.  Boland,  177  Mass.,  11;  58  N.  E.  R., 
282.  A  habitual  drunkard  has  been 
judicially  defined  as  one  who  is  given 
to  inebriety  or  excessive  use  of  intox- 


WHO   ARE    SUBJECT   TO    ADJUDICATION   AS   INCOMPETENT.      581 

York  it  seems  that  a  committee  of  property  is  not  necessarily  to 
be  appointed  in  every  case  where  the  owner  is  not  competent  to 
manage  some  particular  business  enterprise;  the  question  is 
whether  he  is  able  to  manage  the  ordinary  aff airs  of  business  and 
life.1  And  the  appointment  of  a  committee  rests  in  the  sound 
discretion  of  the  court ;  not  every  case  of  mental  weakness  or 
impaired  intellectual  power  will  justify  the  court  in  assuming  the 
care  of  the  owner's  property.2 

The  jurisdiction  over  the  person  and  property  of  insane  per- 
sons is  vested  in  the  State  and  rests  upon  its  duty  to  protect  the 
person  and  property  of  those  who,  because  of  weakness,  are  un- 
able to  care  for  themselves,  and  to  prevent  injury  to  the  com- 
munity from  the  acts  of  those  not  under  the  guidance  of  reason. 
This  jurisdiction  has  been  delegated  in  most  instances  by  express 
provision  of  statute  to  the  courts. 

Such  Statutes  are  Constitutional. — In  Colorado  the  State  Consti- 
tution contains  a  guaranty  of  the  right  to  acquire  and  possess 
property ;  a  statutory  provision  for  the  appointment  of  a  con- 
servator of  the  property  of  one  so  mentally  unsound  as  to  be  un- 
able properly  to  manage  his  property  has  been  held  not  to  be 
in  derogation  of  this  guaranty.3 

The  assumption  by  the  courts  of  the  care  and  management  of 
a  lunatic's  property  does  not  deprive  him  of  his  property,  with- 
in the  constitutional   prohibition  against  deprivation  of  prop 
erty  without  due  process  of  law,  and  therefore  no  jury  trial  is 
requisite.4 

Such  authority  usually  includes  the  power  to  appoint  a  com- 
mittee of  the  estate  within  a  court's  jurisdiction,  of  a  non-resi- 
dent lunatic;5  and  this  exercise  of  judicial  power  has  been  sus- 
tained by  the  courts  as  constitutional.6 

icating  drinks,  and  who  has,  by  fre-  5  Vide  statutes  digested  infra,  pp. 

quent  indulgence,  lost  the  power  or  G'Jfi  ct  seq. 

will  to  control  his  appetite  for  them.  *  Appointment  of  receiver  for  estate 

Litton  v.  Grand  Lodge  A.O.U.W.,  84  of  non-resident.     In  re  Barteline,  34 

Mo.  App.,  208.  Misc.  R.  (N.  Y.),  131,  9  N.  Y.  Ann. 

« In  re  Williams,  24  App.  Div..  247;  Cas.,  448,  69  N.  Y.  Supp.,  468;    Beall 

48  N.  Y.  Supp.,  475;    affd,  157  N.  Y.,  v.  Stokes,  95  Ga.,  357,  22  S.  E.  R., 

704;   52  N.  E.  R.,  1,126.  637;  due  process  of  law  in  such  cases,  , 

2/n  re  Burke,  HON.  Y.  Supp.,  1004;  Nobles  v.  Georgia,  168  Mass.,  398. 
125  App.  Div.,  889;  Matter  of  Clark,  Appointment  of  guardian  of  non- 
175  N.  Y.,  139;  67  N.  E.  R..  212.  resident  lunatic.  Wallis  v.  Brown 

1  Shapter  v.  Pillar, 63  Pac.  R.,  302.  (N.  J.),  52  All.  R.,  475.    See  "  Foreign 

4  Sporza  v.  German  Savings  Bank,  Curators  of  Lunatics  and  the  English 

192  N.  Y.,  8;  84  N.  E.  R.,  406.  Courts,"  36  Law  J.,  480. 


582  INCOMPETENT  PERSONS — BROWN  AND   BECKER. 

In  England  the  King,  as  parens  patrice,  is  considered  to  be  in- 
vested with  the  care  and  control  of  all  his  subjects,  who  by  reason 
of  imbecility  or  want  of  understanding  are  incapable  of  taking 
care  of  themselves.  This  care  and  custody,  as  executed  by  him, 
falls  under  the  direction  of  the  court  of  chancery,  by  virtue  of  a 
standing  warrant  to  the  Lord  Chancellor  under  the  sign  manual 
of  the  King.1  In  the  United  States  the  care  and  custody  of  the 
insane,  if  not  otherwise  specially  and  expressly  provided  for,  are 
vested  in  the  equity  courts.2  If  such  care  and  custody  are  vested 
by  statute  in  some  other  tribunal,  it  is  a  much  discussed  question 
whether  the  chancery  courts  do  not  possess  a  concurrent  juris- 
diction. 

In  New  York  the  statute  gave  the  care  and  custody  of  the  per- 
son and  estates  of  lunatics,  idiots,  and  habitual  drunkards,  with- 
out any  restriction,  to  the  court  of  chancery.  It  is  now  vested 
absolutely  in  the  supreme  court.  In  Pennsylvania  the  authority 
of  the  courts  over  lunatics  is  held  not  to  be  derived  from  the 
statutes  conferring  equity  jurisdiction  on  the  courts,  but  from  the 
provisions  of  the  constitution  of  the  commonwealth.  In  South 
Carolina  the  care  exercised  by  the  court  of  chancery  over  the  per- 
sons and  property  of  insane  persons  is  considered  as  a  branch  of 
the  equity  jurisdiction  proper,  and  not,  as  in  England,  distinct 
from  its  functions  as  a  court  of  equity.3  In  New  Jersey  the  con- 
trol of  insane  persons  and  their  estates  is  committed  by  statute  to 
an  Orphan's  Court;  and  in  many  States  the  entire  jurisdiction  is 
by  statute  or  constitutional  provision  entrusted  to  the  court  of 
probate.  However  this  jurisdiction  may  be  exercised,  there  is 
no  departure  from  the  rules  and  principles  adopted  in  like  cases 
by  the  courts  of  chancery ;  and  very  generally  the  character  of 
the  committee,  guardian,  and  conservator  in  the  American  courts 
is  assimilated  to  that  of  the  committee  under  the  English  system.4 
In  the  determination  of  matters  relating  to  such  care  and  custody, 
where  rules  of  law  and  equity  are  conflicting,  the  equitable  rules 
governing  the  case  will  control.5 

A  much  wider  jurisdiction  over  the  property  and  estates  of 

1  Eyre  v.  Shaftsbury,  2  P.  Wms.,          4Hovey  v.  Harmon,  49  Maine,  269; 
118;  Burfordv.  Denthall,  2Atk.,553.      Wheeler  v.  The  State,  34  Ohio  St., 

2  Sporza  v.  German  Savings  Bank,      394. 

192  N.  Y.,  8,  15;   84  N.  E.  R.,  406;  5 Richards,  ex  parte,  Brev.  Vol.  B. 

Matter  of  Tracy,  1  Paige  (N.Y.),  580;  (S.  C.),  375;  Campbell  v.  Campbell, 

Mormon  Church  v.  U.  S.,  136  U.  S.,  1.  39  Ala.,  312. 

3  Ashley  v.  Holman,  15  S.  C.,  97.  Shapter  v.  Pillar,  63  Pac.  R.,  302. 


WHO   ARE  SUBJECT  TO  ADJUDICATION  AS  INCOMPETENT.      583 

insane  persons  obtains  in  the  American  courts  than  in  the  Eng- 
lish courts  of  chancery ;  for  while  the  possession  vested  in  the 
committee  appointed  by  the  latter  is  that  of  a  mere  bailiff  or 
agent,  so  that  in  the  absence  of  express  statutory  authority  neither 
the  court  nor  the  committee  can  alienate  the  property  of  the 
lunatic  or  satisfy  the  claims  of  his  creditors,  the  courts  in  several 
of  the  United  States  have  exclusive  jurisdiction  both  to  sell  the 
lunatic's  property  and  to  determine  and  satisfy  his  just  debts. 
In  many  States  it  is  held  that  the  courts  of  equity  have  an  inher- 
ent power  to  order  the  sale  of  the  personal  and  real  estate  of  an 
insane  person.1 

In  the  States  where  the  care  and  custody  of  the  insane  are 
committed  by  statute  to  the  courts  of  probate  and  exercised  by 
committees,  guardians,  or  curators  appointed  by  the  court,  the 
power  of  the  court  in  respect  to  the  property  of  the  insane  ward 
is  generally  the  same  as  that  exercised  over  the  estates  of  minors ; 
and  the  court  may,  upon  the  petition  of  the  guardian,  upon  due 
notice  and  for  good  cause  shown,  order  a  sale  of  so  much  of  the 
insane  person's  property  as  may  be  necessary  for  the  payment  of 
his  debts  or  for  the  support  and  maintenance  of  himself  or  his 
family.  This  may  also  be  done  where  it  is  shown  to  the  satisfac- 
tion of  the  court  that  his  real  estate  or  interests  therein  may 
profitably  be  sold  and  the  proceeds  invested  in  productive  per- 
sonal property.  This  can  only  be  done  upon  the  application  to 
the  court  of  the  guardian,  committee,  or  trustee.2 

"Where  there  is  no  general  jurisdiction  conferred  upon  the 
court  by  statute  or  constitution,  the  jurisdiction  is  to  be  regarded 
as  purely  legislative,  limited  and  special ;  that  is,  as  far  as  the 
statute  law  confers  jurisdiction  on  the  court  it  may  go,  but  no 
further.3 

In  New  York  the  exclusive  care  and  custody  of  the  estates 
and  persons  of  lunatics,  idiots,  and  habitual  drunkards  is  vested 
in  the  supreme  court.  Hence  there  arises  a  special  and  exclusive 
jurisdiction  of  the  court,  and  it  is  charged  with  the  duty  of  pro- 
viding for  the  payment  of  the  insane  person's  debts  out  of  his 
estate,  and  of  seeing  that  the  equitable  and  legal  rights  of  his 
creditors  are  protected  and  enforced.  These  rights  are  subject 

'  Dodge  v.  Cole  (111.),  37  Am.  Rep.,  '  Modawell  v.  Holmes,  40  Ala.,  291; 

11;    Palmer  v.  Garland,  81  Va.,  444.  State  v.  Wilcox,  24  Minn.,  143;  North 

3  Hamilton  v.  Traber,  27  At.  (Md.),  v.  Joslin,  59  Mich.,  624. 
229. 


584  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

to  the  prior  rights  of  the  maintenance  of  the  subject  and  his  im- 
mediate family.  In  many  of  the  States  it  is  held  that  the  estate 
of  a  lunatic  cannot  be  subjected  to  legal  process,  for  debts  either 
incurred  for  his  support  as  a  lunatic  or  existing  prior  to  his 
lunacy,  but  that  his  estate  is  to  be  administered  only  by  order  of 
the  court  having  lunacy  jurisdiction.1  But  in  Pennsylvania  any 
creditor  of  a  lunatic  may  litigate  his  claim  in  a  court  of  law,  after 
due  notice  given  to  the  committee,  and  such  a  suit  brought  in 
good  faith  will  be  conclusive  as  to  the  amount  and  merit  of  such 
claim.  But  the  creditor,  having  obtained  judgment,  may  not 
levy  execution  upon  the  insane  person's  property  in  the  hands  of 
the  committee,  his  sole  remedy  being  an  application  to  the  court, 
which  will  order  the  committee  to  raise  and  pay  over  the  funds 
necessary  to  satisfy  the  judgment.2 

THE   INQUISITION. 

In  England  and  the  United  States  it  is  the  ordinary  practice 
to  issue  a  commission  out  of  the  court  having  jurisdiction  in  the 
nature  of  a  writ  de  lunatico  inquirendo,  to  inquire  into  a  case  of 
alleged  insanity.  The  issuing  of  the  commission  is  at  all  times 
in  the  discretion  of  the  court.  If  the  procedure  is  prescribed  by 
statute,  it  must  be  strictly  followed.3  Ordinarily  the  court  does 
not  acquire  jurisdiction  to  adjudicate  the  question  of  insanity 
until  the  requirements  of  the  statute  preliminary  to  the  grant- 
ing of  the  inquest  are  met.4  In  Delaware  a  different  rule  seems 
to  govern.  In  that  State  the  court  of  chancery  by  special  legisla- 
tion assumes  jurisdiction  of  an  alleged  lunatic  from  the  inception 
of  the  proceedings  by  which  his  sanity  or  insanity  is  to  be  finally 
and  definitely  ascertained,  and  has  power  to  restrain  him  from 
exercising  control  over  his  property  pending  the  proceedings. 
The  presumption  of  sanity  which  obtains  in  such  proceedings 
must  remain  in  abeyance  so  far  as  it  relates  to  the  temporary 
restraint  of  the  personal  liberty  of  the  alleged  insane  person.5 

NOTICE. — In  most  of  the  States  it  is  generally  held  that  the 
party  alleged  to  be  insane  has  the  right  to  have  notice  of,  and  be 
present  at,  the  proceedings  instituted  for  determining  the  issue 

1  Smith  v.  Pipkin,  77  N.  C.,  569;  3  State  v.  Beard,  47  Mo.,  301. 

Balke  ?>.  Rerpass,  ibid.,  193.  4  Hallet  v.  Patrick,  49  Cal.,  590. 

'Kcksine's   Estate,    1   Clark,   224;  s  Re  Harris  (Del.),  28  Atl.,  329. 
Guthrie's  Appeal,  16  Penn.  St.,  321. 


THE  INQUISITION.  585 

of  insanity.1  If  there  are  any  circumstances  in  the  case  which 
render  it  improper  or  unsafe,  as  in  some  cases  of  furious  madness, 
the  facts  should  be  stated  in  the  application  to  the  court  so  that 
a  provision  may  be  inserted  in  the  commission  dispensing  with 
the  necessity  of  the  notice.2  A  verbal  statement  to  the  alleged 
lunatic,  that  an  application  for  the  appointment  of  a  commission 
is  to  be  made  at  a  certain  time,  is  not  sufficient  notice  to  him.3 
In  South  Carolina  the  courts,  following  the  English  precedents, 
held  that  it  was  not  necessary  that  the  alleged  lunatic  have  notice 
of  the  inquisition.  But  the  courts  of  that  State  also  adopt  the 
English  rule  that  the  alleged  lunatic  has  at  all  times  the  right  to 
traverse  the  inquisition.4  In  Pennsylvania  the  same  rules  seem 
to  be  adopted,  the  commission  and  jury  not  being  required  to  ex- 
amine the  party,  although  when  practicable  the  jury  is  required 
to  see  him  and  if  possible  hear  his  conversation,  and  he  is  per- 
mitted to  be  present  and  have  all  the  rights  of  a  defendant.5  In 
Kentucky  the  statute  requires  all  inquisitions  to  be  made  in  open 
court,  and  that  the  idiot  or  lunatic  shall  be  brought  into  court 
for  the  inspection  and  examination  of  the  jurors,  unless  it  ap- 
pears by  affidavit  that  he  cannot  be  controlled  or  that  ill  health 
forbids  it.  And  it  is  held  that  when  the  lunatic  is  so  brought 
into  court  and  trial  had,  the  necessity  of  either  notice  or  writ  is 
dispensed  with.6  Notice  of  an  application  for  a  commission  de 
idiota  inquirendo  need  not  be  given  the  alleged  idiot,  where  notice 
of  the  time  and  place  of  the  execution  of  the  commission  is 
given.7  But  in  Morton  v.  Sims,  64  Ga.,  298,  it  was  held  that  a 
commission  issued  without  a  requisite  notice  and  neither  preceded 
nor  followed  by  the  appointment  of  a  guardian  ad  litem  is  not 
aided  by  the  presence  of  the  imbecile  and  his  representation  by 
counsel,  even  where  the  counsel  gives  his  consent  to  the  judgment 
appointing  the  guardian,  it  appearing  that  the  commission  was 
executed  on  the  next  day  after  it  was  issued  and  that  the  judg- 
ment followed  immediately.  The  object  of  the  notice  is  that 
there  may  be  due  warning  to  make  objection  for  legal  cause  to 

1  In  re  Tracy,  1  Paige  (N.  Y.),  580;  8  McAfee  v.  Commonwealth,  3  B. 

in  re  Russell,  1  Barb.  Ch.  (N.  Y.),  38.  Mon.,  305;  Lackey  v.  Lackey,  8  B. 

'Huttsv.  Hutts,  62  Ind.,214;  Van  Mon.,  107;  Nyce  v.  Hamilton,  90 

Auken's  Case,  2  Stock.  (N.  J.),  186.  Ind.,  417;  in  re  Demeet,  27  Hun  (N. 

3  In  re  Blewitt,  131  N.  Y.,  541.  Y.),  480. 

*  Medlock  v.  Cogburn,  vol.  B,  Rich.  7  Gridlcy    v.    St.    Francis    Xavier 
En.,  477.  College,  137  N.  Y.,  327.  Butc/.Oster 

*  In  re  Lincoln,  1  Brewster,  392.  v.  Meyer  (Ky.),  67  S.  W.  R.,  851. 


586 


INCOMPETENT  PERSONS — BROWN  AND  BECKER. 


the  commission  or  any  of  the  commissioners,  as  well  as  to  prepare 
for  introducing  evidence  on  the  main  question.  The  notice  must 
be  served  upon  the  party  in  person,  and  it  is  insufficient  for  the 
attorney  appointed  to  defend  the  party,  or  a  guardian  ad  litem, 
to  accept  service  of  it.1 

In  those  States  in  which  the  jurisdiction  over  insane  persons 
is  committed  to  the  probate  court,  the  statute  generally  requires 
a  notice  to  be  served  upon  the  order  of  the  court  in  a  manner 
similar  to  that  provided  in  the  case  of  a  minor. 

It  is  largely  within  the  discretion  of  the  court  as  to  what  par- 
ties other  than  the  alleged  lunatic  shall  have  notice  of  the  com- 
mission and  be  entitled  to  be  present  at  its  execution.2  Such 
relatives  and  friends  as  favor  a  finding  against  the  alleged  lunatic 
are  not  competent  to  receive  such  notice.3 

A  failure  to  give  notice  of  an  application  for  a  commission  to 
one  of  the  heirs  of  the  lunatic  is  at  most  only  an  irregularity,  as 
he  has  no  absolute  right  to  notice.4  In  some  cases  want  of 
notice  to  the  alleged  incompetent  person  has  been  held  to  ren- 
der the  proceedings  void.5  He  should  be  served  with  notice8 


1  Morton    v.    Sims,    64    Ga.,    298; 
Chase  v.  Pellerin,  16  La.,  63;  Germon 
v.   Dubois,  23  La.   Ann.,   26;    in  re 
Pettit,  2  Paige  (N.  Y.),  174. 

2  In  re  Nesbitt,  2  Phillips,  245. 

3  Ex  parte  Hinchman,  4  Clark  (Pa.), 
184. 

*  In  re  Rodgers,  9  Abb.  N.  C.  (N. 
Y.),  141. 

6  McCury  v.  Hooper,  12  Ala.,  823; 
Eslava  v.  Lepretre,  21  Ala.,  514; 
Molton  v.  Henderson,  62  Ala.,  426; 
Airington  v.  Airington,  32  Ark.,  674; 
Commonwealth,  ex  rel.,  v.  Groh,  10 
Pa.  Co.  Ct.,  557;  Martin  v.  Mott- 
singer  (Ind.),  30  N.  E.,  523;  State  v. 
Billings,  55  Minn.,  467, 57  N.  W.  Rep., 
794;  French  v.  State,  55  N.  W.  Rep., 
566,  85  Wis.,  400;  South  Perm.  Oil  Co. 
v.  Mclntire,  44  W.  Va.,  296,  28  S.  E. 
Rep.,  922;  in  re  Dowdell,  169  Mass., 
387,  47  N.  E.  Rep.,  1033.  As  to 
equal  protection  of  the  laws,  in  Nobles 
v.  State  of  Georgia,  168  U.  S.,  398,  it 
was  held  that  after  conviction  of 
crime  the  method  of  inquiring  into 
insanity,  at  common  law,  addressed 
itself  to  the  judicial  discretion,  and 
therefore  the  method  is  now  purely 
a  matter  for  legislative  regulation, 
and  a  statute  authorizing  an  inquiry 


not  in  the  presence  of  court  or  judge 
is  not  a  denial  of  due  process  of  law. 
See  also  Porter  v.  Ritch,  70  Conn., 
235,  39  L.  R.  A.,  353,  39  Atl.  Rep., 
169. 

Cf.  State  v.  Judge  of  Eighth  Jud. 
Dist.,  48  La.  Ann.,  503;  19  So.  Rep., 
475,  respecting  inquiry  into  insanity 
after  conviction;  French  v.  State,  93 
Wis.,  325,  67  N.  W.  Rep.,  706,  re- 
specting constitutionality  of  prelimi- 
nary trial  of  question  of  sanity  at  time 
of  trial. 

Cf.  contra,  Kimball  v.  Fisk,  39  N. 
H.,  110. 

6  Allis  v.  Morton,  4  Gray  (Mass.), 
63;  Evans  v.  Johnson,  39  W.  Va.,  299; 
23  L.  R.  A.,  137;  19  S.  E.  R.,  623; 
Oil  Co.  v.  Mclntire,  44  W.  Va.,  296; 
28  S.  E.  R.,  922;  but  see  Swope  v. 
Frazier,  18  Ky.  L.  R.,  649;  37  S.  W. 
R.,  495;  Heckman  v.  Adams,  50  Ohio 
St.,  305;  34  N.  E.  R.,  155;  Jones  v. 
Learned,  66  Pac.  R.,  1071  (Colo. 
App.);  Taylors.  Moore,  23  Ky.  L.  R., 
1572;  65  S.  W.  R.,  612.  And  actual 
notice  is  sufficient;  it  is  not  necessary 
that  there  be  process  served  in  the 
name  of  the  commonwealth,  Oster  v. 
Meyer  (Ky.),  67  S.  W.  R.,  851. 


THE   INQUISITION.  587 

and  be  afforded  opportunity  to  be  present  in  person  or  by 
counsel.1 

No  advantage  can  be  taken  collaterally  because  of  want  of 
notice.2  In  Illinois  an  inquest  of  lunacy  was  held  void  where  the 
record  showed  service  of  summons  upon  the  alleged  lunatic  at 
less  than  the  statutory  time  before  the  date  of  hearing  and  that 
the  service  was  otherwise  irregular.3 

According  to  some  decisions  a  statute  may  authorize  the  court 
in  its  discretion  to  dispense  with  personal  service  of  notice  upon 
him,  without  infringing  his  constitutional  rights.4  According  to 
others  a  statute  which  authorizes  a  court  for  cause  to  dispense 
with  notice  is,  to  that  extent  at  least,  invalid.5  And  an  adjudi- 
cation made  under  an  unconstitutional  statute  is  void.8  The 
same  rules  are  applied  to  the  adjudication  and  commitment  of 
habitual  drunkards. 7 

Another  ground  on  which  the  constitutionality  of  statutes  pro- 
viding for  the  trial  of  the  inquisition  by  a  commission,  when  a 
jury  trial  is  not  demanded  by  the  alleged  lunatic,  has  been  at- 
tacked, is  that  they  violate  the  constitutional  guaranty  of  the  right 
to  trial  by  jury.  But  it  has  been  answered  by  the  courts  that 
the  inquiry  being  a  civil  trial,  the  right  to  trial  by  jury  may  be 
waived,  and  is  waived  by  the  neglect  or  refusal  of  the  incompe- 
tent to  demand  a  jury  trial.8 

THE  PETITION  AND  COMMISSION. — The  commission  de  luna- 
tico  inquirendo  is  issued  out  of  the  court  in  which  the  care  and 
custody  of  incompetent  persons  is  vested,  upon  a  petition  made 

1  In  re  Wellman,  3  Kan.  App.,  100;  Sporza  v.   German  Savgs.   Bk.,   192 
45  Pac.  R.,  726;   Saules  v.  Robinson  N.  Y.,  8,  20;    84  N.  E.  R.,  406. 
(Ind.),  60  N.  E.  R.,  726;    Stewart  v.  8  Hunt  v.  Searcy  (Mo.),  67  S.  W.  R., 
Taylor,  23  Ky.  L.  R.,  577;   63  S.  W.  206;  Stewart  v.  Taylor,  23  Ky.  L.  R., 
R.,   783;    Arnett's  Com.   v.   Owens,  517;  63  S.  W.  R.,  783;  in  re  Lambert, 
23  Ky.  L.  R.,  1409;  65  S.  W.  R.,  151.  134  Cal.,  626;    66  Pac.  R.,  851;    55 
A  provision  for  temporary  confine-  L.  R.  A.,  856;   but  his  presence  may 
mcnt  without  a  hearing  is  valid.    In  undoubtedly  be  dispensed  with.  Oster 
re  Le  Donne,  173  Mass.,  550;    54  N.  v.  Meyer  (Ky.),  67  S.  W.  R.,  851; 
E.  R.,244;  Porter  v.  Ritch,  70  Conn.,  Simon  v.  Craft,  182  U.  S.,  427;    21 
235;  39  Atl.  R.,  169;  39  L.  R.  A.,  353.  Supr.  Ct.  R.,  836. 

2  Rodgers  v.  Walker,  6  Penn.  St.,  "Cases  cited. 

371;    Willis  v.  Willis,  12  Penn.  St.,  T  People  v.  St.  Sav.  San.,  34  App. 

159;    Durchcr  v.  Hill,  29  Mo.,  271;  Div.  (N.  Y.),  363;  People  v.  Creamer, 

Arington  v.  Short,  3  Hanks  (N.  C.),  30  App.  Div.,  624. 

71.  8  Sporza  v.  German  Savgs.  Bk.,  192 

3  Behrensmeycr  v.  Krcitz  (111.),  26  N.  Y.,  8;    84  N.  E.  R.,  406;    People 
N.  E.,  704.  ex  rel.  Morrell  v.  Dold,  189  N.  Y.,  546; 


4  In  re  Walker,  57  App.  Div.,  1 ;  67      cf.  in  re  Le  Donne,  173  Mass.,  550;  54 

Supp.,    647;     Pe 
Morrell  v.  Dold,  189  N.  Y.,  546;    cf. 


N.    Y.    Supp.,    647;     People    ex  rel.      N.  E.  R.,  244. 


588  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

by  a  person  related  by  blood  or  marriage  to  the  alleged  lunatic 
or  interested  in  his  estate,  and  must  be  accompanied  by  affidavit 
of  the  facts  upon  which  the  petition  is  founded.1 

The  commission  cannot  be  issued  upon  the  petition  of  a  mere 
stranger,2  unless  some  statute  otherwise  provides.1  In  Alabama 
the  petition  cannot  be  made  by  the  wife  of  the  alleged  lunatic, 
but  must  be  by  her  next  friend.3 

The  issuing  of  the  commission  is  within  the  discretion  of  the 
court  and  it  will  not  be  granted  unless  it  be  shown  that  it  is  for 
the  well-being  of  the  lunatic.4  The  issuing  of  the  commission 
being  discretionary  with  the  court,  it  follows  that  the  refusal  of 
the  court  to  issue  it  cannot  be  reviewed  by  a  court  of  appellate 
jurisdiction.5 

When  the  commission  is  to  be  executed  the  commissioners  in 
lunacy  issue  their  precept  to  the  sheriff,  requiring  him  to  cause 
a  jury  of  good  and  lawful  men  of  his  county  to  come  before  them 
at  a  certain  time  and  a  certain  place,  to  inquire  into  the  questions 
which  by  virtue  of  the  commission  will  be  properly  given  in 
their  charge.6  Where  the  proceedings  upon  the  commission  are 
commenced  before  a  greater  number  of  jurors  than  is  necessary, 
it  is  irregular  to  continue  the  proceedings  before  a  part  only.7 
The  commissioners  have  the  power  to  subpoena  witnesses  and  to 
compel  their  attendance.8 

They  also  have  the  power  to  examine  the  alleged  lunatic  per- 

1  Nailor  v.   Nailor,   4   Dana,   339;  such  notice,  she  was  not  entitled  to 

Washer  v.  Slater,  67  App.  Div.,  385;  appeal  from  the  refusal  of  the  Court 

73  N.  Y.  Supp.,  425;   but,  if  thestat-  to  permit   her  to  take   part.     In  re 

ute  so  provides,  the  petition  may  be  Edgerly,  84  N.  W.  Rep.,  653. 

presented  by  a  stranger  or  a  non-  2  Covinhovin's  case,  vol.  B  Saxton, 

resident  relative,  in  re  Burke,  110  N.  c.  19;   and  see  Rorback  v.  Van  Blar- 

Y.  Supp.,  1004;    Commonwealth    v.  coom,  20  N.  J.  Eq.,  461. 

Metz,   2   Dauph.   Co.   R.,   360.     See  3  Campbell    v.  Campbell,  39  Ala., 

also  in  re  Solomon  Wolf,  195  Pa.  St.,  312. 

438,  46  Atl.  R.,  72,  defining  "  person  4  Overing's    Case,    1    Blandf.    Ch. 

aggrieved"    entitled  to  traverse   an  (Md.),  290;  Colvin's  Case,  3  Md.  Ch., 

inquisition    under  the  statute  as  a  206;  In  re  Burke,  110  N.  Y.  Supp., 

person    related    to    incompetent  by  1004;    125  App.  Div.,  889;  Matter  of 

blood  or  marriage  or    interested  in  Clark,  175  N.  Y.,  139;  65  N.  E.  R., 

his    estate.    See    also    in    re   Wolf,  212. 

10  Kulp.,  112.     Upon   the  appoint-  5  In  re  Colvin,3  Md.  Ch.,258.    See, 
ment  of  a  guardian  for  a  foreign  in-  however,  in  re  Burke,  supra;  Law- 
competent,  in  Minnesota,   who  had  son  v.  Hilton,  69  App.  Div.  (N.  Y.), 
property  in  the  State,  the  administra-  303;  85  Supp.,  863. 
trix  of  a  decedent,  in  whose  estate  6/n  re  Wager,  6  Paige  (N.  Y.),  11. 
the  incompetent  had  an  interest,  was  7  Tebout's  Case,  9  Abb.  Pr.,  211. 
held   not   entitled   to  notice   of   the  8  Ex  parte  Plank,  5  Clark  (Pa.),  35. 
appointment.     And  notwithstanding 


THE   INQUISITION.  589 

soually  and  to  compel  those  having  him  in  charge  to  produce 
him.1  The  luuatic  has  the  right  to  be  present  at  the  execution 
of  the  commission,  but  his  appearance  may  be  dispensed  with, 
and  the  proceedings  will  not  be  void  because  the  lunatic  was  not 
present.  In  those  States  where  the  proceedings  upon  the  execu- 
tion of  the  commission  are  ex  parte,  the  supposed  lunatic  not  being 
entitled  as  of  right  to  notice  thereof,  he  has  not,  strictly  speak- 
ing, the  right  to  be  present.  But  when  the  proceedings  are  in 
the  nature  of  a  full  litigation  of  the  question  of  sanity  between 
the  supposed  lunatic  and  the  petitioner,  the  lunatic,  having  a 
right  to  notice,  can  avail  himself  of  such  notice  and  be  present, 
unless  his  presence  be  attended  with  danger  to  himself  or  other 
persons.2  The  return  of  the  commission  should  be  made  within 
a  reasonable  time.  There  should  be  incorporated  in  the  commis- 
sion a  return  day,  and  in  any  event  the  court  out  of  which  it  was 
issued  should  limit  the  time  in  which  the  commission  shall  be 
executed. 3 

FINDING  OF  THE  INQUISITION. — The  commission,  the  ver- 
dict, and  return  in  lunacy  proceedings  must  be  consistent  upon 
the  face  of  the  records,  and  therefore  the  verdict  must  be  in  the 
words  of  the  commission  or  in  equivalent  words.  The  inquisition 
must  show  that  the  imbecility  of  the  mind  is  such  as  to  render 
the  imbecile  unfit  for  the  government  of  himself  and  property ;  a 
return  that  the  party  is  not  a  lunatic  but  that  his  mind  is  im- 
paired by  age  and  other  causes,  so  that  he  is  incapable  of  man- 
aging his  business,  is  insufficient.4 

To  authorize  the  court  to  appoint  a  committee  for  the  care 
and  custody  of  an  insane  person,  the  jury  must  find  distinctly 
that  he  is  of  unsound  mind  and  mentally  incapable  of  governing 
himself  or  managing  his  affairs.5  The  reason  of  the  rule  obvi- 
ously rests  on  the  principle  that  it  is  not  every  case  of  mental 
weakness  or  imbecility  which  will  authorize  the  court  to  exercise 
the  power  of  appointing  a  committee  of  the  person  and  estate; 
but  to  justify  the  exercise  of  such  a  power  the  mind  of  the  indi- 
vidual must  be  so  impaired  as  to  be  reduced  to  a  state  which  as 
a  congenital  incapacity  would  have  constituted  a  case  of  idiocy.8 

'  Ex  parte  Childs,   1   C.  E.  Green  *  In  re  Lindsey,  44  N.  J.  Eq.,  564; 

(N.  J.),  498.  s.  c.,  15  Atl.,  1. 

»  In  re  Dickie,  7  Abb.  N.  C.  (N.  Y.),  5  In  re  Morgan,  7  Paige  (N.  Y.), 

417.  236;    in  re  Rodgers,  9  Abb.  N.  Cas. 

3  Lincoln's  Case,  1  Brewster  (Pa.),  (N.  Y.).  141. 

392;  in  re  Plank,  f>  Clark  (Pa.),  35.  •  In  re  Morgan,  7  Paige  (N.  Y.),  236; 


590  INCOMPETENT  PERSONS — BROWN  AND  BECKER. 

The  court  may  in  its  discretion  set  aside  the  finding  and  order  the 
issue  of  a  new  commission.1  In  New  York  the  proceedings  upon 
the  inquisition  not  being  ex  parte,  and  the  party,  strictly  speak- 
ing, not  having  the  right  to  traverse  the  inquisition,  it  is  held 
that  the  subject  of  the  commission  is  entitled  to  a  new  trial  of 
the  writ  if  it  appear  that  the  finding  against  his  sanity  was  in- 
duced by  bias  or  previously  formed  opinion  on  the  part  of  the 
jury.2  The  court  may  make  a  personal  examination  of  the  lunatic 
in  order  to  ascertain  whether  the  finding  of  the  inquisition  is 
erroneous.3  And  where  there  is  doubt  of  the  insanity  of  one 
declared  a  lunatic  he  should  be  apprised  of  the  fact  and  of  the 
chancellor's  readiness  to  hear  any  communication  from  him  or  in 
his  behalf.4  An  inquisition  will  not,  however,  beset  aside  for 
mere  irregularity  when  the  subject  has  been  found  a  lunatic 
in  proper  form  and  there  is  no  doubt  of  his  insanity.5 

TRAVERSE  OF  THE  INQUISITION. — In  those  of  the  United 
States  where  proceedings  upon  the  writ  de  lunatico  iriquirendo  are 
ex  parte  and  the  alleged  lunatic  is  not  of  right  entitled  to  notice, 
a  right  to  traverse  the  inquisition  is  accorded.6  But  in  those 
States  where  notice  of  the  time  and  place  of  holding  the  commis- 
sion is  allowed  to  the  alleged  lunatic  as  matter  of  right,  a  trav- 
erse is  only  allowed  in  the  discretion  of  the  court.  In  Christie's 
case,  5  Paige  (N.  Y.),  242,  Chancellor  Wai  worth  declined  to 
grant  an  application  for  leave  to  traverse  the  inquisition  unless 
satisfied  upon  a  private  examination  of  the  lunatic,  or  by  the 
report  of  a  master  that  such  was  the  wish  of  the  lunatic  and  that 
he  was  capable  of  understanding  the  nature  and  object  of  the  ap- 
plication.7 But  an  alleged  lunatic  should  be  allowed  to  traverse 
an  inquisition  when,  the  jury  on  a  commission  de  lunatico  inqui- 
rendo  finding  in  favor  of  his  incapacity,  upon  an  examination  of 
the  proceedings  there  appears  to  be  a  reasonable  doubt  as  to  the 

query,  if  this  case  does  not  state  the  4  Morgan's    Case,    3    Blandf.    Ch. 

rule  too  strongly.  (Md.),  332. 

lln   re   Lasher,  2    Barb.  Ch.,  97;  &Inre  Rodgers, 9  Abb.  N.  C.  (N.  Y.), 

Weaver's  appeal,   116  Pa.  St.,  225;  141. 

Matter  of  Lewis,  57   Misc.  (N.  Y.),  6  Walker  v.  Russell,  10  S.  Car.,  82; 

670;   Matter  of  Mason,  1  Barb.  (N.  Covenhoven's  Case,  Saxt.  Ch.  Cases 

Y.),  436;  Matter  of  Cooper,  5  Law.  (N.  J.),  19. 

Bull.,   338;    Matter   of    Preston,  43  7  See  also  ex  parte  Tracy,  1  Paige 

Misc.  (N.  Y.),  550.  (N.  Y.),  580;   Clapp's  Case,  20  How. 

2  Tebout's  Case,  9  Abb.  Pr.  (N.  Y.),  Pr.  (N.  Y.),  385;  in  re  Russell,  1  Barb. 
211.  Ch.  (N.  Y.),  38. 

3  In  re  Fitzgerald,  3  Stewart,  59. 


RESTORATION   TO  SANITY.  591 

propriety  of  their  finding.1  In  Indiana  it  is  held  that  one  being 
found  insane  by  a  jury  and  a  guardian  appointed,  he  cannot, 
upon  his  own  application  or  that  of  his  next  friend,  have  inquiry 
into  the  proceedings  upon  the  inquisition,  or  into  the  fact  of  his 
restoration  to  sound  mind.  Such  inquiry  can  only  be  had  upon 
the  application  of  some  other  person.2  A  party  in  interest  with 
the  alleged  lunatic  may  be  allowed  to  traverse  the  inquisition- 
In  New  York  under  the  former  practice,  a  purchaser  whose  con- 
veyance was  invalidated  by  the  inquisition  was  permitted  to 
traverse  it,  on  stipulating  to  be  bound  by  the  final  decision 
therein.3  And  when  such  a  person  had  joined  in  a  traverse,  and 
consented  to  be  bound  by  its  results,  the  other  parties  could 
abandon  it  without  his  consent.4 

In  Massachusetts  and  generally  in  those  States  where  the  care 
of  insane  persons  and  their  property  is  vested  in  guardians  ap- 
pointed by  probate  courts,  such  guardians  may  be  discharged  by 
the  courts  upon  the  application  of  the  ward  or  another,  when- 
ever it  appears  that  the  guardianship  is  no  longer  necessary  for 
the  safety  and  well-being  of  the  ward  or  his  estate.  And,  as  in 
other  probate  proceedings,  an  appeal  lies  from  the  decree  in  any 
case  appointing  a  guardian  for  an  insane  person.5 

Upon  the  trial  of  a  traverse  the  inquisition  is prima  facie  evi- 
dence of  the  insanity  of  the  subject  and  places  upon  the  traverser 
the  burden  of  proof.8  Like  a  legal  presumption  the  inquisition 
continues  to  operate  until  overpowered ;  and,  standing  as  full 
proof  till  then,  it  necessarily  remains  in  force  until  the  question 
of  sanity  has  been  finally  decided.7 

RESTORATION   TO   SANITY. 

Upon  the  recovery  of  a  lunatic,  so  found  by  inquisition,  the 

court  upon  his  petition  may  grant  supersedcas  of  the  commission.8 

The  procedure  to  supersede  an  adjudication  of  lunacy  varies 

1  De  Hart  v.  Cowdit,  51  N.  J.  Eq.,  8  McGinnis  v.   Commonwealth,   74 
611;  28  Atl.,  607.  Pa.  St.,  245. 

2  Gillespie  v.  Thompson,  7  Ind.,  353;  7  Rogers  v.  Walker,  66  Pa.  St.,  371, 
Mebany  v.  Mebany,  59  Ind.,  257.  and  see  also  Ludwick  v.  Common- 

*  In  re  Christie,  5  Paige  (N.  Y.),      wealth,  18  Pa.  St.,  175;  Lackyv.  Cun- 
242.  ningham,  56  Pa.  St.,  373;  Hill  v.  Day, 

4  In  re  Giles,  11  Paige  (N.  Y.),  243;      34  N.  J.  Eq.,  150. 

in  re  Folger,  4  Johns.  Ch.,  169.  *  In  re  Rogers,  I  Hulst.  N.  J.,  46; 

5  Pub.  Sts.  Mass.,  c.  139,  s.  12,  and      in  re  Hailes,  3  Johns.  Ch.  (N.  Y.),  567. 
see  M'Donald  v.  Morton,  1  Mass.,  543. 


592  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

in  different  jurisdictions  and  is  usually  defined  by  statute.1  Dis- 
charge from  an  asylum  is  sometimes  secured  by  a  writ  of  habeas 
corpus2  or  by  mandamus  for  a  writ  of  discharge.3 

In  Missouri  it  has  been  said  that  a  decree  of  lunacy,  until 
terminated  by  a  decree  of  restoration,  cannot  be  impeached  by 
proof  that  the  lunatic  has  become  capable  of  managing  his  own 
affairs.4  But  in  Kansas  an  adjudication  of  restoration  to  reason 
was  dispensed  with  where  no  guardian  had  been  appointed,  and 
she  was  in  fact  restored  to  reason.5 

Insanity  having  been  judicially  ascertained,  the  law  presumes 
its  continuance  until  a  restoration  to  sanity  or  lucid  intervals  is 
established.  A  discharge  from  an  insane  asylum  because  the 
officers  adjudged  the  patient  restored  would  be  at  least  prima 
facie  evidence  of  such  restoration.6 

But  a  commission  in  lunacy  will  not  be  superseded  where  the 
petitioner  previously  found  insane  is  liable  at  any  moment  to  be- 
come excited  beyond  control  and  requires  constant  supervision, 
when  his  property  may  be  squandered,  when,  in  fact,  he  is  an 
insane  man  with  lucid  intervals.7 

Where  one  had  been  duly  found  a  lunatic  and  committees  of 
his  person  and  estate  had  been  appointed  the  court  declined  to 
discharge  the  committee  of  the  person  upon  the  lunatic's  petition 
alleging  that  he  was  so  far  restored  to  reason  as  to  be  able  to 
govern  himself,  it  not  appearing  that  he  had  become  competent 
to  manage  his  estate,  and  no  application  having  been  made  for 

1  E.g.,  N.   Y.   Code  Civil  Pro.,   s.  3  Statham  v.  Blackford,  89  Va.,  771, 
2343,  2017.     In  re  Lanier,  170  N.  Y.,       17  S.  E.  Rep.,  233. 

7,  62  N.  E.  Rep.,  761,  68  App.  Div.,  4  Kiehne  v.  Wessell,  53  Mo.  App., 

320,  74  N.  Y.  S.,  70.    In  re  Blewitt,  667.     See   Mutual   Life   Ins.    Co.   v. 

138  N.  Y.,  148,  33  N.  E.  Rep.,  820.  Wiswell,  56  Kan.,  765,  44  Pac.  Rep., 

Coot  v.  Ionia  Probate  Judge,  93  Mich. ,  996. 

304,  53  N.  W.,  395.    In  re  Sherman,  See  supra,  p.  527,  for  effect  of  ad- 

17  R.  I.,  356.     In  re  Lowe,  64  Hun  judi cations  as  evidence. 

(N.  Y.),  633,   19  N.  Y.   Supp.,  245.  5  Topeka  Water  Supply  Co.  v.  Root, 

Storms    v.    Allegan    Circuit     Judge  56  Kan.,  187,  42  Pac.  R.,  715.    Walk- 

(Mich.),  57  N.  W.  Rep.,  1074.    Al-  er  v.  Coates,  5  Kan.  App.,  209,  47 

drich  v.  Superior  Ct.,  120  Cal.,   140;  Pac.    Rep.,    158.      Lower    v.    Schu- 

52  Pac.  R.,  148.    In  re  Miller's  Lu-  macher,61  Kan.,  625,  60  Pac.  R.,  538. 

nacy,  7  Pa.   Dist.    R.,   269.     Appeal  See  also  Clay  v.  Hammond,  199  111., 

of  Thompson    (Pa.),  16  Montg.   Co.  370,  65  N.  E.  R.,  352,  where  evidence 

Law  Rep.,  102.  in  collateral  inquiry  made  out  a  prima 

2  Gresh's  Case    (Pa.  Quarter    Ses-  facie    case    of    restoration,  notwith- 
sions),  12  Pa.  Co.  Ct.  R.,295.     In  re  standing  previous  adjudication  and 
Breese,  82  Iowa,  573.     In  re  Thorp,  commitment. 

64  Vt.,  398,  24  Atl.  Rep.,  991.    Gard-          °  2  Lawson's  Rem.  and  Pr.,  §  848. 
ner  ?>.  Jones,  126  Cal.,  614,  59  Pac.  R.,  7  /»  re  Humboldt,  12  Phila.,  424. 

126. 


COSTS   IN   LUNACY   PROCEEDINGS.  593 

the  discharge  of  the  committee  of  the  estate.1  The  right  to  the 
control  of  his  property  after  aii  adjudication  of  his  insanity  is 
not  based  upon  his  competency  to  manage  his  business,  be  it 
great  or  small,  but  upon  his  restoration  to  mental  health  and 
consequent  fitness  to  manage  the  ordinary  affairs  of  life.2  • 

The  usual  practice  in  the  United  States  is  to  refer  the  petition 
for  a  supersedeas  to  a  referee  to  take  proofs  as  to  the  state  of 
mind  of  the  petitioner  and  to  report  the  proofs  and  his  opinion 
thereon.3 

In  those  States  where  the  determination  of  the  facts  of  insan- 
ity is  had,  and  the  appointment  of  a  guardian  if  the  subject  be 
insane  is  made,  by  a  court  of  probate,  the  party  in  case  of  his 
restoration  may  take  a  remedy  similar  to  that  afforded  by  a 
mpersedeas,  by  a  petition  to  the  judge  of  such  probate  court  to 
have  the  letters  of  guardianship  set  aside  and  his  estate  returned 
to  him. 

Restoration  of  civil  powers  after  an  adjudication  of  habitual 
intern perance  may  be  secured  after  reformation  in  the  manner 
provided  and  regulated  either  by  statute  or  local  practice.4 

COSTS   IN   LUNACY   PROCEEDINGS. 

The  general  rule  seems  to  be  that  in  proceedings  to  establish 
the  insanity  of  a  party  the  allowance  of  costs  rests  entirely  iii  the 
discretion  of  the  court.  Where  the  proceedings  are  undertaken 
upon  probable  cause  aiid  in  good  faith,  the  costs  are  regarded  as 
necessary  expenses  incurred  for  the  benefit  of  the  party  and  are 
payable  out  of  his  estate.5  The  costs  are  not  payable  out  of  the 
proceeds  of  the  sale  of  a  lunatic's  real  estate  until  the  costs  of  the 
sale  and  the  debts  of  the  creditors  having  a  prior  lieu  are  satis- 
fied.6 In  Indiana  it  was  held  that  when  a  proceeding  to  set 
aside  a  guardianship  of  an  insane  person  is  unsuccessful  the 
costs  should  be  taxed  on  the  plaintiff  and  not  upon  the  guardian 
or  estate  of  the  insane  person.7  The  estate  of  the  lunatic  in  the 

1  In  re  Burr,  17  Barb.  (N.  Y.),  9.  tatc,  197  Pa.  St.,   621;  47  Atl.   R., 

2  In  re  Burgh,  61  How.,  193.  987. 

3  In  re  Rogers,  1  Halst.  Ch.  (N.  J.),  8  In  re  Beckwith,  3  Hun  (N.  Y.), 
46;  Weaver's  Appeal,  1 16  Pa.  St.,  225.  443;  in  re  Root,  8  Paige  (N.  Y.),  625; 

4  The    practice    is    illustrated    by:  in  re  Arnhout,  1  Paige  (N.  Y.),  497; 
Makepeace  v.  Bronnenherg,  146  Ind.,  in  re  White,  2  C.  E.  Green  (N.  J.), 
243;    45  N.   E.  R.,  336;    Cockrill  v.  274. 

Cockrill,  79  Fed.,  143;   92  Fed.,  811;         •  Malone's  App.,  79  Pa.  St.,  481. 
34  C.  C.  A.,  254;   in  re  Roberta's  Es-         7  Cochran  v.  Amsden,  104  Ind.,  282. 
III.— 38 


594  INCOMPETENT  PERSONS — BROWN  AND   BECKER. 

hands  of  the  committee  is  liable  for  the  professional  services  of 
the  attorney  who  conducted  the  lunacy  proceedings.1  It  would 
seem  that  generally  where  a  traverse  of  an  inquisition  has  been 
had,  which  was  instituted  in  good  faith  by  parties  interested  other 
than  the  supposed  lunatic  himself,  costs  may  be  awarded  out 
of  the  estate  to  both  the  committee  and  the  petitioner  for  the 
traverse. 

COMMITTEES   AND   GUARDIANS. 

Upon  the  return  of  an  inquisition  pronouncing  the  party  in- 
sane, the  appointment  of  a  committee  or  guardian  is  within  the 
discretion  of  the  court.  Since  such  appointment  is  discretionary 
with  the  court,  it  follows  that  no  order  made  for  such  a  purpose 
can  be  the  subject  of  an  appeal.2  A  different  rule,  however, 
prevails  in  those  States  where  the  proceedings  of  lunacy  are  had 
upon  a  petition  to  a  court  of  probate  praying  for  the  appointment 
of  a  guardian  for  an  alleged  insane  person.  In  such  States  the 
subject  of  the  petition  may  have  the  benefit  of  an  appeal  as  in 
ordinary  probate  proceedings.3 

The  relatives  of  lunatics  are  to  be  preferred  in  the  appoint- 
ment of  a  committee.4  The  heirs  and  next  of  kin  are  entitled  as 
of  right  to  propose  themselves  for  the  office ;  any  other  person 
must  obtain  an  order  for  the  purpose,  and  his  petition  must 
state  particularly  existing  objections  to  the  appointment  of 
the  heir  or  next  of  kin.5  The  father  of  a  lunatic  having 
custody  of  his  estate  should  be  appointed  his  committee.6  In 
New  York  it  has  been  held  that  a  stranger  cannot  be  ap- 
pointed without  the  consent  of  the  next  of  kin,  except  after  a 
reference  of  which  they  are  entitled  to  notice.7  The  guardian- 
ship of  the  estate  of  a  lunatic  will  not  in  all  cases  be  committed 
to  those  who  are  presumptively  entitled  to  it  as  his  heirs  or  next 
of  kin.  These  persons  will  be  appointed  only  when  it  appears 
that  they  are  the  ones  most  likely  to  preserve  the  lunatic's  estate 
and  promote  his  personal  welfare  and  happiness. 8  In  the  appoint- 
'Weir  v.  Myers,  34  Pa.  St.,  677;  *  In  re  Livingstone,  1  John.  Ch. 
Brownlee  v.  Sweitzer,  49  Ind.,  221.  (N.  Y.),  436;  in  re  Webb,  2  Phillips, 

2  Willis  v.  Lewis,  5  Ired.  (N.  C.),  14.       10. 

See,  however,  in  re  Burke,  110  N.  Y.  6Coleman  v.  Commissioners,  6  B. 

Supp.,   1004;    125  App.   Div.,    889;  Mon.  (Ky.),  239. 

Lawson  v.  Hilton,  69  App.  Div.,  303;  T  In  re  Lamoree,  32  Barb.  (N.  Y.), 

85  N.  Y.  Supp.,  363.  122;    in  re  Owens,  47  How.  Pr.  (N. 

3  M'Donald  v.  Martin,  1  Mass.,  543.  Y.),  150. 

4  Richards,  ex  porte.Brev.  Vol.  B.  (S.  8/nre  Taylor,  9  Paige  (N.  Y.),  611; 
C.),375;  in  re  Colvin,  3  Md.  Ch.,27S.  in  re  Paige,  7  Daly  (N.  Y.),  155. 


MANAGEMENT  OP  ESTATES.  595 

ment  of  a  committee  of  the  person  the  court  will  regard  so  far 
as  possible  and  proper  so  to  do,  under  the  circumstances,  the 
wishes  and  inclinations  of  the  lunatic  himself.1 

Where  a  wife  is  found  insane  and  the  husband  is  a  suitable 
person  for  the  trust,  the  intimate  and  confidential  nature  of  the 
marriage  relation  renders  it  proper  that  he  should  be  preferred 
in  the  appointment  of  a  guardian  to  a  third  person.2  But  the 
husband  will  not  be  allowed  the  custody  of  the  person  of  his  in- 
sane wife  where  it  appears  his  friendliness  toward  her  is  very 
questionable,  and  that  his  motives  for  seeking  to  obtain  letters 
are  actuated  by  self-interest.3 

A  committee  appointed  by  a  court  of  equity  in  the  exercise 
of  ordinary  equity  powers  is  a  mere  officer  of  the  court.  He  is 
responsible  to  the  court  and  acts  under  its  orders  and  discretion, 
and  is  removable  by  the  court  like  an  ordinary  receiver.4 
Where  the  guardianship  of  insane  persons  is  committed  by 
statute  to  the  probate  courts  the  duties  and  responsibilities  of 
the  guardian  are  the  same  as  those  of  the  guardians  of  minors.5 

The  committee  of  the  lunatic's  estate  is  generally  required  to 
give  security  for  the  proper  performance  of  his  duties  and  judi- 
cious management  of  the  estate.  The  bonds  are  properly  made 
payable  to  the  people  of  the  State.6 

In  the  United  States  the  courts  of  chancery  ordinarily  allow 
to  the  committees  of  insane  persons  such  reasonable  compensa- 
tion as  would  be  allowed  to  guardians  and  trustees  in  similar  cir- 
cumstances. 7  This  same  rule  obtains  in  States  where  the  custody 
of  the  person  and  estate  of  insane  persons  is  vested  in  guardians 
appointed  by  the  probate  courts.8 

MANAGEMENT   OF  ESTATES. 

The  estate  of  the  insane  person  is  to  be  so  managed  as  best  to 
promote  the  personal  interest  and  to  provide  for  the  care  and 
comfort  of  the  lunatic. 

A  committee  of  a  lunatic  is  bound  to  use  such  diligence  and 

1  In  re  Leacocke,  Lloyd  and  Goold  6  Auilerson  v.  Auilerson,  42  Vt.,  350. 

(Eng.  Ch.),  498.  •  In  re  White,  1  Barb.  Ch.,  43. 

'Drew's  Appeal,  57  N.  II.,  181.  7  In  re  Livingston,   9   Paige,   440; 

3  Feegan's  Estate,  1  Myrick  Prob.  in  re  Roberts,  3  Johns.  Ch.,  43. 

Rep.  (Cal.),  10.  8  May  v.  May,  109  Mass.,  252. 

<  Boiling  v.  Turner,  6  Rand.  (Va.), 
584. 


596  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

prudence  in  the  care  and  management  of  the  lunatic's  estate  as, 
in  general,  prudent  men  of  intelligence  and  discretion  in  such 
matters  employ  in  their  own  like  affairs;  the  preservation  of  the 
fund  and  the  procurement  of  a  just  and  proper  income  therefrom 
are  primary  objects  of  the  creation  of  the  trust  and  are  to  be 
primarily  regarded.1 

In  May  v.  May,  109  Mass.,  256,  the  court  said:  "The guardian 
is  appointed  for  the  welfare,  comfort,  and  security  of  the  ward, 
and  not  for  the  increase  of  the  estate  in  his  hands  by  accumula- 
tion from  the  income  in  order  to  enlarge  the  wealth  of  remote  or 
collateral  relations  who  may  ultimately  succeed  to  the  inherit- 
ance. It  is  no  part  of  his  duty  to  diminish  the  reasonable  com- 
fort of  his  ward,  or  to  prevent  him  from  enjoying  such  luxuries 
or  indulging  such  tastes  as  would  be  allowable  and  proper  in  the 
care  of  a  man  similarly  situated  in  other  respects,  but  in  full 
possession  of  his  faculties.  The  preservation  of  the  estate  to  the 
advantage  and  interest  of  possible  heirs  is  of  secondary  and  sub- 
ordinate consideration.  The  lunatic's  property  should  be  liber- 
ally applied  to  secure  him  every  comfort  his  situation  will  admit 
of,  and  the  amount  is  not  necessary  to  be  limited  to  the  annual 
income  of  the  estate." 

In  some  States  it  is  held  that  the  guardian  or  committee 
of  an  insane  person  cannot  without  an  order  of  the  court  expend 
an  amount  exceeding  the  annual  income  of  the  estate  for  and  on 
account  of  the  wrard.2  But  the  court  will  at  all  times  direct  to 
be  done  whatever  appears  to  the  advantage  of  the  lunatic  without 
regard  to  the  interests  of  the  next  of  kin.3  In  a  California  case 
it  is  held  that,  it  being  the  husband's  duty  to  provide  for  the 
support  of  his  insane  wife,  notwithstanding  she  may  have  suf- 
ficient estate  of  her  own,  her  separate  estate  is  not  to  be  ap- 
plied to  her  support  until  the  husband's  estate  is  exhausted.4 

After  ample  provision  is  made  for  the  support  of  the  insane 
person,  the  income  of  his  property  may  be  applied  for  the  benefit 
of  those  for  whom  he  is  under  obligation  to  provide.5  The 
court  will  in  all  cases  act  for  the  lunatic,  in  the  disposition  of  his 
property,  as  it  supposes  he  would  act  in  like  cases  if  sane.6 

1  Matter  of  Hathaway,  80  Hun,  186.          "  Myer's   Estate,   1    Myrick    Prob. 

2  Patton  v.  Thompson,  2  Jones  Eq.       Rep.  (Cal.),  178. 

(N.  C.),  411;  Kennedy  v.  Johnson,  65          s Hambleton's  Appeal,  102  Pa.  St.,  5. 
Pa.  St.,  4.51.  'In  re  Willoughby,   11   Paige  (N. 

3  In  re  Colah,  3  Daly  (N.  Y.),  529.       Y.),  257. 


MANAGEMENT   OF   ESTATES.  597 

The  personal  property  of  an  insane  person  must  first  be  ex- 
hausted before  the  real  estate  can  be  sold  for  his  support  and 
maintenance.1  But  if  the  statute  provide  that  a  sale  be  made  by 
order  of  the  court  upon  the  application  of  a  guardian,  trustee,  or 
committee,  the  court  has  no  power  to  make  such  order  upon  its 
own  motion  or  upon  the  application  of  any  other  party.2 

The  real  estate  of  a  lunatic  may  be  sold  to  pay  debts,  but  not 
where  the  effect  of  the  sale  would  be  to  reduce  the  lunatic  to  a 
condition  of  want.3  An  excess  of  a  lunatic's  property  over  an 
amount  sufficient  for  the  reasonable  support  of  his  wife  and  chil- 
dren may  be  sold  with  the  court's  sanction,  and  the  assets  applied 
by  the  guardian  in  payment  of  his  debts.4  Such  excess,  if  in- 
sufficient to  pay  all  his  debts,  must  be  applied  ratably  among 
the  creditors,  and  the  guardian  has  no  right  to  exhaust  all 
of  such  amount  by  paying  certain  creditors  in  full,  when  he 
knows  of  other  debts  due  from  his  ward  on  which  he  pays 
nothing.5 

The  committee  or  guardian  has  no  power  to  convey  or  lease 
the  lauds  of  the  ward  without  an  order  of  the  court.8  Ordi- 
narily all  contracts  affecting  the  estate  of  a  lunatic  are  to  be 
executed  under  the  direction  of  the  court.  All  such  contracts 
must  appear  to  be  for  the  interest  of  the  lunatic.7 

The  court  may  authorize  the  committee  to  apply  the  lunatic's 
personal  property  for  the  improvement  of  unproductive  real 
estate  as  by  the  erection  of  buildings  thereon.8  The  court  cannot 
direct  the  lease  of  lands  beyond  a  time  when  the  lunatic  shall 
have  been  restored  to  reason.9 

A  committee  or  guardian  cannot  relinquish  an  insane  wife's 
right  of  dower  in  the  estate  of  her  husband;10  or  make  an  elec- 
tion for  her  of  her  dower  or  of  a  provision  in  her  husband's  will 
in  lieu  thereof.11  Nor  can  a  committee  maintain  ejectment  against 
the  lunatic's  wife  to  eject  her  and  her  children  from  the  home 

1  In  re  Taylor,  9  Paige  (N.  Y.),  61 1 ;       (S.  C.)f  35;  21  Am.  Dec., 519;  McLean 
in  re  Pettit,  2  Paige,  596;  in  re  Hoag,      v.  Breese,  109  (N.  C.),  564. 

7  Paige  (N.  Y.),  312.  7  In  re  Salisbury,  3  Johns.  Ch.  (N. 

2  Hamilton  v.  Traher,  27  Atl.,  229  Y.),  347;  in  re  Colvin,  4  Md.  Ch.,  278. 
(Md.).  8  In  rt  Livingston,  9  Paige  (N.  Y.), 

3  Adams  v.  Thomas,  81  N.  C.,  296;  440. 

in  re  Sartam,  14  Eq.  (N.  C.),  231.  9  De  Treville  v.  Ellis,  21  Am.  Dec., 

4  McLean  v.  Breese,  109  (N.  C.),564.  519;  Bailey  Eq.  (S.  C.),  35. 

5  Frost  v.  Bedford,  54  Mo.  App.,  10  Eslava  v.  Lepretre,  2  Ala.,  504. 
345.                                                                 "  Kennedy  v.  Johnson,  65  Pa.  St., 

•De  Treville   v.   Ellis,  Bailey  Eq.       451. 


598  INCOMPETENT  PERSONS — BROWN  AND   BECKER. 

provided  for  them  by  him  while  sane.1  The  cases  cited  in  the 
note  illustrate  the  powers  of  guardians  and  others  in  actions  in 
behalf  of  and  against  the  incompetent.2 

Death  of  Incompetent  Under  Guardianship.— On 
the  death  of  the  incompetent  the  guardianship  of  property  as 
well  as  of  person  ceases,  but  the  guardian  is  still  trustee  of  the 
property  in  his  custody,  liable  to  account  therefor  to  the  persons 
who  succeed  to  the  rights  of  his  ward,3  though  his  rights  and 
power  over  the  property  as  against  such  persons  terminate  upon 
the  death.4 

Bankruptcy  of  Insane  Persons. — Under  the  present 
national  bankrupt  law  (1898)  it  has  been  held  that  a  lunatic  can- 
not, through  his  committee  or  in  his  own  behalf,  voluntarily 
petition  in  bankruptcy.5 

CARE  AND   RESTRAINT   OF  PERSONS  OF  UNSOUND  HIND. 

The  care  and  custody  of  the  person  of  a  lunatic  being  com- 
mitted by  statute  to  the  court,  it  is  its  duty  to  see  that  he  is  main- 
tained as  comfortably  as  his  unfortunate  situation  will  admit 
and  his  pecuniary  resources  will  allow,  and  that  everything  is 
done  that  can  be,  by  care,  skill,  and  medical  treatment,  to  pro- 
mote his  general  health  and  his  restoration  to  reason.8 

Most  of  the  States  have  provided  by  statute  for  the  proper 

1  Shaffer  v.  List,  114  Pa.  St.,  486.  S.),  294.    And  where  only  next  of  kin 

2  Divorce:   Sims  v.  Sims,  28  S.  E.  is  also  lunatic  see  in  re  Druce,  68  L. 
R.,407;  121  N.  C.,  297;  lagov.  lago,  J.  Prob.    (Eng.),  120;  81  L.  T.  (N. 
168  111.,  339;   48  N.  E.  R.,  30.    Lu-  S.),  458. 

natic  and  guardian  as  parties:    Scott          'Matter  of  Eisenberg,  U.  S.  Dist.  Ct. 

v.  Bassett,  194  111.,  602;  62  N.  E.  R.,  S.  D.  of  N.  Y.,  8  Am.  Bk'cy.  Rep., 

94;    Mullen  v.  Dunn,  134  Cal.,  247;  551.    Nor  will  an  involuntary  petition 

66  Pac.  R.,  209.  Citizenship  of  ward,  lie    against    an    adjudicated    lunatic 

not  guardian,  determines  jurisdiction:  under  guardianship.     U.  S.  Dist.  Ct. 

Stout  v.  Rigney,  107  Fed.,  545;    46  Iowa,  In   re   Funk,  101    Fed.  Rep., 

C.  C.  A.,  459.    No  adverse  possession  244.     Under  former    bankrupt    law 

against  lunatic:   Clairty  v.  Sheridan,  the  petition  would  lie,  if  the  act  of 

91  Iowa,  304;  59  N.  W.  R.,  52;  Clarke  bankruptcy    was    committed    before 

v.  Irwin  (Neb.),  88  N.  W.  R.,  783.  insanity  and  appointment  of  guard- 

For  matters  of  practice  the  statutes  Jan.     In  re  Pratt,  6  N.  B.  R.,  276, 

of  the  several  States  must  be  con-  Fed.  Cas.  11,371.    In  re  Weitzel,  14 

suited.  N.  B.  R.,  466,  Fed.  Cas.  17,365.    But 

3  Downing   v.    Whitney,    46   App.  a  person  of  unsound  mind  could  not 
Div.,  307;   61  N.  Y.  Supp.,  540.  be  declared  bankrupt  in  an  invplun- 

4  Forbell  v.  Denton,  53  App.  Div.,  tary  proceeding.     In  re   Marvin,    1 
402;  65  N.  Y.  Supp.,  1120.  Dill.,  178,  16  Fed.  Cas.  927. 

For  appointment  of  administrator          6  Parsee  Merchant's  Case,  11  Abb. 
of  deceased  lunatic  see  in  re  Harper,      N.  S.  (N.  Y.),  209. 
68  L.  J.  Prob.  (Eng.),  48;  80  L.  T.  (N. 


CARE  OP  PERSONS  OP  UNSOUND   MIND.  599 

care  and  restraint  of  such  persons  in  public  institutions  supported 
and  maintained  at  the  expense  of  the  State.  As  the  jurisdiction 
of  the  State  over  persons  of  unsound  mind  rests  in  part  upon  its 
duty  to  protect  the  community  from  acts  of  those  who  are  not 
under  the  guidance  of  reason,  the  law  admits  the  duty  of  the  State 
to  provide  proper  means  for  the  restraint  of  such  persons,  where 
their  estate  is  not  sufficient  to  provide  such  care  and  restraint, 
or  where  there  are  no  persons  of  sufficient  means  upon  whom 
such  lunatics  are  a  lawful  charge.  The  father  of  an  insane  son, 
whose  estate  is  barely  sufficient  for  the  comfortable  support  of 
his  family,  cannot  be  compelled  to  pay  the  cost  of  the  mainte- 
nance of  such  insane  son  in  an  insane  asylum,  when  such  son  is 
committed  as  an  indigent  insane  person  by  a  court  having  juris- 
diction under  a  statute  providing  therefor.1 

We  have  seen  that  the  support  and  maintenance  of  insane 
persons  is  a  primary  charge  upon  their  estate,  and  this  is  so  even 
if  such  persons  are  confined  within  institutions  maintained  at 
State  expense. 

Such  insane  persons  as  are  so  violent  that  their  remaining  at 
liberty  would  be  dangerous  to  themselves  and  the  community 
may  be  confined  by  any  person  without  warrant,  and  with  no 
other  authority  than  the  inherent  necessity  of  the  case.2 

It  is  as  competent  for  a  magistrate  to  order  into  custody  an 
insane  person  who  is  in  the  act  of  committing  a  breach  of  the 
peace  as  to  order  the  arrest  of  a  sane  person  under  like  circum- 
stances, for,  although  the  insane  person  may  be  incapable  of 
crime,  he  may  lawfully  be  prevented  from  doing  harm.3  But 
such  confinement  can  only  continue  during  the  time  necessary  to 
institute  proceedings  to  inquire  into  the  person's  condition  and 
provide  for  his  legal  custody.4 

To  justify  the  arrest  and  restraint  of  an  insane  person  it  is 
not  necessary  that  he  should  at  the  time  of  his  arrest  be  actually 
engaged  in  the  commission  of  a  crime.  Any  insane  person  may 
be  restrained  of  his  liberty  by  his  family  or  others  to  prevent 
injury  to  himself  or  others. 5 

1  Trustees   of    Poor   v.    Jacobs,    6  Deusen  v.  Newcomer,  40  Mich.,  90; 

Houst.  (Del.),.  330.  Williams  v.  Williams,  2  Hun  (N.  Y.), 

'Emmerich  v.   Thorley,   35  App.  111. 

Div.,  452;    54  N.  Y.  Supp.,  79.  4  Lott  v.  Sweet,  33  Mich.,  308. 

3  Colby  v.  Jackson,  12  N.  H.,  526;  *  In  re  Oakes,  8  Law  Rep.  (Mass.), 

Davis  v.  Merrill,  47  N.  H.,  208;   Van  122. 


600  INCOMPETENT  PERSONS — BROWN   AND   BECKER. 

COMMITMENT  AND  CONFINEMENT  OF  THE  INSANE. — Under 
a  constitutional  government  no  person  can  be  deprived  of  life, 
liberty,  or  property  without  "due  process  of  law,"  and  therefore 
no  person  can  be  lawfully  declared  insane  and  his  personal 
liberty  permanently  restrained  without  formal  proceedings  and 
an  opportunity  afforded  him  to  appear  personally  and  with  wit- 
nesses, to  refute  the  allegations  of  the  persons  seeking  his  confine- 
ment. Various  forms  of  procedure  are  prescribed  by  statute  for 
the  determination  of  the  question  of  insanity  and  the  consequent 
commitment  of  the  alleged  insane  person  to  an  institution.  In 
many  States  a  trial  by  jury  is  required  in  every  case,  and  all  the 
facts  are  presented  and  passed  upon,  and  a  verdict  rendered  as 
in  all  other  cases  where  the  liberty  of  the  person  is  at  stake.  The 
trial  is  in  open  court,  attended  with  all  the  form  of  a  criminal 
proceeding.  The  theory  is  that  the  charge  of  insanity  is  inimical 
to  the  interests  of  the  person  sought  to  be  confined,  and  that  he 
should  therefore  be  given  the  opportunity  of  defending  the 
charge  and  that  the  truth  thereof  should  be  determined  by  a 
jury  of  "his  peers."  Such  a  system  of  commitment  exists  in  the 
State  of  Illinois. 

It  is  not  satisfactory;  justice  to  the  alleged  lunatic  is  not 
thereby  accorded.  Under  this  system  sane  persons  have  been 
declared  insane,  and  persons  clearly  and  undoubtedly  of  unsound 
mind  have  been  "acquitted." 

The  empanelling  of  a  jury  and  the  complicated  form  of  pro- 
cedure attendant  thereto  have  caused  delays,  which  often  injure 
the  health  of  patients  requiring  immediate  treatment.  The  pub- 
licity and  commotion  of  such  a  trial  injuriously  affect  the  dis- 
ordered minds  of  alleged  lunatics  and  disgust  and  grieve  their 
friends  and  relatives. 

Lunacy  is  not  a  crime,  but  a  disease.  A  jury  of  laymen  is 
not  requisite  justly  to  determine  the  question  of  whether  a  per- 
son is  suffering  from  this  infirmity.  It  is  a  question  for  medical 
experts,  who  from  their  training  and  experience  are  qualified  to 
pass  upon  it.  Hence  in  most  of  the  States  the  order  of  commit- 
ment is  issued  only  after  an  examination  of  the  alleged  lunatic 
by  medical  experts.  The  experts  are  required  to  certify  the 
results  of  such  examination  to  the  judge  having  jurisdiction,  and 
such  judge,  if  satisfied  from  the  certificate  and  such  other  proof 
as  may  be  presented  that  the  alleged  insane  person  should  be  con- 


CARE   OF  PERSONS  OF  UNSOUND   MIND.  601 

4p 

fined  in  an  institution,  shall  make  an  order  to  that  effect.  In 
some  States  it  is  provided  that  the  question  of  insanity  shall  in 
each  case  be  determined  by  a  commission,  composed  of  a  medical 
expert  and  one  or  two  laymen,  associated  with  the  judge  to  hear 
the  proofs  and  examine  the  person  alleged  to  be  insane.  Upon 
their  decision  the  order  is  issued. 

Other  methods  of  commitment  are  provided  in  the  several 
States,  more  or  less  complex  in  form  of  proceeding  and  more  or 
less  adapted  to  the  welfare  and  protection  of  alleged  lunatics. 

It  is  evident  that  the  right  to  confine  a  person  because  of 
alleged  insanity  is  based  upon  the  benefit  to  be  derived  by  such 
person  and  the  necessity  of  protecting  the  community  from  his 
acts.  No  lunatic  should  be  deprived  of  his  liberty  unless  re- 
straint is  necessary  or  beneficial.1  The  new  theory  of  "care  and 
treatment "  has  supplemented  and  become  associated  with  the 
common  law  right  of  detention,  so  that  now  the  confinement  of  a 
lunatic  in  an  institution  is  an  incident  of  his  proper  medical  and 
scientific  care  and  treatment.  While  the  safety  and  welfare  of 
the  community  are  subserved  by  taking  therefrom  a  person 
suffering  mentally  in  such  a  manner  as  to  be  dangerous  to  those 
about  him,  yet  the  chief  end  is  the  improvement  of  his  unfortu- 
nate condition  and  the  alleviating  of  his  physical  sufferings. 

The  commitment  should  be  hedged  about  by  safeguards ;  the 
law  should  be  so  framed  and  construed  as  to  reduce  to  a  mini- 
mum the  likelihood  of  the  improper  restraint  of  those  not  in 
need  thereof.  But  the  theory  that  a  person  afflicted  with  mental 
disease  should  be  tried  and  convicted  therefor,  that  the  proceed- 
ing to  determine  the  question  of  his  mental  condition  should  be 
in  the  form  of  a  criminal  proceeding,  is  antiquated,  and  in  view 
of  the  advance  of  medico-legal  science  with  reference  to  lunacy 
should  have  no  place  in  our  statute  law. 

The  alleged  lunatic  should  in  every  case  be  examined  by  weil 
qualified  and  competent  medical  experts.  The  judge  whose  duty 
it  is  to  pass  upon  the  question,  if  in  doubt  as  to  the  motives  actu- 
ating the  petitioner  and  dissatisfied  with  the  result  of  the  exami- 
nation by  the  experts,  should  be  empowered  to  examine  other 
witnesses  and  secure  further  expert  testimony.  A  notice  of  the 
time  and  place  set  for  the  hearing  should  be  given  not  only  to 
the  alleged  insane  person,  but  to  other  persons  who,  because  of 
1  Com.  ex  rel.  v.  Kirkbride,  2  Brewster  (Pa.),  586. 


602  INCOMPETENT  PERSONS— BROWN  AND   BECKER. 

kinship  or  friendship,  are  interested  in  his  welfare.  Oppor- 
tunity should  be  given  for  the  persons  so  served  to  refute  the 
allegations  of  the  petitioner  and  produce  witnesses  in  aid  thereof. 
If  issue  be  joined,  the  trial  should  be  had  before  a  commission 
of  not  more  than  three,  one  or  more  of  whom  should  be  expert 
in  the  treatment  of  mental  diseases.  The  determination  of  the 
question  of  insanity  should  be  based  upon  testimony  of  a  scien- 
tific character.  The  medical  experts  should  be  fit  and  responsi- 
ble, they  should  bring  to  bear  upon  the  case  at  hand  the  best  of 
their  professional  knowledge.  They  should  carefully  examine 
the  person  alleged  to  be  insane,  and  in  forming  their  opinion 
should  apply  all  the  best  accredited  and  most  recent  tests. 

Upon  the  medical  profession  should  properly  be  placed  the 
responsibility  of  the  proper  care  and  treatment  of  the  insane. 
To  them,  more  than  to  all  others,  should  we  look  for  a  proper 
determination  of  questions  of  insanity.  While  it  will  probably 
be  admitted  that  there  are  in  this  profession  men  who  lack  pro- 
fessional integrity,  yet  the  fact  that  there  is  scarcely  a  case  re- 
ported in  this  country  where  a  physician  has  been  accused  and 
convicted  of  falsely  certifying  to  a  person's  insanity  would  lead 
us  to  believe  that  they  have  with  fidelity  and  honor  performed 
the  duties  imposed  upon  them  by  the  statutes  of  the  different 
States. 

LIABILITY  OF  MEDICAL  EXAMINEE  FOR  FALSE  CERTIFI- 
CATE.— In  most  of  the  States  the  executing  of  a  false  certificate 
by  a  medical  examiner  is  a  misdemeanor.  If  a  person  maliciously 
and  without  any  reasonable  or  probable  cause  has  signed  a  cer- 
tificate that  a  person  was  insane,  in  a  state  requiring  confine- 
ment, and  in  consequence  thereof  a  party  has  been  detained  in 
custody  as  a  lunatic,  such  person  is  liable  for  damages  caused ; 
and  such  a  certificate  may  be  considered  as  libel,  in  which  case 
an  indictment  would  lie  against  the  person  who  signed  it.1 

The  first  duty  of  a  medical  examiner  professionally  called  to 
testify  to  the  mental  condition  of  a  person  alleged  to  be  insane 
is  carefully  and  strictly  to  follow  the  various  requirements  of 
the  statute  or  the  rules  and  regulations  prescribed  by  competent 
authorities. 

If  the  examiner  is  a  physician  of  good  repute,  if  the  exam- 
ination is  made  and  the  certificate  executed  in  good  faith,  if  he 
1  King  v.  Harvey  and  Chapman,  2  Barn,  and  Cress.,  257. 


CARE  OF  PERSONS  OF  UNSOUND   MIND.  603 

possesses  the  requisite  knowledge  and  skill  to  enable  him  to 
judge  of  the  mental  condition  of  the  patient  under  examination, 
and  the  examination  be  made  with  the  usual  professional  care 
and  attention,  such  a  certificate  meets  every  requirement  of  the 
law ;  and  if  error  is  committed  therein,  and  if  unfortunately,  by 
reason  thereof,  a  person  of  sound  mind  is  committed  to  an 
asylum  for  the  insane,  the  medical  examiners  will  be  relieved  of 
responsibility  and  liability  for  unjust  restraint  of  liberty.1 

A  medical  examiner  is  not  responsible  for  an  honest  mistake 
of  judgment,  and  particularly  in  reference  to  that  judgment 
which  is  the  conclusion  of  his  examination  of  a  person  supposed 
to  be  insane. 

A  physician  or  surgeon  is  under  obligation  to  possess,  and  it 
is  his  duty  in  the  treatment  of  a  case  to  employ,  such  reason- 
able skill  and  diligence  as  is  ordinarily  exercised  in  his  profes- 
sion.2 

A  medical  expert  before  signing  the  certificate  of  insanity 
should  take  due  care  and  make  due  inquiries ;  if  he  does  not  he 
is  liable  in  damages  for  the  consequences. 

In  Hall  v.  Semple,  3  Fost.  and  Fin.,  337,  Crompton,  Justice, 
says:  "The  true  grounds  of  plaintiff's  complaint  is  the  negli- 
gence of  the  defendant  and  the  want  of  due  care  in  the  discharge 
of  the  duty  thrown  upon  him,  and  I  think  that  if  a  person  as- 
sumes the  duty  of  a  medical  man  under  the  statutes  and  signs  a 
certificate  of  insanity  which  is  untrue,  without  making  the  proper 
examination  and  inquiries,  which  the  circumstances  of  the  case 
would  require  from  a  medical  man  using  proper  skill  in  such  a 
matter,  if  he  states  that  which  is  untrue  and  damage  ensues  to 
the  party  thereby,  he  is  liable  in  an  action. " 

It  is  the  physicians'  duty  to  make  the  examination  with  or- 
dinary care.  This  duty  must  be  measured  by  the  trust  which 
the  statute  reposes  in  them,  and  by  the  consequences  flowing  from 
its  improper  performance.  They  assume  the  duty  by  accepting 
the  trust.  They  are  not  judicial  officers,  and  as  such  therefore 
free  from  the  charge  of  a  lack  of  due  and  ordinary  care  and  pru- 
dence. They  are  not  clothed  with  judicial  immunity  and  are 
chargeable  with  that  negligence  which  attaches  to  a  professional 

1  Penn.  Lunacy  Laws,  p.  191  (Bar-  459;  Long  v.  Morrison,  14  Ind.,  595; 

low).  Jones  v.  Angell,  95  Ind.,  376;  Carpen- 

2McCandlers  v.  McWha,  22  Penn.,  ter  v.  Blake,  75  N.  Y.,  12;  Barton  v. 

261;  Holtzman  v.  Hoy,  19  111.  App.,  Goran,  42  Hun  (N.  Y.),  655. 


604  INCOMPETENT   PERSONS— BROWN  AND   BECKER. 

expert  who  does  not  use  the  care  and  skill  which  his  profession, 
per  se,  implies  that  he  will  bring  to  his  professional  work.1 

LIABILITY  FOR  ILLEGAL  DETENTION. — The  inherent  juris- 
diction of  the  State  over  persons  of  unsound  mind  rests  in  part 
upon  its  duty  to  protect  the  community  from  the  acts  of  those 
who  are  not  under  the  guidance  of  reason,  and  it  therefore  fol- 
lows that  if  any  person  is  so  insane  that  his  remaining  at  liberty 
would  be  dangerous  to  himself  or  the  community,  any  other  per- 
son may,  without  warrant  or  other  cause  than  the  inherent  neces- 
sity of  the  case,  confine  such  dangerous  insane  person,  but  only 
during  so  long  a  time  as  may  be  necessary  to  institute  and  carry 
to  a  determination  proper  proceedings  to  inquire  into  the  party's 
condition  and  provide  for  his  legal  custody.  And  it  is  not 
necessary,  in  order  to  justify  the  arrest  and  restraint  of  the  insane 
person,  that  he  should  at  the  time  of  arrest  be  actually  engaged 
in  the  commission  of  violence ;  for  any  insane  person  may  be  re- 
strained of  his  liberty,  by  his  family  or  others,  to  such  an  extent 
and  for  such  a  length  of  time  as  may  be  necessary  to  prevent  in- 
jury or  damage  to  persons  or  property  or  to  the  lunatic.2 

Except  in  such  cases  of  violent  and  dangerous  insanity,  any 
person  who  assumes  illegally  to  arrest,  detain,  or  confine  an 
insane  person  does  so  at  his  peril,  and  he  will  become  liable  for 
his  act  as  if  the  person  arrested,  detained,  or  confined  was  sane. 
Where  his  confinement  was  without  just  cause  a  person  can  re- 
cover damages  in  an  action  for  false  imprisonment,  from  all  those 
who  united  to  procure  his  commitment,  including  those  who  ac- 
tually kept  him  in  confinement.3  But  where  he  was  detained  by 
the  authorities  of  an  asylum,  having  been  properly  received  and 
without  collusion  or  fraud,  a  mistake  in  judgment  as  to  his  in- 
sanity would  not  subject  the  authorities  to  liability ;  for  the  evi- 
dence must  show  either  malice  or  gross  negligence  before  there 
can  be  recovery  for  false  imprisonment,  or  that  they  detained  him 
after  they  knew  he  was  not  a  proper  subject  for  confinement.4 
And  mere  improvement  so  as  to  make  it  proper  to  deliver  the  in- 
competent to  the  custody  of  friends  does  not  give  rise  to  such  lia- 
bility;  the  improvement  must  first  be  such  as  to  make  it  the  duty 
of  the  custodian  to  release  him  without  the  company  of  friends.4 

1  Ayres  v.  Russel,  50  Hun  (N.  Y.),          3  Bacon  v.  Bacon,  76  Miss.,  458;  24 

So.  Rep.,  968.     See  supra,  p.  599. 

2  Buswell  on  "  Insanity,"  B.  23.  *Hindman  v.  Hutchinson,  SOPittsb. 

Leg.  J.  (N.  S.),  422. 


CARE   OF    PERSONS   OF   UNSOUND    MIND.  G05 

An  adjudication  of  insanity  made  under  a  statute  at  the  in- 
stance of  a  person  who  under  the  statute  is  not  empowered  to 
present  the  petition  is  no  justification  in  a  suit  for  false  imprison- 
ment, by  the  person  so  adjudged.1 

A  person  harmlessly  insane  cannot  be  arrested  without  a  war- 
rant, even  though  the  purpose  is  to  detain  him  until  he  can  be 
carried  before  a  proper  tribunal  and  procure  warrant  of  com- 
mitment to  an  insane  asylum.  The  statutes  providing  for  the 
detention  and  confinement  of  an  insane  person  must  be  strictly 
followed.  Any  deviation  therefrom,  is  an  injury  to  the  person 
detained  and  he  may  recover  from  all  parties  involved  in  such 
arrest,  detention,  or  confinement  for  all  damages  occasioned 
thereby.2  The  mere  fact  that  a  person  is  insane  does  not  warrant 
his  summary  arrest  and  confinement.  The  law  provides  iii  what 
way  and  by  what  proceedings  the  liberty  of  the  alleged  insane 
person  shall  be  restrained.  There  can  be  no  valid  excuse  for  a 
failure  to  comply  with  all  the  legal  requirements.  If  persons 
interested  in  securing  the  detention  and  confinement  of  insane 
persons  would  be  relieved  from  liability  therefor,  they  must  see 
to  it  that  the  letter  of  the  law  is  strictly  obeyed. 

WRIT  OF  HABEAS  CORPUS. — In  the  statutes  of  most  of  the 
States  the  right  to  a  writ  of  habeas  corpus  is  accorded  to  all  per- 
sons detained  as  insane  in  or  out  of  an  institution  for  the  cus- 
tody, care,  and  treatment  of  insane  persons.  In  such  cases  the 
statute  generally  provides  that  the  question  of  sanity  shall  be 
tried,  and  although  no  irregularities  may  have  occurred  in  secur- 
ing his  confinement,  and  at  the  time  of  the  commitment  the  per- 
son was  insane,  if  at  the  time  of  the  issuance  of  the  writ  he  is  re- 
stored to  reason  he  must  be  discharged  from  custody. 

To  detain  a  person  after  his  restoration  to  sanity  would  be 
like  detaining  a  prisoner  after  he  had  served  out  the  period  of 
his  sentence.  However  legal  and  proper  the  confinement  may 
have  been  at  the  beginning,  and  while  the  patient  was  insane,  to 
restore  the  patient  to  his  liberty  and  to  society  when  his  sanity 
is  established  is  an  appropriate  office  of  the  writ  of  habeas 
corpus. 

Judge  Potter,  in  Matter  of  Dixou,  11  Abb.  N.  C.  (N.  Y. ), 
118,  so  held  regardless  of  the  fact  that  the  New  York  statute  pro- 

1  Washer  v.  Slater,  67  App.  Div.,          2  Look  v.  Choate,  108  Mass.,  116. 
385;   73  N.  Y.  Supp.,  425. 


606  INCOMPETENT  PERSONS — BROWN  AND    BECKER. 

vides  no  such  remedy  for  persons  confined  in  asylums  who  have 
been  restored  to  sanity.  If  a  person  is  detained  or  confined  as  a 
lunatic  without  authority  of  law,  he  may  be  brought  into  court 
upon  a  writ  of  habeas  corpus  and  the  legality  of  his  detention  be 
determined. 

On  an  application  for  the  writ,  it  should  be  made  to  appear 
that  the  applicant  was  acting  under  due  authority  from  the 
alleged  lunatic.  In  most  of  the  States  the  statutes  provide  that 
provision  shall  be  made  for  the  unrestricted  communication  of 
inmates  of  institutions  with  persons  of  authority  or  friends  or 
relatives  named  by  such  inmates,  and  that  every  means  shall  be 
afforded  for  carrying  on  such  communication.  Such  letters  are 
required  to  be  mailed  without  examination  by  the  authorities  of 
the  institution.  Commissions  are  established  in  nearly  all  the 
States  who  have  a  visitorial  power  over  all  institutions  for  the 
custody  and  treatment  of  the  insane.  The  duty  is  placed  upon 
them  to  investigate  the  conduct  of  all  such  institutions,  and  if, 
in  their  judgment,  persons  are  illegally  detained  therein,  they 
are  required  to  secure  their  discharge. 

CARE  AND  CUSTODY  OP  THE  INDIGENT  INSANE. — For  the 
provisions  which  have  been  made  in  the  several  States  for  the  care 
and  cure  of  the  indigent  insane,  examination  must  be  made  of 
the  statutes  of  these  States,  as  synopsized  below. 

Liability  of  Insane  Asylums  for  Torts  of  Employ- 
ees.— In  many  States,  as  will  be  observed  from  the  statutes 
digested  below,  the  hospitals  for  the  insane  or  their  trustees  are 
bodies  corporate.  In  other  States,  the  asylums  have  no  inde- 
pendent corporate  existence,  but  are  merely  State  institutions. 
The  question  has  arisen  to  what  extent  is  the  asylum  corporation 
or  the  State  liable  for  the  wrongful  acts  of  its  agents. 

The  general  rule  is  that  when  the  State  acts  in  its  public, 
governmental  capacity,  it  is  not  liable  for  the  wrongful  or  negli- 
gent execution  of  such  powers  by  its  agents.  Such  rule  has 
generally  been  held  applicable  to  insane  asylums.  They  are 
"  purely  eleemosynary  institutions  created  by  the  State  and  main- 
tained at  its  expense  for  the  beneficent  purpose  of  caring  for  such 
of  its  citizens  as  may  by  judgment  of  a  court  of  competent  juris- 
diction be  declared  of  unsound  mind,  and,  by  reason  thereof,  dis- 
qualified for  the  duties  of  citizenship  and  of  caring  for  them- 
selves. Such  institutions  are  mere  instrumentalities  of  the  State 


STATUTES   OP  ALABAMA.  607 

government  brought  into  being  to  aid  in  the  performance  of  gov- 
ernment duty,  hence  the  rule  of  respondeat  superior  does  not  apply 
to  them."  They  cannot  therefore  be  made  to  respond  in  dam- 
ages for  a  personal  injury  inflicted  upon  others  by  their  servants, 
or  by  lunatics  in  their  charge,  though  such  injuries  result  from 
negligence  or  malice.1  It  would  seem  that  the  same  rule  applies 
even  when  the  patient  is  a  paying  one.2 

In  the  case  of  private  charities  or  asylums  the  decisions  are 
hopelessly  at  variance.3 

Similarly,  though  the  agents  themselves  who  act  negligently 
or  commit  other  wrongs  are  probably  liable  therefor,  their  supe- 
riors, as  the  general  superintendent,  are  not  liable  for  the  acts 
of  subordinates.4 


THE  STATUTES  OF  ALL  THE  STATES  DIGESTED,  RELAT- 
ING TO  THE  CARE  AND  CUSTODY  OF  INCOMPETENT 
PERSONS  AND  THEIR  ESTATES,  INCLUDING  THE  AD- 
JUDICATION OF  LUNACY,  AND  RESTRAINT  AND  CON- 
FINEMENT OF  THE  INSANE,  AND  TO  THE  SUBSTANTIVE 
LAW  OF  INSANITY. 

[FIRST  EDITION   COMPILED   BY   FRANK  B.    GILBERT,    Esq. ;     COMPILED   AND  REVISED   FOR 
THE   SECOND  EDITION   BY   ALFRED   L.   BECKER,   OF  THE   BUFFALO,    N.    Y.,   BAR.] 

ALABAMA. 

[The  references  are  to  the  Civil  and  Criminal  Codes  of  Ala- 
bama, 1907.] 

CIVIL  EIGHTS. — Idiots  and  insane  persons  are  disqualified 
from  voting  or  holding  office.5 

The  sale  of  liquor  to  an  insane  person  without  the  consent  of 
his  guardian  is  void.8 

1  Leavell  v.  Western  Ky.  Asyl.  for  Fed.,  294;  47  C.  C.  A.,  122;  65  L.  R. 
the  Ins.,  28  Ky.  L.  R.,   1129;  91  S.  A.,  372  (with  full  review  of  authori- 
W.  R.,  671;  4  L.  R.  A.  (N.  S.),  269;  ties);  contra  Glavin  v.  R.  I.  Hosp., 
White  v.Ala.  Ins.  Hosp.,  138 Ala.,479;  12  R.  I.,  411. 

35  So.,  454;  Benton   v.   Boston  City  3See  Justice  Gaynor's  able  opinion 

Hosp.,  140  Mass.,  13;  1   N.  E.,  836;  in  Kellogg  v.  Church  Char.  F.,  128 

City  of  Richmond  v.  Long's  Admrs.,  App.  Div.  (N.  Y.),  214;  112  Supp., 

17  Grat.   (Va.),  375;    Sherbourne  v.  566. 

Yuba  Co.,  21  Cal.,  113;  Murtaugh  v.  4Clough  v.  Worsham,  32  Tex.  Civ. 

City,  44  Mo.,  479;  Downesv.  Harper  App.,    187;  74  S.   W.    R.,   350;   cf. 

Hospital,  101  Mich. ,555;  60  N.W.R.,  Story  on   Agency,  s.   319-320;  Van 

42;  Corbett  v.  St.  Vincent's  Industrial  Deusen  v.  Newcomer,  40  Mich.,  90. 

School,  177  N.  Y.,  16;  68  N.  E.  R.,  s  Const.  Art.  viii.,  s.  3;  Polit.Code, 

997.  s.  1,467,  1,560. 

2  Powers  v.  Mass.  Horn.  Hosp.,  109  '  Civil  Code,  s.  5,764. 


608  INCOMPETENT    PERSONS— BROWN    AND    BECKER. 

CARE  AND  CUSTODY. — Courts  of  probate  have,  in  the  cases 
defined  by  law,  original  jurisdiction  of  the  appoiutmeut  and  re- 
moval of  guardians  for  minors  and  persons  of  unsound  mind 
residing  in  the  county,  having  an  estate  real  or  personal,  and  of 
such  persons  without  the  State,  having  property  within  the  county 
requiring  the  care  of  a  guardian.1 

Such  guardian  is  not  to  be  appointed  until  an  inquisition  has 
been  had  and  taken  in  the  case  of  a  resident.2 

INQUISITION,  PROCEEDING.  —Upon  the  petition  of  any  of  the 
relatives  or  friends  of  any  person  alleged  to  be  of  unsound  mind 
setting  forth  the  facts  and  name,  sex,  age,  and  residence  of  such 
person,  accompanied  by  an  affidavit  that  the  petitioner  believes 
the  facts  therein  stated  to  be  true,  the  court  of  probate  of  the 
county  in  which  such  person  alleged  to  be  of  unsound  mind  re- 
sides must  appoint  a  day  not  more  than  ten  days  from  the  pre- 
sentment of  such  petition  for  a  hearing  thereon.3 

The  judge  must  issue  a  writ  directed  to  the  sheriff  command- 
ing him  to  summon  twelve  disinterested  persons  and  issue  sub- 
po3nas  for  witnesses  returnable  at  the  time  of  trial.  He  must 
also  direct  the  sheriff  to  take  the  person  alleged  to  be  of  unsound 
mind,  and,  if  consistent  with  health  or  safety,  have  him  present 
at  the  place  of  trial.4 

The  jury  must  be  impanelled  and  sworn.  If  any  of  the 
jurors  from  any  cause  do  not  serve,  their  places  must  be  supplied 
from  the  bystanders.5 

If  the  jury  find  the  facts  alleged  in  the  petition  to  be  true,  and 
that  such  person  is  of  unsound  mind,  the  court  must  cause  the 
petition  and  all  the  proceedings  thereon,  to  be  recorded  and  ap- 
point a  suitable  guardian  of  such  person.6 

If  the  person  alleged  to  be  of  unsound  mind  is  a  resident  of 
the  county  and  at  the  time  of  the  application  confined  in  a  hos- 
pital or  asylum  within  or  without  the  State,  the  inquisition  may 
be  had  or  taken  without  notice  to  him.7 

NON-BESIDENT  PERSONS  OF  UNSOUND  MIND. — The  court  of 
probate  may  appoint  a  guardian  for  a  person  of  unsound  mind, 
having  property  within  the  State,  if  such  person  has  been  declared 
insane  by  a  conrt  having  jurisdiction  in  the  State  of  his  residence.8 

'Civil  Code,  s.  4,345.  *  Ibid.,  s.  4,349. 

2  Ibid.,  s.  4,346.  6  Ibid.,  s.  4,350. 

3  Ibid.,  s.  4,347.  7  Ibid.,  s.  4,351. 

4  Ibid.,  s.  4,348.  8  Ibid.,  s.  4,357. 


STATUTES   OP   ALABAMA.  609 

The  application  must  be  in  writing,  verified ;  must  state  the 
name,  sex,  age,  and  residence  of  such  person,  the  court  by  which 
he  was  declared  of  unsound  mind,  and  describe  the  property  re- 
quiring the  care  of  a  guardian.  A  hearing  must  be  given  upon 
notice  for  three  successive  weeks  by  publication.1 

WHO  MAYBE  APPOINTED  GUARDIAN. — The  court  must  pre- 
fer in  the  appointment  of  a  guardian  the  person  who  is  of  near- 
est relationship  and  will  in  the  judgment  of  the  court  best  man- 
age the  estate  of  the  ward.2 

The  general  guardian  of  the  county  must  lie  appointed  guar- 
dian of  a  person  of  unsound  mind  if  no  other  suitable  person 
applies  for  appointment  and  qualifies;  and  if  there  be  no  general 
guardian,  the  sheriff  must  be  appointed.3 

THE  BOND  OF  GUARDIAN. — The  guardian  other  than  the 
general  guardian  for  the  county  or  the  sheriff,  must  enter  into  a 
bond  with  sufficient  sureties  payable  to  the  judge  of  probate 
in  a  penalty  to  be  prescribed  by  the  judge,  with  condition  for 
the  faithful  performance  of  all  his  duties.4 

Land  of  the  ward  cannot  be  sold  until  guardian  has  given  a 
bond  for  double  the  supposed  or  estimated  value  of  such  lands, 
payable  to  the  judge  of  probate,  and  with  condition  that  he  will 
faithfully  account  for  the  proceeds  of  such  sale.5 

EEVOCATION  OF  GUARDIANSHIP. — The  insane  person  him- 
self, or  by  next  friend,  may  apply  in  writing  to  the  court  of  pro- 
bate for  a  revocation  of  the  proceedings  against  him  and  of  the 
letters  of  guardianship,  the  application  to  be  accompanied  by 
the  certificate  in  writing  of  two  physicians  or  of  two  other  com- 
petent persons,  stating  that  after  examination  of  such  person 
they  believe  him  to  be  of  sound  mind.6 

The  court  must  appoint  a  day  for  the  hearing  thereof,  not 
more  than  ten  days  thereafter,  and  the  guardian  and  the  person 
at  whose  instance  the  inquisition  was  had  and  taken  must  be 
cited  to  appear  and  show  cause. 

If  the  guardian  or  such  person  appear  and  in  writing  deny  the 
allegations  of  the  application,  the  court  must  appoint  a  day  for 
the  trial  of  such  contest,  cause  a  jury  to  be  summoned  for  the 
trial  thereof,  and  the  like  proceedings  must  be  had  as  upon  the 
original  inquisition. 

1  Civil  Code,  s.  4,358.  *  Ibid.,  s.  4,361. 

*  Ibid.,  s.  4,359.  *  Ibid.,  s.  4,362. 

*  Ibid.,  s.  4,360.  •  Ibid.,  s.  4.352. 

III.— 39 


G10  INCOMPETENT    PERSONS — BROWN   AND    BECKER. 

If  there  be  no  contest  a  decree  must  be  entered,  revoking  the 
proceedings  of  the  inquisition  and  the  guardianship.1 

If  at  auy  time  after  his  appointment  the  guardian  becomes 
satisfied  that  the  ward  has  been  restored  to  sanity  and  is  capable 
of  managing  his  estate,  and  the  judge  of  probate  is  of  opinion 
from  the  proofs  and  the  facts  stated  that  such  representation  is 
correct,  he  must  make  an  order  that  the  guardian  be  discharged 
and  that  the  estate  of  the  ward  be  restored.2 

THE  MEANING  OF  TERM  PERSONS  OF  UNSOUND  MIND.— 
The  term  "  persons  of  unsound  mind  "  includes  idiots,  lunatics, 
or  the  insane.3 

POWER  AND  DUTY  OF  GUARDIANS. — Within  three  months 
after  his  appointment  the  guardian  must  make  an  inventory  of 
all  the  estate  of  his  ward  and  return  it  upon  oath  to  the  court, 
and  it  must  be  filed  and  recorded.4 

The  guardian  must  manage  the  estate  of  his  ward  frugally 
and  improve  it  to  the  best  of  his  skill  and  ability.5 

The  guardian  may  publicly  or  privately  lease  the  land  of  the 
ward  for  a  term  not  exceeding  one  year  and  make  a  report  there- 
of to  the  court  of  probate.6 

The  court  of  probate  may  authorize  the  guardian  to  lease  the 
lauds  of  the  ward  for  a  term  not  exceeding  ten  years,  reserving 
rent  payable  annually;  such  lease  being  subject  to  revocation 
or  disamrmauce  by  the  ward,  upon  restoration  to  sanity.7 

The  guardian  must  keep  in  good  repair  and  condition  the 
real  estate  of  the  ward,  and  he  can  make  all  such  improvements 
and  repairs  thereon  as  are  necessary  and  proper  for  that  purpose ; 
but  such  improvements  or  repairs  cannot  be  made  from  the 
principal  of  the  funds  of  the  ward  without  an  order  of  the  court 
of  probate.8 

The  court  of  probate  may  authorize  a  guardian  to  compromise 
any  claim  or  debt  due  to  the  ward.9 

The  court  may  authorize  the  guardian  to  take  real  estate  in 
compromise  of  the  debt  or  claim.10 

The  court  may  authorize  the  guardian  to  sell  debts  or  other 
choses  in  action  of  the  ward  which  are  of  doubtful  collection  or 

'Civil  Code,  s.  4,353-4,355.  'Ibid.,  8.  4,379. 

2  Ibid.,  s.  4,356.  7  Ibid.,  s.  4,380. 

8  Ibid.,  s.  4,361.  8  Ibid.,  s.  4,386. 

4  Ibid.,  s.  4,375.  •  Ibid.,  a.  4,391,  4,393. 

8  Ibid.,  s.  4,376.  »  Ibid.,  a.  4,394. 


STATUTES   OF   ALABAMA.  611 

recovery.  This  must  be  done  upon  the  order  of  such  court, 
granted  upon  the  application  in  writing  of  the  guardian  verified 
by  affidavit,  but  a  report  of  the  sale  must  be  made  to  and  con- 
firmed by  the  court.1 

The  court  may  authorize  the  guardian  to  sell  any  property, 
real  or  personal,  when  necessary  for  the  payment  of  debts  of 
such  insane  person  incurred  for  the  maintenance  of  such  person 
or  for  the  maintenance  of  his  family.2 

If  the  sale  is  of  personal  property,  notice  thereof  must  be 
given  by  advertisement  for  twenty  days  in  a  newspaper  published 
in  the  county ;  and  if  of  lauds,  such  notice  must  be  for  thirty  days 
by  advertisement  for  four  consecutive  weeks  in  a  newspaper  pub- 
lished in  the  county.  A  report  of  such  sale  must  be  made  to 
and  confirmed  by  the  court.  The  title  of  the  ward  is  not  di- 
vested until  the  purchase  money  is  fully  paid.3 

The  property  of  the  ward  may  be  sold  for  good  cause  shown  for 
the  purpose  of  reinvestment.  The  court  of  probate  must  direct 
how  the  sale  shall  be  made,  and  such  sale  its  no  completed  until 
confirmed  by  the  court  and  until  all  the  purchase  money  is  paid.4 

Guardians  may  invest  the  money  of  their  wards  in  real  estate, 
and  if  acting  in  good  faith  shall  not  be  individually  responsible 
for  a  depreciation  in  the  value  of  the  land  purchased  with  the 
funds  of  the  ward,  if  such  depreciation  results  from  causes  which 
cannot  be  prevented  by  the  guardian.5 

Real  estate  purchased  by  the  guardian  with  the  funds  of  the 
ward  must  be  conveyed  to  the  ward,  but  managed  and  controlled 
by  the  guardian  for  the  benefit  of  the  ward.6 

The  guardian  is  liable  to  the  ward  for  any  loss  sustained  by 
the  failure  or  defect  of  title  of  the  land  purchased.7 

The  court  of  probate,  on  the  application  of  the  guardian, 
must  direct  what  portion  of  the  income  or  of  the  principal  of  the 
estate  of  the  insane  person  may  be  appropriated  to  the  support 
of  the  family.8 

SETTLEMENT  OF  GUARDIAN. — The  court  of  probate  has 
jurisdiction  of  the  settlement,  partial  or  final,  of  the  accounts  of 
the  guardian.' 

1  Civil  Code,  s.  4,398-4,402.  « Ibid.,  a.  4,396. 

J  Ibid.,  a.  4,407.  T  Ibid.,  s.  4,397. 

*  Ibid.,  B.  4,408.  "  Ibid.,  s.  4,407. 

"  Ibid.,  B.  4,411-4,414.  •  Ibid.,  s.  4,428. 
'/&tW.,s.  4,395. 


612  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

The  guardian  must  at  least  once  in  three  years  file  in  the 
court  an  account  of  his  guardianship  accompanied  with  the 
vouchers  verified  by  affidavit.  The  court  must  appoint  a  day 
for  the  settlement,  of  which  notice  must  be  given  for  three  suc- 
cessive weeks  in  the  manner  directed  by  the  court.  On  the  day 
of  settlement  the  court  must  proceed  to  examine  the  vouchers 
and  audit  and  state  the  account.  If  any  voucher  or  item  be  re- 
jected, all  costs  accruing  on  the  contest  or  examination  thereof 
must  be  taxed  against  the  guardian  personally.  Upon  the  final 
settlement,  the  partial  settlement  must  be  presumed  to  be  cor- 
rect.1 

On  the  death,  resignation,  or  removal  of  the  guardian,  or  on 
the  restoration  to  sanity  of  the  ward  or  on  his  death,  the  final 
settlement  of  the  guardianship  must  be  made.  Upon  such  set- 
tlement the  guardian  must  file  in  the  court  of  probate  a  full 
account  of  the  guardianship,  accompanied  by  the  vouchers  and 
verified  by  affidavit.  The  court  must  appoint  a  day  for  the  set, 
tlemeut  with  ten  days'  notice  to  the  ward  if  restored  to  sanity, 
or  to  his  personal  representatives,  if  dead. 

On  the  day  appointed,  the  court  must  proceed  to  examine  the 
vouchers  and  audit  and  state  the  account.  If  any  voucher  or 
item  be  rejected,  all  costs  accruing  on  the  contest  or  examina- 
tion thereof  must  be  taxed  against  the  guardian.  The  court 
must  thereupon  render  a  decree  declaring  the  amount  due  the 
ward,  which  must  be  entered  and  recorded  and  the  account  and 
vouchers  must  also  be  recorded.2 

COMPENSATION  OF  GUARDIAN. — The  guardian  is  entitled  to 
a  commission  of  two  and  one-half  per  cent,  on  his  disburse- 
ments, and  two  and  one-half  per  cent,  on  his  receipts,  and  on 
final  settlement  an  allowance  must  be  made  for  all  actual  expenses 
necessarily  incurred  by  him.3 

Upon  the  final  settlement,  the  guardian,  if  he  has  not  been 
guilty  of  fraud  or  gross  negligence,  must  be  allowed  a  reasonable 
commission,  not  exceeding  two  and  one-half  per  cent. ,  on  the 
value  of  all  personal  property  surrendered  to  the  ward  or  to  his 
representatives.  But  if  the  value  of  such  personal  property  or 
of  such  moneys  exceed  twenty  thousand  dollars,  the  commission 
on  the  excess  must  not  be  more  than  one  per  cent.4 

1  Civil  Code,  s.  4,429-4,433.  s  Ibid.,  s.  4,440. 

1  Ibid.,  s.  4,434-4,439.  4  Ibid.,  s.  4,441. 


STATUTES  OP  ALABAMA.  613 

RESIGNATION  AND  REMOVAL  OF  GUARDIAN.— A  guardian 
may  resign  by  writing  subscribed  by  him,  filed  in  the  court  of 
probate.  Such  resignation  does  not  affect  the  liability  of  the 
guardian  or  his  sureties.1 

A  guardian  may  be  removed  for  removal  from  the  State, 
wilful  failure  to  file  an  inventory  or  wilful  disobedience  to  an 
order  of  the  court,  drunkenness,  imbecility  of  mind,  continued 
sickness  rendering  him  incapable,  conviction  of  felony,  waste 
of  the  ward's  property,  neglect  of  his  affairs,  or  for  any  other 
good  and  sufficient  cause.2 

An  application  for  removal  may  be  made  by  the  ward  or  by 
next  friend  in  writing,  verified  by  affidavit,  and  must  specify 
the  grounds  of  removal.  The  court  must  appoint  a  day  for  the 
hearing,  of  which  notice  must  be  given  to  the  guardian  of  at 
least  five  days. 

On  the  day  appointed,  the  court  may  proceed  to  hear  the  evi- 
dence and  pass  upon  the  application.  If  determined  against  the 
ward  the  next  friend  must  be  taxed  with  the  costs.  If  against 
the  guardian  he  must  be  taxed  with  costs.  The  court  of  pro- 
bate may,  without  an  application  by  the  ward,  for  any  of  the 
causes  specified  upon  notice,  remove  a  guardian.8 

PROTECTION  OF  ESTATE  OF  INTEMPERATE  PERSONS. — When 
any  man  over  twenty-one  years  of  age  is,  by  reason  of  intemper- 
ance, unfit  to  manage  his  estate,  or  is  wasting  or  squandering  it 
and  is  thereby  in  danger  of  being  reduced  to  poverty  or  want, 
his  wife  or  brother  or  sister  or  next  of  kin,  or  any  or  either  of 
them,  may  themselves,  or  by  their  next  friend  if  minors,  file 
their  bill  in  chancery  to  preserve  the  estate  of  such  intemperate 
person  from  further  waste  and  for  general  relief.4 

The  bill  must  specify  the  cause  for  which  relief  was  prayed 
and  the  estate  proposed  to  be  secured,  and  such  person  with  in- 
temperate habits  must  be  made  a  party  defendant.  If  the  alle- 
gations of  the  bill  are  admitted  either  expressly  or  by  failure 
to  answer,  or  it  is  established  by  proofs  that  such  person  is  wast- 
ing his  estate  or  is  for  the  causes  alleged  unfit  for  its  manage- 
ment so  that  such  person  will  probably  be  reduced  to  want,  the 
chancellor  must  deprive  him  of  all  further  control  over  it  and 
provide  for  its  safe-keeping  by  the  appointment  of  a  trustee. 

1  Civil  Code,  s.  4,452.  » Ibid.,  s.  4,454-4,457. 

2  Ibid.,  s.  4,453.  4  Ibid.,  s.  4,612-4,618. 


614          INCOMPETENT  PERSONS — BROWN  AND   BECKER. 

The  trustee  appointed  must  manage  and  superintend  the  affairs 
of  the  estate  and  from  the  avails  thereof,  provide  for  the  sup- 
port of  such  intemperate  person  or  of  his  wife  and  children. 

Pending  the  suit,  the  chancellor  must  by  injunction  or  other- 
wise secure  the  estate  against  further  waste,  but  no  such  decree 
affects  the  rights  of  creditors  acquired  previous  to  the  institution 
of  a  suit. 

Upon  satisfactory  proof  of  the  reformation  of  such  intem- 
perate person  and  of  his  fitness  to  have  charge  of  his  estate, 
the  chancellor  must  order  it  to  be  restored  to  him.1 

ALABAMA  INSANE  HOSPITAL. — The  Bryce  Hospital  and  the 
Mount  Vernon  Hospital  are  State  hospitals  for  the  care  and 
proper  treatment  of  insane  persons,  which  are  located  near  the 
city  of  Tuscaloosa  and  in  the  county  of  Mobile,  respectively.2 
They  are  managed  by  a  board  of  seven  trustees  who  have  power 
to  fill  vacancies.3  They  appoint  the  superintendent  and  adopt 
rules  for  the  hospital.4 

The  superintendent  must  be  a  physician,  qualified  to  practise 
under  the  existing  laws  of  Alabama.  He  must  be  of  prompt 
business  habits,  and  of  a  humane,  kindly  disposition.5 

Patients  are  admitted  to  the  asylum  on  papers  from  the  judge 
of  probate  in  the  county  where  they  reside.  A  person  shall  be 
fit  to  be  sent  as  a  patient  to  an  insane  hospital,  who,  in  the 
opinion  of  the  court  authorized  to  hold  the  inquisition,  is  men- 
tally so  deficient,  defective,  and  disqualified  that  he  needs  the 
restraint,  management,  and  medical  treatment  of  such  an  insti- 
tution, for  his  safe-keeping  and  improvement,  especially  if  seri- 
ously troublesome,  offensive,  or  dangerous.  Harmless,  incurable 
dements,  dotards,  imbeciles,  or  idiots  are  not  fit  patients.8 

When  the  hospital  is  crowded,  harmless,  incurable  patients 
may  be  exchanged  for  urgent,  curable,  or  dangerous  cases.7 

A  series  of  interrogatories  are  prescribed,  to  be  answered  by 
the  probate  judge  and  sent  to  the  superintendent,  who  shall 
reply  as  to  room  available.  The  probate  judge  determines  as 
to  the  commitment,  with  or  without  a  jury,  and  also  whether  the 
patient  can  pay  his  expenses,  and  issues  a  certificate  of  com- 
mitment.8 

1  Civil  Code,  s.  4,612-4,618.  5  Ibid.,  s.  847. 

2  Polit.  Code,  s.  838-839,  853.  6  Ibid.,  s.  854. 

3  Ibid.,  s.  840-843.  7  Ibid.,  s.  855. 

4  Ibid.,  s.  847,  845.  8  Ibid.,  s.  856-859. 


STATUTES   OF   ALABAMA.  615 

The  superintendent  has  power  to  discharge  and  furlough 
patients.1 

The  superintendent  cannot  be  required  to  testify  as  an  expert, 
if  he  certifies  his  absence  will  interfere  with  his  duties.  His 
deposition  may  be  taken.2  He  and  his  subordinates  are  excused 
from  militia  service,  work  on  public  roads,  and  serving  on  juries.3 

INQUISITIONS  AS  TO  PERSONS  ACCUSED  OF  CRIME. — A 
person  confined  under  indictment  for  certain  felonies  is  entitled 
to  separate  trial  by  jury  of  issue  of  his  sanity.  If  found  insane 
to  be  remanded  to  insane  hospital  and  not  tried  until  recovery. 
The  insanity  of  a  person  sentenced  to  death  must  be  made  to 
appear  to  the  trial  court.  It  may  impanel  a  jury.4 

Person  in  confinement  for  any  other  reason  may  be  confined 
in  the  insane  hospital  on  order  of  judge  of  court  of  record.5 

Person  acquitted  of  crime  or  misdemeanor  on  account  of  in- 
sanity to  be  confined  in  asylum  if  trial  court  finds  that  itcontinues.6 

The  governor  may  send  convicts  to  the  insane  hospital  if  so 
found  by  board  of  three  physicians,  provided  there  is  room  for 
the  patient.7  All  insane  convicts  shall  be  reported  by  the  prison 
physician.8 

CRIMINAL  EESPONSIBILITY. — In  criminal  trials  there  is  a 
presumption  of  responsibility ;  the  burden  of  proving  the  con- 
trary is  cast  on  the  accused.  This  defence  must  be  "clearly 
proved  to  the  satisfaction  of  the  jury."9 

Insanity  as  a  defence  must  be  specially  pleaded:  "Not  guilty 
by  reason  of  insanity." 10 

The  verdict  of  not  guilty  on  this  ground  should  specifically 
find  insanity.11 

CONTRACTS. — Contracts  for  the  purchase  of  land  made  in 
good  faith  without  notice  of  the  insanity  are  not  void,  but  the 
insane  person  may  recover  the  difference  between  the  market 
value  and  the  price  paid.  Other  contracts  are  void,  excepting  lia- 
bility for  necessaries,  which  is  the  same  as  in  the  case  of  minors.12 

ALASKA. 

See  statutes  of  Oregon,  which  by  law  apply  to  Alaska. 

1  Polit.  Code,  s.  867-868.  r  Polit.  Code,  s.  871,  873. 

1  Ibid.,  s.  876.  8  Crim.  Code,  s.  6,525. 

8  Ibid.,  s.  874.  •  Ibid.,  8.  7,175. 

4  Crim.  Code,  s.  7,178,  7,179.  to  Ibid.,  s.  7,176. 

•  Ibid.,  B.  7,180.  "  Ibid.,  s.  7,177. 

•  Ibid.,  s.  7,181-7,182.  »  Civ.  Code,  s.  3,347-3,348. 


616       INCOMPETENT  PERSONS— BROWN  AND  BECKER. 

ARIZONA. 

[The  references  are  to  the  Arizona  Civil  Code,  1901.] 

CARE  AND  CUSTODY. — On  petition  of  any  relative  or  friend, 
the  probate  judge  may  on  notice  to  the  alleged  incompetent  hold 
a  hearing  to  determine  whether  such  person  is  insane  or  from 
any  cause  mentally  incompetent  to  manage  his  property.1 

If  so  found  he  must  appoint  a  guardian  of  his  estate  and 
property.  Such  guardian  must  give  a  bond.2  On  petition,  in- 
quiry shall  be  made  by  the  probate  judge  as  to  restoration  to 
sanity.3 

GUARDIANS,  THEIR  POWERS  AND  DUTIES. — Every  guardian 
must  pay  all  just  debts  of  the  ward,  first  out  of  his  personal 
property.4 

He  may  with  the  approbation  of  the  probate  judge,  compound 
with  debtors,  and  must  appear  for  the  ward  in  all  suits  unless 
another  person  is  appointed  for  the  purpose.5 

He  must  manage  the  estate  frugally,  and  apply  the  proceeds 
for  the  maintenance  of  the  ward  and  his  family,  and  if  the  income 
be  insufficient  he  may  sell  the  real  estate  upon  an  order  from  the 
court.8 

The  probate  judge  upon  application  under  oath  that  a  person 
by  reason  of  insanity  is  dangerous  shall  hold  an  examination 
summoning  two  or  more  witnesses  acquainted  with  the  accused, 
and  one  (or  more)  graduates  of  medicine  who  shall  give  opinions 
as  to  the  insanity  of  the  party  charged,  whether  it  is  dangerous 
he  should  go  at  large,  and  whether  his  malady  is  temporary. 
Upon  such  hearing  the  judge  may  if  satisfied  order  the  confine- 
ment of  such  person  in  the  territorial  insane  asylum.7 

If  indigent,  the  lunatic's  expenses  in  the  asylum  shall  be  paid 
by  his  county.8 

GUARDIAN.  — If  the  insane  person  is  able  to  pay  his  expenses, 
the  probate  judge  shall  appoint  a  guardian  who  may  sell  his 
property,  except,  if  the  insane  person  have  a  family  in  the  terri- 
tory, what  is  exempt  from  execution.9 

1  Arizona  Civ.  Code  [1901],  s.  1,984.  •  Ibid.,  s.  1,990. 

2  Ibid.,  s.  1 ,985,  1,986.  7  Ibid.,  s.  2,768. 

3  Ibid.,  s.  1,987.  •  Ibid.,  s.  2,769. 

4  Ibid.,  s.  1,988.  c  Ibid.,  s.  2,770. 
*  Ibid.,  s.  1,989. 


STATUTES   OF   ARKANSAS.  617 

ARKANSAS. 

[The  references  are  to  the  Digest  of  the  Statutes  of  Arkansas, 
1904.] 

Probate  courts  possess  the  superintending  control  over  guard- 
ians having  the  care,  custody,  and  management  of  idiots,  luna- 
tics, habitual  drunkards,  and  persons  of  unsound  mind,  and  inay 
provide  for  the  safe-keeping  of  such  persons  and  maintenance  of 
themselves  and  their  families  and  the  education  of  their  chil- 
dren. 1 

INQUISITION. — Upon  information  in  writing  that  any  per- 
son in  the  county  is  an  idiot,  lunatic,  or  of  unsound  mind,  if 
satisfied  that  there  is  good  cause  for  the  exercise  of  its  jurisdic- 
tion, the  probate  court  shall  cause  the  person  to  be  brought  be- 
fore such  court  and  inquire  into  the  facts  by  jury. 

If  any  sheriff,  coroner,  or  constable  discovers  such  a  person 
in  the  county,  he  shall  make  application  to  the  court  for  the 
exercise  of  its  jurisdiction. 

If  found  by  the  j  ury  that  the  person  is  of  unsound  mind,  the 
court  shall  appoint  a  guardian  of  the  person  and  estate  of 
such  insane  person. 

The  costs  of  the  proceeding  shall  be  a  charge  on  his  estate, 
or  if  that  is  insufficient,  upon  the  county.  If  the  person  alleged 
to  be  insane  is  discharged,  the  costs  are  paid  by  the  person  in- 
stituting the  proceedings,  unless  such  person  is  an  officer,  in 
which  case  the  costs  shall  be  paid  by  the  county.2 

GUARDIANS,  THEIR  POWERS  AND  DUTIES. — Before  entering 
upon  his  duties,  the  guardian  shall  execute  a  bond  for  the  faith- 
ful performance  of  such  duties  and  the  judicious  management 
of  the  estate  of  his  ward. 

Additional  bonds  may  be  required,  in  the  discretion  of  the 
court. 

The  guardian  shall  take  charge  of  the  person  committed  to 
his  charge  and  provide  for  his  support  and  maintenance.  He 
shall  take  into  his  possession  the  goods,  chattels,  moneys,  and 
all  evidences  of  debt  and  of  writing  touching  the  estate  of  the 
person  under  his  guardianship. 

Within  three  mouths  he  shall  make  out  and  file  in  the  office 
of  the  clerk  of  the  court  an  inventory  of  the  estate  of  his  ward. 
1  Statutes  of  Arkansas,  s.  3,814.  *  Ibid.,  s.  3,815-3,818. 


618          INCOMPETENT  PERSONS — BROWN  AND  BECKER. 

Additional  inventories  shall  be  filed  whenever  other  property 
belonging  to  the  estate  shall  be  discovered. 

The  court  may  make  orders  for  the  restraint,  support,  and 
safe-keeping  of  such  person ;  for  the  maintenance  of  his  estate 
and  the  support  and  maintenance  of  his  family  and  education 
of  his  children,  out  of  the  proceeds  of  his  estate.1 

SALE,  MORTGAGE,  AND  LEASE  OF  EEAL  ESTATE. — If  the 
personal  estate  be  insufficient  for  the  discharge  of  the  debts  and 
maintenance  of  the  family,  or  education  of  the  children  of  the 
insane  ward,  or  if  it  shall  clearly  appear  to  the  court  that  it 
would  be  for  the  benefit  of  the  ward,  or  if  there  are  joint  owners 
and  it  would  be  for  their  benefit  and  not  detrimental  to  the 
ward,  the  guardian  may  petition  the  court  for  authority  to  mort- 
gage, lease,  or  sell  such  part  of  the  real  estate  as  is  necessary  to 
supply  the  deficiency. 

The  court  shall  direct  the  time  and  terms  of  the  sale,  mort- 
gage, or  lease,  and  the  manner  in  which  the  proceeds  shall  be 
secured  and  the  income  applied.  The  court  shall  direct  the 
manner  of  making  the  sale,  which  shall  be  at  public  vendue  to 
the  highest  bidder,  and  the  guardian  shall  report  the  proceedings 
to  the  court.  If  the  court  approve  the  proceedings,  the  guardian 
shall  execute  a  deed  to  the  purchaser.  If  the  report  be  disap 
proved,  the  court  may  set  aside  the  sale  and  order  the  refund- 
ing of  all  money  paid. 

When  the  court  shall  order  a  lease  or  mortgage,  no  deed  or 
instrument  shall  be  executed  until  approved  by  the  court.2 

WHEN  WARD  MAY  BE  SUPPORTED  BY  COUNTY. — If  the 
estate  of  any  ward  is  insufficient  to  maintain  himself  and  fam- 
ily, or  educate  his  children,  his  guardian  may  apply  to  the 
county  court  for  an  appropriation  from  the  county  treasury  for 
the  support  of  his  ward. 

The  petition  shall  be  accompanied  by  an  account  of  his 
guardianship,  an  inventory  of  the  estate  of  the  ward,  and  a  list 
of  the  debts  due  from  such  ward.  If  the  court  is  satisfied  that 
the  estate  is  insufficient  for  such  purposes,  it  may  order  such 
sum  to  be  paid  to  the  guardian  out  of  the  county  treasury  as  is 
sufficient  to  provide  for  the  support  of  his  ward.3 

EESTORATION  OF  INSANE  PERSON. — If  any  person  allege  in 

1  Statutes  of  Arkansas,  a.   3,821-          *  Ibid.,  8.  3,832-3,844. 
3,831.  «  Ibid.,  s.  3,848-3,851. 


STATUTES   OF  ARKANSAS.  619 

writing  that  the  person  declared  of  unsound  mind  is  restored  to 
bis  right  niiud,  or  to  correct  and  sober  habits,  the  court  shall 
cause  the  facts  to  be  inquired  into,  and  if  it  be  found  that  such 
person  has  been  restored,  he  shall  be  discharged  from  care  and 
custody  and  his  property  shall  be  restored  to  him.1 

SETTLEMENT  OF  ACCOUNTS  OF  GUARDIAN.— All  accounts 
of  guardians  shall  be  settled  on  the  termination  of  the  guard- 
ianship. The  guardianship  is  terminated  by  the  restoration 
of  the  ward,  his  death,  or  removal  from  office.2 

CONFINEMENT  OF  INSANE  PERSON  BY  GUARDIAN. — If  a 
person  be  furiously  mad,  or  so  far  disordered  in  his  mind  as  to 
endanger  his  own  person  or  the  person  or  property  of  others,  it 
shall  be  the  duty  of  the  guardian,  or  the  person  under  whose  care 
he  may  be,  and  who  is  bound  to  provide  for  his  support,  to  con- 
fine him  in  some  suitable  place  until  the  probate  court  shall  make 
an  order  for  his  proper  restraint,  support,  and  safe-keeping. 

If  such  person  is  not  confined,  any  judge  of  a  court  of  record, 
or  any  two  justices  of  the  peace,  may  cause  such  insane  person 
to  be  apprehended,  and  may  provide  for  his  confinement  in  some 
suitable  place  until  the  court  shall  make  further  order  thereon.3 

Any  peace  officer  may  arrest  an  insane  person  found  at  large 
and  uucared  for,  and  take  steps  to  have  him  sent  to  the  lunatic 
asylum.4  The  maintenance  of  the  insane  is  a  charge  on  the 
county,  which  may  recover  the  same  from  father  or  mother,  chil- 
dren or  grandchildren.5 

LUNATIC  ASYLUM.  —The  Arkansas  State  lunatic  asylum  is 
located  at  Little  Eock.  It  is  governed  by  a  board  of  trustees 
of  the  State  institutions,  composed  of  six  members  appointed  by 
the  governor.6 

The  trustees  shall  appoint  a  superintendent,  who  shall  be 
a  skilful  physician,  a  married  man,  and  hold  his  office  for  a 
term  of  four  years;  also  a  steward.7 

They  shall  maintain  an  effectual  inspection  of  the  asylum, 
for  which  purpose,  one  or  more  of  them  shall  visit  it,  at  least 
once  in  every  week  and  the  whole  of  such  board  once  in  three 
months,  holding  a  meeting.  They  shall  report  biennially.8 

'Statutes  of  Arkansas,  s.  3,852-          5  Ibid.,  s.  3.864-3,865. 
3,853.  *  IbuL,  s.  3,976,  3,928-3,931. 

2  Ibid.,  s.  3,854-3,857.  1  Ibid.,  s.  3,977-3,978. 

3  Ibid.,  s.  3,858,  3,859.  *Ibid.,  s.  3,979-3,983. 

4  Ibid.,  s.  3,861-3,862. 


620  INCOMPETENT   PERSONS— BROWN   AND   BECKER. 

THE  SUPERINTENDENT. — The  superintendent  appoints  all 
subordinate  officers,  and  is  the  general  superintendent  of  the 
buildings,  grounds,  and  farm,  with  all  their  fixtures  and  stock, 
and  has  the  direction  and  control  of  all  persons  therein,  subject 
to  the  by-laws  and  regulations  of  the  trustees.  He  shall  daily 
ascertain  the  condition  of  the  patients  and  prescribe  their  treat- 
ment.1 The  steward  is  the  accounting  officer.2 

ADMISSION  TO  ASYLUM. — Any  person  may  be  admitted  to 
the  asylum  as  a  patient  who  is  a  citizen  of  the  State,  and  who 
may  be  insane. 

Any  reputable  citizen  may  file  a  written  statement  with  the 
county  and  probate  judge,  that  to  the  best  of  his  belief  the 
alleged  insane  person  ought  to  be  admitted,  and  that  his  being 
at  large  is  dangerous  to  the  community  or  prejudicial  to  his 
chances  to  recover. 

Thereupon  a  time  shall  be  appointed  by  the  judge  for  a  hear- 
ing, and  at  such  time  such  competent  witnesses  as  are  produced 
shall  be  heard.  In  addition  to  the  testimony  of  such  witnesses 
the  judge  shall  cause  the  alleged  insane  person  to  be  examined 
by  one  or  more  physicians,  who  shall  present  in  writing  the 
result  of  the  examination,  including  the  answers  to  certain 
questions  which  are  prescribed  by  statute. 

If  satisfied  that  such  person  is  insane,  he  shall  so  decide,  and 
without  delay  transmit  to  the  superintendent  of  the  asylum  his 
decision  in  writing  with  copies  of  the  statements  taken  in  the 
proceeding. 

The  superintendent  shall  notify  the  judge  of  his  readiness 
to  admit  the  insane  person  into  such  asylum,  if  there  be  room 
unoccupied.  If  there  be  no  room  unoccupied  he  shall  notify 
the  judge  of  the  fact  and  return  the  papers  indorsed  accordingly. 

On  receipt  of  notice  of  the  superintendent's  willingness  to 
receive  the  patient  he  shall  be  transferred  to  such  asylum  by 
the  sheriff  or  any  person  deputized  by  the  county  judge. 

Such  person  shall  be  supported  in  such  asylum  at  public 
expense  unless  such  insane  person  have  more  than  sufficient 
estate  for  the  support  of  his  family. 

The  superintendent  and  trustees  are  supreme  in  the  matter  of 
admissions  and  discharges.3 

1  Statutes  of  Arkansas,  8.  3,984.  » Ibid.,  s.  3,990-4,014. 

3  Ibid.,  a.  3,985-3,987. 


STATUTES   OF   CALIFORNIA.  021 

CRIMINAL  INSANE. — Persons  acquitted  of  crime  upon  the  plea 
of  insanity  are  admitted  to  the  asylum  upon  the  certificate  of  the 
judge;  also  persons  who  are  indicted  and  cannot  be  tried  by 
reason  of  insanity.1 

Upon  the  recovery  of  such  persons  the  sheriff  of  the  county 
shall  be  notified.2 

Persons  who  become  insane  while  under  sentence  for  crime 
are  to  be  treated  in  the  penitentiary.3 

"A  lunatic  or  insane  person,  without  lucid  intervals,  shall 
not  be  found  guilty  of  any  crime  or  misdemeanor  with  which  he 
may  be  charged. "  * 

CALIFORNIA. 

[The  references  are  to  Kerr's  Cyclopaedic  Codes  of  California, 
vols.  i.-iv.,  1905,  and  General  Laws  of  California,  Henniug,  vol. 
v.  of  the  same  set,  1905.] 

NOTE. — In  California  and  Georgia  some  matters  of  general  law  have  been 
codified.  As  an  exhibit  of  the  present  state  of  the  law  respecting  insanity, 
we  quote  in  full  several  of  the  more  important  sections  stating  (with  or  with- 
out modification)  principles  of  the  common  law. 

CONTRACTS. — "A  person  entirely  without  understanding  has 
no  power  to  make  a  contract  of  any  kind,  but  he  is  liable  for 
the  reasonable  value  of  things  furnished  to  him  necessary  for  [1] 
his  support  or  [2]  the  support  of  his  family."5 

"  A  conveyance  or  other  contract  of  person  of  unsound  mind 
but  not  entirely  without  understanding,  made  before  his  in- 
capacity has  been  judicially  determined,  is  subject  to  rescission, 
as  provided  in  the  chapter  on  rescission  of  this  code."6 

"After  his  incapacity  has  been  judicially  determined,  a  per- 
son of  insane  mind  can  make  no  conveyance  or  other  contract, 
nor  delegate  any  power  or  waive  any  right,  until  his  restoration 
to  capacity.  But  a  certificate  from  the  medical  superintendent 
or  resident  physician  of  the  insane  asylum  to  which  such  person 
may  have  been  committed,  showing  that  such  person  has  been 
discharged  therefrom  cured  and  restored  to  reason,  shall  estab- 
ish  the  presumption  of  legal  capacity  in  such  person  from  the 
time  of  such  discharge."7 

1  Statutes    of   Arkansas,  [1901],  s.  5  Vol.  2,  s.  38,  p.  51. 
4,001-4,002,  1,440.  •  Vol.  2,  s.  39,  p.  54.     Cf.  s.  1,556- 

2  Ibid.,  s.  4,003-4,004.  1,557,  pp.  1,265-1,266. 

3  Ibid.,  s.  4,005.  '  Vol.  2,  s.  40,  p.  58. 

4  Ibid.,  s.  1,439. 


622          INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

A  proposal  for  a  contract  is  revoked  by  the  insanity  of  the 
proposer.1 

Every  employment  in  which  the  power  of  the  employee  is 
not  coupled  with  an  interest  in  its  subject  is  terminated  by 
notice  to  him  of  his  employer's  legal  incapacity  to  contract  or 
by  the  employee's  legal  incapacity  to  act  as  such.2 

An  agency  is  likewise  terminated.3 

Annulment  of  marriage  may  be  decreed  when  one  party  was 
insane  at  the  time  of  the  marriage.4 

TORTS. — A  "person  of  unsound  mind,  of  whatever  degree,  is 
civilly  liable  for  a  wrong  done  by  him,  but  is  not  liable  in  ex- 
emplary damages  unless  at  the  time  of  ti*e  act  he  was  capable  of 
knowing  that  it  was  wrongful."5 

APPOINTMENT  OF  GUARDIANS  OF  INSANE  AND  OTHER  IN- 
COMPETENT PERSONS. — Power  of  appointment  vested  in  Supe- 
rior Court. 

Appointment  made  upon  petition  of  relative  or  friend  that 
such  person  is  insane  or  for  any  cause  incompetent  to  manage 
his  property. 

Notice  to  be  given  su^h  person  not  less  than  five  days  before 
hearing.  If  it  appears  upon  the  hearing  that  the  person  is  in- 
capable of  taking  care  of  himself  and  managing  his  property, 
guardian  must  be  appointed.6 

PROCEEDINGS  TO  DETERMINE  EESTORATION  OF  INSANE. — 
Insane  person  or  any  relative  or  friend  may  apply  by  petition 
to  court  to  have  the  fact  of  his  restoration  judicially  determined. 

Court  must  appoint  a  day  for  hearing  and  upon  request  order 
investigation  before  a  jury.  Notice  of  the  trial  must  be  given 
to  the  guardian  of  the  person,  to  his  or  her  husband  or  wife,  or  to 
his  or  her  father  or  mother,  if  living  in  the  county. 

Guardian  or  relative  of  such  person  may  contest  the  right  to 
the  relief  demanded.7 

POWERS  AND  DUTIES  OF  GUARDIANS. — Guardian  has  the 
care  and  custody  of  the  person  of  his  ward  and  the  management 
of  all  his  estate.8 

Guardian  must  pay  all  the  ward's  debts  out  of  his  personal 

1  Vol.  2,  s.  1,587,  p.  1,319.  4  Vol.  2,  s.  82,  p.  130. 

2  Vol.  2,  s.  1,996-1,997,  pp.  1,631-          6  Vol.  2,  s.  41,  p.  59. 

1,632.  6  Code  Civil  Pro.,  s.  1,763-1,764. 

3  Vol.  2,  s.  2,355-2,366,  pp.  1,819-          7  Ibid.,  s.  1,766. 
1,820.  » Ibid.,  a.  1,765. 


STATUTES   OF  CALIFORNIA.  623 

estate  or  income  of  his  real  estate,  if  sufficient ;  if  not,  then  out 
of  real  estate  upon  obtaining  order  for  sale. 

Must  settle  all  accounts  of  the  ward,  demand,  sue  for,  and 
receive  all  debts  due  him. 

Manage  the  estate  of  his  ward  frugally  and  without  waste, 
and  apply  the  income  for  suitable  maintenance  of  ward  and  his 
family ;  and  if  insufficient,  may  sell  the  real  estate  upon  order 
of  the  court  and  apply  the  proceeds  of  such  sale  for  such  main- 
tenance. 

Guardian  to  be  allowed  credits  for  proper  advances  for  the 
benefit  of  the  ward  upon  proper  vouchers,  etc.  Guardian  may 
be  compelled  to  furnish  suitable  maintenance,  etc.  The  court 
may  direct  the  guardian  to  pay  the  persons  supplying  ward 
with  suitable  maintenance,  etc. 

Guardian  may  join  in  and  assent  to  a  partition  of  the  real 
estate  of  the  ward. 

Guardian  must  return  to  the  court  an  inventory  of  the  estate 
of  his  ward  within  three  months  after  his  appointment  and  an- 
nually thereafter.  Inventories  must  be  recorded  by  the  clerk 
of  the  court. 

Guardian  must  upon  the  expiration  of  a  year  from  the  time 
of  his  appointment,  and  as  often  as  required,  present  to  the  court 
his  account  for  a  settlement. 

Every  guardian  must  be  allowed  the  amount  of  his  reasonable 
expenses,  and  have  such  compensation  as  the  court  deems  just 
and  reasonable.1 

SALE  OF  PROPERTY  OF  WARD  AND  DISPOSITION  OF  PRC$- 
CEEDS. — When  income  of  estate  is  insufficient  to  maintain  the 
ward  and  his  family,  guardian  may  sell  real  or  personal  estate 
upon  order  of  the  court.  Court  may  order  the  sale  of  the  prop- 
erty of  the  ward  for  the  purpose  of  reinvestment. 

The  proceeds  of  the  sale  must  be  applied  to  the  purposes  for 
which  made  and  the  residue  invested  until  the  capital  is  wanted 
for  such  purposes. 

If  sold  for  purposes  of  investment,  investment  must  be  made 
according  to  guardian's  best  judgment  or  in  pursuance  of  an 
order  of  the  court. 

Order  must  be  made  upon  petition  containing  a  statement  of 
facts  and  circumstances  showing  necessity  for  the  sale. 
'Code  Civil  Proc.,  B.  1,768-1,776. 


624  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

Notice  must  be  given  to  the  next  of  kin. 

A  copy  of  the  order  must  be  served  on  the  next  of  kin  and  all 
persons  interested  in  the  estate  at  least  fourteen  days  before  a 
hearing  of  the  petition. 

The  order  of  the  court  must  specify  the  causes  of  the  sale. 

Guardian  authorized  to  sell  real  estate  must  give  a  bond  ap- 
proved by  the  court. 

Such  order  not  to  continue  for  more  than  one  year  after  being 
granted.  * 

GENERAL  PROVISIONS. — Court  may  cite  persons  suspected 
of  having  concealed,  embezzled,  or  conveyed  any  of  the  property 
belonging  to  the  ward  or  to  his  estate,  upon  complaint  of  guard- 
ian, ward,  creditor,  or  other  person  interested  in  the  estate,  and 
may  summon  him  in  the  same  manner  as  persons  suspected  of 
concealing  the  effects  of  a  decedent.2 

Guardian  may  be  removed  if  incapable  of  discharging  his 
trust,  or  if  he  has  wasted  or  mismanaged  the  estate,  or  failed  for 
thirty  days  to  render  an  account  as  required  by  the  court.  A 
guardian  may  resign  when  it  appears  proper  to  allow  the  same.3 

Guardianship  is  terminated  when  it  appears  that  it  is  no 
longer  necessary.4 

Court  may  require  a  new  bond  by  the  guardian  when  deemed 
necessary. 

Every  bond  of  a  guardian  must  be  filed  in  the  office  of  the 
clerk  of  the  Superior  Court  of  the  county. 

No  action  can  be  maintained  on  such  bond  unless  commenced 
within  three  years  after  the  discontinuance  of  the  guardianship. 

No  action  can  be  maintained  for  the  recovery  of  any  estate 
sold  by  a  guardian  unless  commenced  within  three  years  from 
the  termination  of  the  guardianship.5 

CUSTODY  OF  INSANE  PERSONS. — Persons  of  unsound  mind 
may  be  placed  in  an  asylum  upon  the  order  of  the  superior 
court  of  the  county  in  which  he  resides,  as  follows: 

1.  The  court  must  be  satisfied  upon  examination  in  open 
court  and  in  the  presence  of  the  person  from  the  testimony  of 
two  reputable  physicians  that  such  person  is  of  unsound  mind 
and  unfit  to  be  at  large. 

1  Code  Civil  Proc.,  s.  1,777-1,792.  "  Ibid.,  s.  1,802. 

2  Ibid.,  s.  1,800.  8  Ibid.,  s.  1,803-1,805. 
'Ibid.,  s.  1,801. 


STATUTES   OF   CALIFORNIA.  625 

2.  After  the  order  is  granted  the  person  alleged  insane,  his  or 
her  husband  or  wife  or  relative  to  the  third  degree,  or  any  citi- 
zen, may  demand  an  investigation  before  a  jury,  which  must  be 
conducted  in  all  respect  as  under  an  inquisition  of  lunacy.1 

EXAMINATION  AND  COMMITTAL  OF  INSANE  PERSONS. — When- 
ever it  appears  by  affidavit  to  the  satisfaction  of  a  magistrate  of 
the  county  that  any  person  within  the  county  is  so  far  dis- 
ordered in  his  mind  as  to  endanger  health,  persons,  or  property, 
he  must  issue  and  deliver  to  some  peace  officer  a  warrant  direct- 
ing that  such  person  be  arrested  and  taken  before  any  judge  of 
a  court  of  record  within  the  county  for  examination.2 

Judge  must  issue  subpoenas  to  two  or  more  witnesses  best  ac- 
quainted with  such  insane  person  to  appear  and  testify  before 
him,  and  have  at  least  two  graduates  of  medicine  appear  and 
attend  such  examination.  Each  person  subprenaed  must  appear 
and  answer  all  questions  pertinent  to  the  matter.  The  physi- 
cians must  hear  such  testimony  and  make  a  personal  examination 
of  the  alleged  insane  person.3 

Physicians  after  hearing  testimony  and  making  examination 
must  make  a  certificate  if  they  believe  such  person  to  be  danger- 
ously insane — 

1.  Showing  that  such  person  is  so  far  disordered  in  his  mind 
as  to  endanger  health,  person,  or  property. 

2.  Premonitory  symptoms,   apparent  cause  or  class  of  in- 
sanity, and  the  duration  and  condition  of  the  disease. 

3.  The  nativity,  age,  residence,    occupation,  and   previous 
habits  of  the  person. 

4.  The  place  from  whence  the  person  came  and  the  length 
of  his  residence  in  this  State. 

The  service  must  be  made  in  the  form  prescribed  by  the 
medical  superintendent  of  the  asylum.4 

The  judge,  if  he  believes  the  person  so  far  disordered  in  his 
mind  as  to  endanger  health,  person,  or  property,  must  make  an 
order  that  he  be  confined  in  the  insane  asylum.  A  copy  of  such 
order  shall  be  filed  and  recorded  by  the  county  clerk. 

Clerk  shall  keep  an  index  book  showing  data  connected  with 
the  commitment.5 

1  Civil  Code,  s.  258.  •  Ibid.,  s.  2,215-2,216. 

"Ibid.,  s.  2,210.  *  Ibid.,  s. 2,217 

llbid.,  s.  2,211-2,214. 
III.— 40 


626  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

The  physicians  attending  each  examination  of  an  insane  per- 
son are  allowed  five  dollars  each,  to  be  paid  by  the  county  treas- 
urer of  the  county  where  the  examination  was  had,  on  the  order 
of  the  board  of  supervisors. 

COLORADO. 

[The  references  are  to  Mills'  Annotated  Statutes,  1891,  with 
supplementary  volume  (vol.  iii. ),  1905;  and  to  Mills' Annotated 
Code  (of  Civil  Procedure),  1905.] 

In  the  construction  of  the  Code  of  Civil  Procedure,  "The 
phrase  'of  unsound  mind7  includes  idiots,  non  compos  mentis, 
lunatics,  and  distracted  persons."  "The  phrase  'under  legal 
disabilities'  includes  infants  and  persons  of  unsound  mind."1 

The  provisions  for  care  and  custody  apply  to  the  foregoing 
and  also  to  "every  person  who  by  reason  of  intemperance,  or  any 
disorder  or  unsoundness  of  mind,  shall  be  incapable  of  managing 
and  caring  for  his  own  estate. " 2 

In  an  action  against  one  judicially  declared  incompetent,  the 
summons  is  served  on  guardian.3 

PROCEDURE  FOR  APPOINTMENT  OF  CONSERVATOR  OF  ES- 
TATE.— Complaint  to  county  court  of  any  reputable  person; 
jury  of  six  persons ;  proof  to  court  that  lunatic  or  insane  person 
owns  property;  verdict  of  jury,  "such  person  is  so  insane,  or 
distracted  in  mind,  as  to  render  him  or  her  incapable  of  manag- 
ing his  or  her  estate  " ;  conservator  appointed  by  the  court.4 

CARE  AND  CUSTODY. — The  court  may  also,  when  a  lunatic 
so  adjudged  has  no  friend  or  relative  who  will  assume  the  care 
of  him,  order  the  lunatic  placed  in  a  State  asylum  or  other  hos- 
pital or  place  suitable  for  the  treatment  of  the  insane.  If  the 
lunatic  has  property  the  expense  of  care  is  to  be  paid  from  it, 
but  not  for  treatment  in  the  State  asylum.5 

Discharge  on  recovery  may  be  had  on  the  finding  of  two 
physicians,  or  the  certificate  of  the  superintendent  of  the  State 
asylum.8 

COMMITMENT  OF  OTHER  LUNATICS. — Lunatics  may  be  con- 
fined :  (1)  On  the  complaint  to  the  county  court  of  two  reputable 
persons  or  of  an  authorized  medical  examiner  alleging  that  the 

1  Code  of  Civil  Proc.,  s.  442.  4  Mills'  Ann.  Stats.  [1905],  s.  2,935. 

2  Mills'  Ann.  Stats.  [1891],  s.  2,968.          8  Ibid.,  s.  2,957. 

3  Code  of  Civil  Proc.,  s.  38.  e  Ibid.,  s.  2,961. 


STATUTES  OF  COLORADO.  627 

person  "is  so  insane  or  distracted  in  his  mind,  as  to  endanger  his 
own  person  and  property  or  the  person  and  property  of  another, 
or  others,  if  allowed  to  go  at  large";  (2)  on  the  complaint  of  a 
sheriff;  (3)  on  the  election  of  the  insane  person.  An  inquest 
shall  be  held  as  above  and  pending  the  inquest  the  lunatic  may 
be  confined.  Commitment  follows  to  a  State  hospital  or  else- 
where for  treatment.1 

No  insane  person  shall  be  confined  in  jail  unless  he  is  violent 
and  it  is  absolutely  necessary.  Infraction  of  this  law  is  a  mis- 
demeanor.2 

Ten  days'  notice  of  the  inquest  must  always  be  given  the 
alleged  lunatic,  and  a  guardian  ad  litem  appointed  for  him. 
Every  inquest  is  to  be  conducted  in  the  name  of  the  people,  and 
in  case  of  a  person  charged  with  crime  there  must  be  notice  to 
the  district  attorney.3 

All  expenses  for  maintenance  shall  be  paid  by  the  county  of 
the  lunatic's  residence,  and  are  recoverable  by  the  county  from 
any  person  liable  to  maintain  the  lunatic.4 

EXAMINERS  IN  LUNACY. — It  is  not  lawful  for  any  physician 
to  testify  to  the  insanity  of  any  person  "for  the  purpose  of 
securing  his  commitment  to  custody,"  unless  he  is  of  reputable 
character,  a  graduate  of  some  incorporated  medical  college,  a 
permanent  resident  of  the  State,  and  in  the  actual  practice  of  his 
profession ;  possession  of  such  qualifications  is  to  be  certified  by 
a  judge  of  a  court  of  record;  such  certificate  constitutes  such 
physician  "  an  examiner  in  lunacy  " ;  a  copy  of  such  certificate 
is  to  be  filed  with  the  clerk  of  the  county  court  where  the  phy- 
sician resides ;  it  is  unlawful  for  any  examiner  in  lunacy,  except 
the  superintendent  of  the  State  asylum,  to  testify  to  the  insanity 
of  any  person  to  procure  commitment  to  an  asylum  of  which  said 
examiner  is  the  proprietor  or  an  officer  or  a  regular  medical  at- 
tendant.5 The  penalty  is  fine  or  imprisonment  or  both.8  A 
medical  examiner's  fee  is  $10,  and  mileage,  ten  cents  per  mile.7 

PROVISIONS  RELATING  TO  THE  "  COLORADO  INSANE  ASYLUM.  " 
—New  buildings  are  to  be  on  the  " cottage  plan."8  There  shall 
be  a  separate  ward  for  the  criminal  insane.9  Persons  are  to  be 

1  Mills'  Ann.  Stats.  [1905],  s.  2,962.  •  Ibid.,  s.  2,962c. 

2  Ibid.,  s.  2,962a.  7  Ibid.,  s.  2,9G2d. 

3  Ibid.,  s.  2,963.  •  Ibid.  [1905],  s.  2,970b. 

4  Ibid.  [1891],  s.  2,963-2,965.  9  Ibid.,  s.  2,970c. 
4  Ibid.  [1905],  s.  2,962b. 


G28          INCOMPETENT   PERSONS— BROWN  AND  BECKER. 

confined  therein  who  have  committed  certain  high  crimes  or  mis- 
demeanors; those  charged  with  the  same  who  are  believed  to 
feign  insanity  or  of  whose  insanity  there  is  great  doubt;  those 
acquitted  of  the  same  on  the  ground  of  insanity  and  adjudged 
dangerous  persons ;  those  charged  with  the  same  and  becoming 
insane  before  trial  or  sentence ;  those  who  have  committed  any 
crime  and  have  no  friends  or  relatives  to  care  for  them  on  expi- 
ration of  sentence ;  insane  convicts  generally  whose  insanity  has 
been  ascertained  and  transfer  ordered.1 

CONNECTICUT. 

[The  references  are  to  the  General  Statutes  of  Connecticut, 
Ee vision  of  1902.] 

CARE  AND  CUSTODY.  — The  commitment  of  the  insane  or  idiots 
to  an  asylum  is  vested  in  the  district  court  of  probate,  upon 
complaint  of  any  person.  Notice  of  the  application  must  be 
given  to  him,  and,  as  directed,  to  friends,  etc.  Testimony  may 
be  taken  and  the  certificate  of  two  resident  graduate  physicians 
obtained.2  The  superior  court  also  has  jurisdiction  through  a 
commission.3 

The  indigent  insane  are  similarly  committed  and  their  support 
paid  by  the  town  and  State.4 

On  application  by  the  town  selectmen  or  relatives,  and  on 
similar  notice,  the  court  of  probate  may  commit  "an  habitual 
drunkard,  a  dipsomaniac,  or  one  so  addicted  to  the  intemperate 
use  of  narcotics  or  stimulants  as  to  have  lost  the  power  of  self- 
control  "  to  an  inebriate  asylum.  The  physicians'  certificate  must 
be  obtained.  Voluntary  patients  may  be  received  and  retained 
for  one  year.5 

Any  person  aggrieved  may  appeal  from  any  order  of  the  court. 
The  superior  court  then  rehears  the  matter.8 

The  court  of  probate  may  order  the  discharge  of  a  person  con- 
fined as  insane.7  The  writ  of  habeas  corpus  also  lies.8 

On  a  bond  being  given  for  the  proper  confinement  of  one  in- 
sane, commitment  to  an  asylum  may  be  suspended.9 

1  Mills'  Ann.  Stats.  [1905],  s.  2,970d.  5  Ibid.,  s.  2,744-2,749. 

2  Connecticut  General  Statutes,  s.  *  Ibid.,  s.  2,751-2,752. 
2,735-2,741.  7  Ibid.,  B.  2,756. 

3  Ibid.,  s.  2,768-2,769.  8  Ibid.,  s.  2,760. 

4  Ibid.,  B.  2,742-2,743.  g  Ibid.,  s.  2,753. 


STATUTES   OF  CONNECTICUT.  629 

.Private  asylums  are  subject  to  the  visitation  of  the  State 
Board  of  Charities.1  They  must  be  licensed  by  the  governor.2 

Fraudulently  causing  or  attempting  to  cause  the  confinement 
of  a  person  as  insane  is  punishable.* 

A  judge  of  the  superior  court  may  appoint  a  commission  to 
inquire  whether  any  person  is  unjustly  confined,  who  shall  in- 
vestigate.4 

The  twelve  trustees  appointed  by  the  governor  have  the  gov- 
ernment of  the  Connecticut  Hospital  for  the  Insane,  at  Middle- 
town.5 

Pauper  or  indigent  imbecile  children  may  be  sent  to  the 
school  for  imbeciles  at  Lakeville  upon  application  of  the  town 
selectmen  and  order  of  the  court  of  probate. 

CRIMINAL  INSANE. — Any  person  committed  for  trial  appear- 
ing to  be  insane  may  if  so  found  after  a  hearing  and  on  the  re- 
port of  three  physicians,  be  committed  by  the  superior  court  to 
the  State  asylum.6 

Any  person  acquitted  on  the  ground  of  insanity  or  dementia 
may  be  confined  in  the  State  hospital  for  such  time  as  the  court 
may  direct.7 

Upon  his  application  or  that  of  the  officers  of  the  asylum, 
notice  to  the  town  selectmen,  to  the  person  if  any  upon  whom  the 
offense  charged  was  committed,  and  to  the  State's  attorney,  he 
may  be  discharged.8 

Upon  the  expiration  of  the  term  fixed  for  his  confinement  or 
that  of  the  sentence  of  an  insane  convict,  he  may  be  further  con- 
fined if  still  insane.9 

Insane  convicts  in  a  jail,  or  female  insane  convicts  in  the 
State  prigon,  may  be  removed  to  the  hospital  or  returned  to  jail 
therefrom,  upon  the  report  of  the  jailer  to  the  governor  and  the 
opinion  of  a  commission  of  not  more  than  three  experts.10  In  the 
State  prison  an  insane  ward  is  provided  for  males.11 

If  any  insane  or  idiotic  person  is  about  to  be  confined  in  the 
State  prison  the  warden  shall  report  the  date  of  his  discharge  to 
the  Connecticut  Prison  Association,  which  sees  to  his  return  to 
his  town  selectmen,  etc. 

'Connecticut  General  Statutes,  a.          *  Ibid.,  s.  1,472. 

2,765-2,766.  T  Ibid.,  8.  1,473. 

1  Ibid.,  s.  2.772.  '  Ibid.,  s.  1,474, 2 ,780. 

1  Ibid. ,  s.  2.7G7.  B  Ibid.,  s.  1 .47"),  2,784. 

4  Ibid.,  s.  2,770.  10  Ibid.,  s.  2,782-2,786. 

5  Ibid.,  s.  2,773-2,777.  ll  Ibid.,  s.  2,904,  2,906. 


630  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

STATUTES  OF  LIMITATION,  ETC. — They  are  usually  suspended 
during  insanity,  etc.1 

The  wife  of  an  insane  husband  has  power  to  deed  upon 
authorization  of  the  court  of  probate.2 

WILLS. — All  persons  of  the  age  of  eighteen  "and  of  sound 
mind  "  may  dispose  of  their  property  by  will.3 

CONSERVATORS. — The  court  of  probate  may  appoint  a  con- 
servator of  the  estate  of  any  person  who  "  shall  be  found  to  be 
incapable  of  managing  his  affairs."4  Some  form  of  notice  to 
such  person  is  required.5 

Pending  such  au  application,  properly  filed  with  the  town 
clerk,  no  contract  is  valid  unless  approved  by  the  court.6 

The  conservator  has  the  usual  powers  and  duties.  He  may 
apply  the  principal  as  well  as  the  income,  if  necessary,  to  support 
the  incompetent  and  his  family.  The  court  may  order  the  sale 
of  the  real  estate.7 

Non-residents'  property  may  be  taken  by  a  conservator  ap- 
pointed here.8 

Upon  the  removal  of  the  insane  person  to  another  town  a  new 
resident  conservator  may  be  appointed.9 

DELAWARE. 

[The  references  are  to  Eevised  Statutes  of  the  State  of  Dela- 
ware, 1893.] 

CARE  AND  CUSTODY.  — The  court  of  chancery  has  the  care  of 
the  insane  over  twenty-one  years  of  age,  so  far  as  to  appoint  a 
trustee  of  the  person  and  estate.  The  inquiry  is  by  jury.10 

The  statute  provides  that  the  trustee  shall  have  the  usual 
powers  and  duties,  and  file  a  bond.  The  chancellor  may  direct 
the  sale  of  the  real  estate,  and  receive  and  invest  the  proceeds. 
For  the  maintenance  of  the  insane  person  the  income  may  be 
expended,  and  for  his  support  or  the  repair  or  improvement  of 
his  real  estate  a  specified  sum  may  be  expended.  The  timber  on 
his  land  may  be  sold  for  the  same  purpose.11 

'Connecticut  General  Statutes,  s.          6  Ibid. ,  8.  239. 

1,108-1,110.  7  Ibid.,  s.  240-241,  243. 

!  Ibid.,  s.  247.  8  Ibid.,  s.  242. 

3  Ibid.,  s.  292.  g  Ibid.,  s.  244. 

4  Ibid.,  s.  237.  10  Chap.  49,  8.1;  p.  381. 
8  Ibid.,  s.  238.  "  Ibid.,  s.  2-6. 


STATUTES   OF   DELAWARE.  Col 

Barring  insane  wife's  dower  on  a  conveyance ;  see  reference 
in  the  note.1 

A  foreign  trustee  may  acquire  such  powers  by  filing  a  certifi- 
cate of  his  appointment  with  the  clerk  of  the  court  and  of  having 
given  a  bond.  Under  authority  of  the  chancellor  he  may  remove 
property.2 

The  indigent  insane  may  be  sent  to  the  insane  department  of 
the  !New  Castle  County  Almshouse  (now  Delaware  State  Hospi- 
tal) by  the  governor  upon  recommendation  of  the  chancellor, 
upon  the  application  of  relatives  or  friends,  the  certificate  of  the 
physician  of  the  county  almshouse  and  another,  and  the  report 
of  the  county  trustees  of  the  poor,  that  treatment  may  be  of 
benefit  (see  also  below).  If  cured  or  incurable  he  may  be  dis- 
charged or  returned  to  the  almshouse  of  his  county.3 

The  nine  trustees  have  full  control  of  the  Delaware  State  Hos- 
pital at  Farnhurst.  Three  are  appointed  from  each  county. 
The  cost  of  maintenance  of  the  hospital  is  borne  by  the  State.4 

The  indigent  insane  may  be  admitted  to  the  hospital  upon  the 
written  order  of  a  trustee,  or  of  any  two  county  trustees  of  the 
poor,  and  the  certificate  of  two  physicians,  sworn  to.  If  the 
"insane  person  shall  be  able,  after  a  reasonable  and  proper  pro- 
vision is  made  for  the  support  and  education  of  his  family,  to 
support  himself,  he  shall  be  liable  for  his  support. " 5 

The  hospital  may  receive  paying  patients  from  Delaware  or 
other  States.8 

The  associate  judges  of  the  superior  court  are  trustees  for  in- 
digent imbecile  children,  and  may  commit  them  to  the  Pennsyl- 
vania training-school  for  feeble-minded  children,  Media,  Pa. 
But  the  number  to  be  committed  and  the  appropriation  to  pay 
for  their  support  are  limited.7 

CRIMINAL  INSANE. — If  the  defense  of  insanity  shall  be  made 
and  established  in  a  criminal  case  "to  the  satisfaction  of  the 
jury"  they  may  return  a  verdict  of  "not  guilty  by  reason  of  in- 
sanity." A  commitment  to  an  almshouse  or  asylum  results.  The 
court  of  the  county  where  he  was  tried  may  order  him  set  at 
large.8 

1  Chap.  616,  vol.  17;  p.  634.         •  Ibid.,  s.  7. 

2  Chap.  49,  B.  7-9.  T  Chap.  53,  vol.  12;  pp.  387-S88. 

'  Chap.  92,  vol.  18,  s.  1-3;  p.  384.      "Chap.  397,  vol.  11,  a.  1-2;  pp. 

4  Chap.  553,  vol.  18;  p.  385.        382-383. 

5  Ibid.,  s.  6,  9,  also  c.  644,  vol.  19,  s. 
1-7;  p.  387;  c.  48,  s.  22;  p.  379. 


G32  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

Iii  a  capital  case  the  court  may  appoint  a  commission,  two  of 
whom  are  physicians,  to  inquire  into  the  criminal's  mental  con- 
dition. They  may  take  testimony.  If  he  is  found  insane  he 
shall  not  be  executed  until  he  recovers. 1 

Insane  persons  confined  in  jail  may  be  removed  to  the  alms- 
house.2 

DEFINITION. — In  the  statutes  "the  words  'insane  person' 
shall  be  construed  to  include  every  idiot,  non  compos,  and  lunatic 
person.3 

WILLS.  — Any  person  of  the  age  of  twenty-one  years  "  of  sound 
and  disposing  mind  and  memory  "  may  make  a  will.4 

FLORIDA. 

[The  references  are  to  the  Eevised  Statutes  of  Florida,  1906.] 

The  terms  "  insane  person  "  and  "  lunatic  "  include  every  idiot, 
non  compos,  lunatic,  and  insane  person.5 

INQUIRY  AS  TO  LUNACY. — Upon  a  petition  signed  by  five 
citizens,  not  more  than  one  of  whom  is  a  relative,  setting  forth 
that  a  resident  of  Florida  is  insane,  either  non  compos  mentis  or 
sufficiently  devoid  of  reason  to  be  incapable  of  self-control,  the 
county  judge  or  judge  of  the  circuit  court  having  jurisdiction 
shall  appoint  a  commission  of  three,  two  of  whom  are  physicians. 

If  it  be  found  by  the  commission  that  such  person  is  a  lunatic, 
the  judge  may  confirm  the  report  and  pass  the  usual  order  or 
decree. 

If  it  appear  that  the  lunatic  is  destitute,  then  such  person 
shall  be  transported  to  the  asylum  for  the  indigent  insane  and 
delivered  to  the  officer  having  charge  of  the  same,  provided, 
however,  that  if  the  insanity  is  chronic  and  harmless,  or  caused 
by  epilepsy  or  senility,  the  judge  may  direct  the  lunatic  to  be 
delivered  to  the  county  commissioners,  who  must  provide  for 
his  care,  custody,  and  maintenance.6 

GUARDIANS. — County  judges  may  appoint  guardians  of  per- 
sons adjudged  insane  or  lunatic,  who  have  the  same  powers  as 
guardians  of  infants.7 

POWERS  OF  GUARDIANS. — Guardians  may  make  contracts 

1  Chap.  79,  vol.  17;  pp.  383,  384.  *  Revised  Statutes  of  Florida,  s.  1. 

2  Chap.  8,  s.  31;  p.  85.  8  Ibid.,  s.  1,200-1,203. 

3  Chap.  5,  s.  1,  subd.  5;  p.  43.  7  Ibid.,  s.  2,629-2,630. 

4  Chap.  84,  B.  2. 


STATUTES   OF  GEORGIA.  633 

relative  to  the  person  and  estate  of  lunatics,  but  before  such 
contracts  shall  biud  the  estate  they  must  be  confirmed  by  the 
circuit  court.  The  real  estate  may  be  sold  on  application  of 
their  guardians  in  the  same  manner  as  the  real  estate  of  infants.1 
CRIMINAL  INSANE. — When  an  accused  is  acquitted  on  the 
ground  of  insanity  (to  be  specifically  so  found  by  the  jury)  and 
is  manifestly  dangerous  at  large,  the  judge  may  commit  him  to 
jail  or  to  the  care  of  friends  giving  bond.2 

GEORGIA. 

[The  references  are  to  the  Georgia  Codes,  1895,  Supplement, 
1901.] 

NOTE. — In  Georgia  and  California  some  matters  of  general  law  have  been 
codified.  As  an  exhibit  of  the  present  state  of  the  law  respecting  insanity 
we  quote  in  full  several  of  the  more  important  sections,  stating  (with  or  with- 
out modification)  principles  of  the  common  law. 

"Lunatic,"  "insane,  "or  "  non  compos  mentis,"  each  includes 
all  persons  of  unsound  mind.3 

Courts  of  ordinary  have  authority  to  exercise  original,  exclu- 
sive, and  general  jurisdiction  of  the  following  subjects: 

5.  The  appointment  and  removal  of  guardians  of  persons  of 
unsound  mind. 

6.  All  controversies  as  to  right  of  guardianship.4 
GUARDIANS. — The  ordinaries  of  the  several  counties  of  this 

State  may  appoint  guardians  for  idiots,  lunatics,  and  insane 
persons,  deaf  and  dumb  persons  when  incapable  of  managing 
their  estates,  habitual  drunkards  or  persons  imbecile  from  old 
age  or  other  causes  and  incapable  of  managing  their  estates.5 

Guardians  shall  take  the  same  oath  and  give  a  like  bond 
as  guardians  of  minors,  and  their  powers,  duties,  and  liabilities 
shall  be  the  same  and  be  exercised  under  the  same  rules  and 
regulations.6 

A  wife  shall  in  all  cases  be  entitled  to  preference  to  the 
appointment  as  guardian.7 

COMMISSION  TO  INQUIRE  AS  TO  LUNACY. — Commission 
granted  upon  petition  of  any  person.  Commission  shall  be 

1  Revised    Statutes  of  Florida,  8.  4  Civil  Code,  s.  4,232. 

2,631-2,632.  •  Ibid.,  s.  2,570. 

a  Ibid.  [1891],  s.  2,922.  •  Ibid.,  s.  2,571. 

3 Civ.  Code,  s.  5.  Crim.  Code,  s.  2.  7  Ibid.,  s.  2.572. 


634  INCOMPETENT   PERSONS — BROWN  AND  BECKER. 

directed  to  eighteen  proper  persons,  one  of  whom  shall  be  a  phy- 
sician. Require  any  twelve  of  them,  including  the  physician, 
to  examine  the  person  by  inspection  for  whom  guardianship  or 
commitment  to  the  asylum  is  sought,  to  hear  and  examine 
witnesses  as  to  his  condition  and  capacity  to  manage  his  estate, 
and  to  make  return  of  such  examination  to  the  said  ordinary, 
specifying  in  such  return  into  which  of  said  classes  they  find  the 
person  to  come. 

Upon  such  return,  if  the  person  be  found  insane,  the  ordinary 
shall  appoint  a  guardian  or  commit  him  to  an  asylum. 

An  appeal  may  be  had  by  persons  dissatisfied  and  interested 
in  the  application  for  the  commission  upon  bond,  etc.,  to  the 
superior  court  of  the  county. 

Guardians  may  be  appointed  without  a  trial  when  the  lunatic 
is  in  the  asylum  upon  commitment.1 

REVOCATION  OF  GUARDIANSHIP.— Upon  restoration  to  sanity 
and  capacity  of  any  person  for  whom  a  guardian  is  appointed, 
such  person  may  petition  the  ordinary  praying  the  revocation 
of  the  guardianship.  The  ordinary  shall  examine  into  the 
truth,  and  if  satisfied,  and  the  guardian  consenting  thereto,  the 
ordinary  shall  grant  the  prayer  and  deliver  to  such  person  his 
property  and  effects. 

If  the  ordinary  is  not  satisfied  as  to  the  truth  of  the  petition, 
the  question  shall  be  tried  before  a  jury.2 

CONFINEMENT  OF  WARD. — Guardians  of  insane  persons  are 
authorized  to  confine  them  if  such  a  course  is  necessary,  either 
for  their  protection  or  for  the  safety  of  others ;  and  a  guardian 
wilfully  failing  to  take  such  precaution  with  his  ward  shall  be 
responsible  for  injuries  inflicted  on  others  by  such  ward. 

Where  there  is  no  guardian  or  the  guardian  refuses  to  confine 
his  ward,  and  any  person  shall  make  oath  that  such  insane 
person  should  not  longer  be  left  at  large,  the  ordinary  shall 
issue  a  warrant  for  the  arrest  of  such  person,  and  on  an  investi- 
gation of  the  facts  may  commit  him  to  a  lunatic  asylum  and  if 
necessary  cause  him  to  be  temporarily  confined  in  a  jail.3 

EXPENSES  OF  PROCEEDINGS:  How  PAID. — Where  the  estate 
of  an  insane  person  is  insufficient  to  defray  the  expenses  of 
conducting  the  proceedings  inquiring  as  to  his  lunacy  and  for 

'Civil  Code,  s.  2,573-2,575,  2,584-          2  Ibid.,  s.  2,578-2,579. 
2,587.  *  Ibid.,  s.  2,581-2,582. 


STATUTES   OF    GEORGIA.  635 

carrying  or  conveying  such  insane  person  from  the  county  to 
the  State  lunatic  asylum,  when  committed  to  such  asylum,  then 
the  county  shall  defray  such  expenses. ' 

LUNATIC  ASYLUM. — The  State  lunatic  asylum  at  Midway  is 
managed  by  ten  trustees,  one  a  physician,  appointed  by  the 
governor.  The  trustees  have  general  authority  over  the  asylum, 
appointing  all  officers.  They  shall  visit  the  asylum  monthly  by 
one  of  the  board,  and  annually  by  all  of  them.2 

The  asylum  is  open  to  all  residents  who  are  lunatics,  idiots, 
epileptics,  or  demented  inebriates,  but  harmless  lunatics  may  be 
discharged.  Paying  patients  are  admitted.  All  must  pay  when 
able.3 

The  trustees  hold  examinations  for  appointments  as  physicians 
at  the  asylum.4 

The  superintendent  has  general  control  subject  to  the  trustees.5 

CRIMINAL  INSANE. — Insane  convicts  may  be  admitted  to  the 
asylum  on  certificate  of  the  ordinary.6 

Persons  acquitted  of  crime  on  account  of  insanity  may  be 
committed  by  the  court  to  the  asylum;  in  the  case  of  capital 
crime  he  cannot  be  discharged  except  by  special  act  of  the  legis- 
lature; in  other  cases  by  order  of  the  governor.7 

No  lunatic  shall  be  tried  while  in  that  condition.8 

An  idiot  or  "a  lunatic  or  person  insane,  without  lucid  inter- 
vals, shall  not  be  found  guilty.  .  .  .  Provided,  the  act  so  charged 
as  criminal  was  committed  in  the  condition  of  such  lunacy  or  in- 
sanity ;  but  if  a  lunatic  has  lucid  intervals  of  understanding,  he 
shall  answer  for  what  he  does  in  those  intervals  as  if  he  had  no 
deficiency. " 9 

CONTRACTS. — "An  insane  person  cannot  contract  prior  to 
commission  sued  out  and  guardian  appointed.  A  lunatic  may 
contract  during  lucid  interval ;  after  guardianship  he  cannot ; 
nor  can  a  person  restored  to  sanity  contract  until  the  guardian- 
ship is  dissolved.  Necessaries  furnished  an  insane  person  may 
be  recovered  upon  the  same  proof  as  if  furnished  to  infants." 10 

"A  drunkard,  when  actually  intoxicated  to  such  an  extent  as 

'Civil  Code,  s.  2,583.  •  Ibid.,  s.  1,446-1,448;  Grim.  Code, 

*lbid.,  s.  1,409-1,413,  1,421-1,422.  s.  1,183-1,185. 

3  Ibid.,  s.  1,414,  1,416,  1,429-1,434,  ^  Civil  Code,  s.  1,451;   Crim.  Code, 
1,435-1,442.  s.951-952,  1,047-1,049. 

4  Ibid.,  s.  1,423-1,424.  8  Crim.  Code,  s.  953. 
4  Ibid.,  s.  1,427-1,428.  fl  Ibid.,  s.  35,  36. 

10  Civil  Code,  s.  3,652,  3,647,  3,653. 


636  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

to  deprive  him  of  reason,  can  make  no  valid  contract  with  any 
one  cognizant  of  the  fact  of  his  condition.  If  the  party  contract- 
ing was  at  all  instrumental  in  producing  the  state  of  intoxication, 
the  contract  is  invalid,  however  partial  the  intoxication  may 
be."1 

WILLS. — "An  insane  person  cannot  generally  make  a  will. 
A  lunatic  may,  during  a  lucid  interval.  A  monomaniac  may 
make  a  will,  if  the  will  is  in  no  way  the  result  of  or  connected 
with  that  monomania.  In  all  such  cases  it  must  appear  that  the 
testament  does  speak  the  wishes  of  the  testator,  unbiassed  by  the 
mental  disease  with  which  he  is  affected."2 

"Eccentricity  of  habit  or  thought  does  not  deprive  a  person 
of  power  of  making  a  testament ;  old  age,  and  the  weakness  of 
intellect  resulting  therefrom,  does  not,  of  itself,  constitute  in- 
capacity. If  that  weakness  amounts  to  imbecility,  the  testa- 
mentary capacity  is  gone.  In  cases  of  doubt  as  to  the  extent  of 
this  weakness,  the  reasonable  or  unreasonable  disposition  of  his 
estate  should  have  much  weight  in  the  decision  of  the  question."8 

"An  incapacity  to  contract  may  coexist  with  a  capacity  to 
make  a  will;  the  amount  of  intellect  necessary  to  constitute 
testamentary  capacity  is  that  which  is  necessary  to  enable  the 
party  to  have  a  decided  and  rational  desire  as  to  the  disposition 
of  his  property.  His  desire  must  be  decided,  in  distinction  from 
the  wavering,  vacillating  fancies  of  a  distempered  intellect.  It 
must  be  rational,  in  distinction  from  the  ravings  of  a  madman, 
the  silly  pratings  of  an  idiot,  the  childish  whims  of  imbecility, 
or  the  excited  vagaries  of  a  drunkard."4 

CIVIL  EIGHTS. — Insane  persons  and  habitual  drunkards  have 
their  persons  and  estates  or  either  of  them  placed  in  the  control 
of  guardians,  but  "retain  all  the  rights  of  citizens  which  they 
have  the  capacity  to  enjoy,  and  which  are  compatible  with  their 
situation."  Their  domicile  is  that  of  their  guardians.5 

HAWAII. 

[The  references  are  to  the  Revised  Laws  of  Hawaii,  1905.] 
INSANE  ASYLUM. — The  Insane  Hospital  is  located  at  Hono- 
lulu.    The  judges  of  the  circuit  and  district  courts  have  power 

1  Civil  Code,  s.  3,654.  4  Ibid.,  s.  3,268. 

2  Ibid.,  s.  3,266.  *  Ibid.,  s.  1,812,  1,828. 

3  Ibid.,  s.  3,267. 


STATUTES   OF   IDAHO.  637 

to  commit  persons  oil  a  satisfactory  complaint  showing  that  pub- 
lic safety  requires  the  commitment. ' 

It  is  under  the  management  of  the  board  of  health.2 

Upon  application  of  relatives  or  friends  a  judge  of  the  circuit 
court  may  appoint  a  guardian.3 

CRIMINAL  INSANE.  —Persons  acquitted  for  insanity  may  be 
committed  to  the  asylum.4 

The  insanity  of  indicted  persons  may  be  tried  by  a  special 


jury.5 


IDAHO. 


[The  Eeferences  are  to  Idaho  Codes  Annotated,  1901.] 

APPOINTMENT  OF  GUARDIAN. — Probate  judge  on  petition  of 
any  relative  or  friend  may  on  notice  to  the  person  and  after  a 
hearing  at  which  the  person  shall  be  present  if  able,  appoint  a 
guardian  of  his  person  and  estate  with  the  usual  powers,  who 
shall  give  bond.6 

Bestoratiou  may  be  found  by  another  hearing,  with  trial  by 
jury  if  requested.7 

When  it  appears  to  the  satisfaction  of  a  magistrate  of  the 
county  that  any  person  within  the  county  is  so  far  disordered 
in  mind  as  to  endanger  health,  person,  or  property,  he  must  issue 
and  deliver  to  some  peace  officer  for  service  a  warrant  directing 
that  such  person  be  arrested  and  taken  before  any  judge  of  the 
court  of  record  within  the  county  for  examination. 

Judge  to  issue  subpoenas  for  at  least  one  graduate  of  medi- 
cine to  attend  such  examination. 

Physician  to  hear  testimony  and  make  a  personal  examina- 
tion of  the  alleged  insane  person. 

If  the  physician  believes  the  person  to  be  dangerously  insane, 
he  must  make  .a  certificate  in  his  own  handwriting  showing, 
as  near  as  possible — 

1.  That  such  person  is  so  far  disordered  in  his  mind  as  to  en- 
danger health,  person,  or  property. 

2.  The  premonitory  symptoms,  apparent  cause,  or  class  of 
insanity,  and  the  condition  of  the  disease. 

'Hawaii   Revised  Laws,    s.  1,112,  •  Ibid.,  s.  2,857,  cf.  s.  2,876. 

1,116.  "Code  Civil  Proc.,  s.  4,353-4,355, 

2  Ibid.,  s.  1,113.  4,357-4,398. 

3  Ibid.,  s.  2,302-2,304,  2,309, 2,322.  7  Ibid.,  s.  4,356. 

4  Ibid.,  s.  1,117. 


638  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

3.  The   nativity,  age,  residence,  occupation,  and   previous 
habits  of  the  person. 

4.  The  place  from  whence  the  person  came  and  the  length  of 
his  residence  within  the  State.     The  judge,  after  such  examina- 
tion and  certificate,  if  he  believes  the  person  so  disordered,  must 
make  an  order  confining  him  in  the  insane  asylum. ' 

The  physician  attending  such  examination  is  allowed  five 
dollars,  to  be  paid  by  the  county  treasurer  on  the  order  of  the 
board  of  county  commissioners.2 

The  Idaho  Insane  Asylum  is  located  at  Blackfoot,  and  is 
under  the  management  and  control  of  a  board  of  directors  con- 
sisting of  three  persons,  appointed  by  the  governor  for  two  years. 

The  medical  superintendent  must  be  a  graduate  of  medicine 
and  have  practised  his  profession  five  years  after  the  date  of 
his  diploma.  He  must  reside  at  the  asylum  and  give  his  entire 
time  and  attention  to  promoting  the  best  interests  of  the  patients. 
He  is  the  chief  executive  officer  of  the  asylum,  and  may  control 
the  patients,  prescribe  the  treatment,  and  prescribe  and 
enforce  the  sanitary  regulations  of  the  asylum.3 

Any  person  received  in  the  asylum  must  after  recovery  be 
discharged  thereform. 

No  person  laboring  under  contagious  or  infectious  disease 
must  be  admitted  into  the  asylum  as  a  patient,  nor  a  non-resident, 
unless  he  became  insane  within  the  State.4 

CONTRACTS. — A  person  so  adjudicated  cannot  contract, 
nor  delegate  any  power  nor  waive  any  right.  A  certificate 
of  discharge  froman  asylum  re-establishes  the  presumption  of 
capacity.5 

A  contract  made  before  adjudication  is  "subject  to  rescis- 
sion," but  the  person  is  liable  for  the  reasonable  value  of 
necessaries  for  himself  or  his  family.6 

CRIMINAL  INSANE. — When  the  jury  finds  the  accused  "not 
guilty  by  reason  of  insanity,"  the  court  may  summon  a  jury  to 
determine  if  it  still  continues,  and  if  so  found  commit  him  to  the 
State  asylum.7 

Insane  persons  cannot  be  tried,  sentenced,  or  punished  while 
in  that  condition.8 

1  Idaho  Polit.  Code,  s.  406-413.  s  Civil  Code,  s.  1,988. 

2  Ibid.,  s.  418.  6  Ibid.,  s.  1,986-1,987. 

3  Ibid.,  s.  387-400.  7  Penal  Code,  s.  5,497,  5,512. 
*  Ibid.,  a.  401-404.  8  Ibid.,  s.  5,663-5,666,  5,338. 


STATUTES  OF  ILLINOIS.  639 

ILLINOIS. 

[The  Eeferences  are  to  Revised  Statutes  of  Illinois,  Hurd, 
1905.] 

INQUISITION  AS  TO  LUNACY. — When  any  person  is  supposed 
to  be  insane  or  distracted,  any  citizen  of  the  county  may  petition 
the  judge  of  the  county  court  for  proceedings  to  inquire  into  such 
alleged  insanity  or  distraction. 

Upon  the  filing  of  such  petition,  the  judge  shall  order  the 
clerk  of  the  court  to  issue  a  writ,  directed  to  the  sheriff  or  any 
constable  or  person  having  the  custody  or  charge  of  such  person, 
requiring  the  alleged  insane  person  to  be  brought  before  him  at 
a  time  and  place  to  be  appointed.  Such  officer  or  person  shall 
bring  the  alleged  insane  person  before  the  court.  Notice  shall 
be  given. 

Subpoenas  to  be  issued  for  such  witnesses  as  may  be  desired 
on  behalf  of  the  petitioner  or  of  the  person  alleged  to  be  insane. 

Trial  to  be  by  a  commission  of  two  physicians,  or,  if  demanded 
or  expedient,  by  a  jury  of  six  persons,  one  of  whom  to  be  a 
physician.  The  case  shall  be  tried  in  the  presence  of  the  person 
alleged  to  be  insane,  who  shall  have  the  right  to  be  assisted  by 
counsel. 

Finding  of  commission  or  jury  to  be  rendered  in  writing, 
signed  by  them,  and  to  be  in  the  form  prescribed  by  the  State 
Commissioners  of  Public  Charities. 

Upon  the  return  of  the  verdict,  it  shall  be  recorded.  If  it 
appear  that  the  person  is  insane  and  a  fit  person,  the  court  shall 
order  that  the  insane  person  be  committed  to  a  hospital  for  the 
insane. ' 

LUNATIC  ASYLUMS.  — All  persons  admitted  are  supported  by 
the  State,  so  far  as  treatment  and  maintenance.  At  the  time  of 
the  inquest  the  county  judge  shall  inquire  into  the  pecuniary 
condition  of  the  person  and  his  relatives  liable  to  support  him. 
If  of  sufficient  means,  private  patients  at  the  State  hospitals 
shall  pay  for  their  clothing  and  incidental  expenses.  Otherwise 
these  shall  be  paid  by  their  county.2 

Upon  a  return  of  the  finding  of  lunacy  by  the  court  to  the 
hospital  for  the  insane  to  which  the  person  is  ordered  committed, 

1  Illinois  Revised  Statutes,  c.  85,  s.  J  Ibid.,  s.  15-16. 

1-11. 


040          INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

he  shall  be  admitted,  unless  impossible  for  lack  of  room.  Harm- 
less chronic  patients  may  be  discharged  to  make  room.1 

Authority  to  discharge  patients  is  vested  in  the  trustees,  but 
they  may  delegate  it  to  the  superintendent.  Discharges  may  be 
for  the  benefit  of  the  patient,  and  of  incurable  cases,  and  paroles 
of  not  exceeding  three  months  may  be  allowed.  Any  person 
confined  is  entitled  to  the  writ  of  habeas  corpus  to  determine  his 
sanity.  The  judge  of  the  county  court  may  hear  evidence  of 
restoration  at  any  time.  Complete  restitution  of  civil  rights 
shall  be  given  upon  discharge.2 

Voluntary  patient  in  early  stages  of  insanity  may  be  admitted 
on  his  application,  approved  by  the  county  court.  He  may  leave 
at  any  time  on  three  days'  notice.3 

APPOINTMENT  OF  CONSERVATOR. — When  any  such  person 
is  adjudged  insane,  if  it  appear  that  he  is  the  owner  or  possessor 
of  any  property  the  county  court  shall  appoint  some  fit  person  to 
be  the  conservator  of  such  insane  person ;  but  in  case  there  is  a 
probate  court  in  the  county,  then  he  shall  transmit  thereto  a 
duly  certified  copy  of  the  record  of  the  verdict  of  the  jury  find- 
ing such  person  insane,  and  upon  presentation  the  probate  court 
may  appoint  some  fit  person  to  be  conservator  of  such  insane 
person.4 

Whenever  any  idiot,  or  insane,  distracted,  or  feeble-minded 
person  lias  any  estate,  real  or  personal,  or  when  any  drunkard 
or  spendthrift,  gaming,  idleness,  or  debauchery  of  any  kind,  so 
spends,  wastes,  or  lessens  his  estate  as  to  expose  himself  or  his 
family  to  want  or  suffering,  the  probate  court,  or  if  none,  the 
county  court  of  the  county  in  which  such  person  resides  shall, 
on  the  application  of  any  reputable  citizen  living  in  such  county, 
order  a  jury  to  be  summoned  to  ascertain  whether  such  person 
be  an  idiot,  lunatic,  or  distracted,  a  drunkard  or  such  spendthrift, 
and  if  the  jury  so  find,  the  court  shall  appoint  some  fit  person  to 
be  the  conservator  of  such  person. 

Summons  to  be  issued  and  served  upon  person  for  whom  con- 
servator is  sought  to  be  appointed.5 

POWERS  AND  DUTIES  OF  CONSERVATOR. — The  conservator 
shall  give  a  bond  in  double  the  amount  of  his  ward's  real  and 

1  Revised  Stats.,  s.  17.  4  Ibid.,  s.  12. 

2  Ibid.,  s.  22-25.  5  Ibid.,  c.  86,  s.  1-2. 
'  Ibid.,  a.  37. 


STATUTES   OF   ILLINOIS.  641 

personal  estate  which  may  be  put  in  suit  in  the  name  of  the 
people  of  the  State  of  Illinois  to  the  use  of  any  person  entitled  to 
recover  on  a  breach  thereof. 

He  shall  have  the  care  and  management  of  the  estate  of  his 
ward  and  the  custody  of  his  person  until  otherwise  ordered  by 
the  court,  and  the  custody  and  education  of  his  children  where 
no  other  guardian  is  appointed,  but  shall  not  deprive  the 
mother  of  the  custody  and  education  of  the  children  without  her 
consent. 

He  shall  take  charge  of  the  estate  of  the  ward  and  within 
sixty  days  return  to 'the  court  a  true  and  perfect  inventory  of 
the  estate  of  the  ward,  signed  and  verified  by  him.  He  shall  at 
the  expiration  of  a  year  settle  his  accounts  as  conservator 
with  the  county  court. 

He  shall  at  the  expiration  of  his  trust  pay  and  deliver  to 
those  entitled  thereto  all  property  in  his  hands  as  conservator  in 
such  manner  as  is  directed  by  the  court. 

On  every  account  or  final  settlement  he  shall  set  forth 
specifically  on  what  account  expenditures  were  made  by  him 
and  all  sums  received  and  paid  out  since  his  last  accounting,  and 
show  the  true  balance  of  money  on  hand,  which  account  shall 
be  accompanied  by  the  proper  vouchers  and  signed  and  verified 
by  him. 

He  shall  deliver  all  accounts  of  his  ward  and  demand  and 
sue  for  and  receive  in  his  own  name  as  conservator  all  property 
of  and  demands  due  the  ward,  and  may  compromise  the  same 
with  the  approbation  of  the  court.1 

He  shall  manage  the  estate  of  his  ward  frugally  and  without 
waste  and  apply  the  income  to  the  support  of  his  ward  and 
family  and  the  education  of  his  children. 

He  shall  invest  the  property  of  his  ward  in  securities  approved 
by  the  court.  He  may  lease  the  ward's  estate  on  terms  and  for 
a  length  of  time  approved  by  the  court.  He  may,  by  leave  of 
the  court,  mortgage  the  real  estate  of  the  ward  upon  petition  to 
the  county  court  setting  forth  the  condition  of  the  estate  and 
the  facts  and  circumstances,  which  shall  be  published  in  a 
newspaper  in  the  county  for  at  least  once  a  week  for  three  suc- 
cessive weeks. 

The  county  court  may  order  the  real  estate  of  the  ward  to  be 

1  Revised  Stats.,  c.  86,  s.  3-11. 
III.— 41 


042  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

sold  iii  the  manner  and  at  a  time  and  place  prescribed  by  the 
court.  The  conservator  making  such  sale  shall  make  a  return 
thereof  to  the  court ;  and  if  the  sale  be  approved  by  the  court, 
the  title  shall  vest  in  the  purchaser  of  the  estate  so  sold.1 

BEMOVAL  OF  CONSERVATOR.  — Conservator  may  be  removed 
by  the  county  court  for  failure  to  give  bond,  for  failure  to  make 
inventory,  or  to  account  and  make  a  settlement,  or  when  he  shall 
have  become  insane,  or  if  moved  out  of  the  State,  or  become 
incapable  or  unsuitable  for  the  discharge  of  his  duties,  or  for 
failure  to  discharge  any  duty  required  of  him  by  law  or  order 
of  the  court. 

Before  removing  the  conservator  the  court  shall  summon 
him  to  show  cause. 

When  it  appears  proper,  the  court  may  permit  the  conser- 
vator to  resign  if  he  first  settles  his  accounts  and  delivers  over 
the  estate  as  the  court  directs.2 

APPOINTMENT  OF  SUCCESSOR. — Upon  the  removal,  resigna- 
tion, or  death  of  the  conservator  another  may  be  appointed.  The 
court  may  compel  the  conservator  so  removed  or  resigned  or 
the  executor  or  administrator  of  a  deceased  conservator  to 
deliver  up  to  such  successor  all  the  property  and  effects  in  his 
custody  or  control  belonging  to  the  ward.3 

COMPENSATION.  — Conservator  on  settlement  shall  be  allowed 
such  fees  and  compensation  for  his  services  as  shall  seem 
reasonable  and  just  to  the  court. 

EESTORATION  TO  EEASON. — When  any  person  for  whom  a  con- 
servator shall  have  been  appointed  shall  be  restored  to  his  reason, 
or  if  a  drunkard  or  spendthrift  shall  have  reformed,  such  person 
may  apply  to  the  county  court  to  have  said  conservator  removed 
and  the  care  and  management  of  his  property  restored  to  him. 

Notice  of  such  application  shall  be  given  to  the  conservator 
ten  days  before  the  commencement  of  the  term  of  the  court  to 
which  application  shall  be  made.  A  jury  shall  be  summoned  to 
try  the  question  whether  said  applicant  is  a  fit  person  to  have 
the  care,  custody,  and  control  of  his  property.  If  they  return 
that  such  person  is  a  fit  person,  then  the  court  shall  enter  an 
order  fully  restoring  such  person  to  all  the  rights  and  privileges 
enjoyed  before  such  conservator  was  appointed. 

1  Revised  Stats.,  s.  17-29.  3  Ibid.,  s.  35. 

3  Ibid.,  e.  86,  s.  32-34. 


STATUTES   OF   INDIANA.  643 

APPEALS. — Appeals  shall  be  allowed  to  the  circuit  court 
from  any  order  or  judgmeut  under  this  act,  upon  the  appellant 
giving  bond  directed  by  the  court.1 

DEFINITIONS. — The  word  insane  as  used  in  the  above  statutes 
relating  to  commitment  means  any  person  who  by  reason  of  un- 
soundness  of  mind  is  incapable  of  managing  or  caring  for  his  own 
estate,  or  is  dangerous  to  himself  or  others,  if  permitted  to  go  at 
large,  or  is  a  fit  subject  for  treatment  in  a  hospital  for  the  insane. 
No  idiot  or  simple  epileptic  shall  be  regarded  as  insane,  "unless 
the  manifestations  of  abnormal  excitability,  violence,  or  homici- 
dal or  suicidal  impulses  "  render  confinement  proper.2 

CRIMINAL  INSANE. — A  lunatic  or  insane  person  without  lucid 
intervals  shall  not  be  found  guilty.  In  case  of  acquittal  by 
reason  of  insanity  the  jury  shall  also  find  whether  it  con- 
tinues, and  if  so  found  the  accused  shall  be  committed  to  a  State 
hospital.3 

No  insane  person  shall  be  tried,  or  if  convicted,  sentenced.4 

INDIANA. 

[The  references  are  to  Burns's  Annotated  Indiana  Statutes, 
Eevision  of  1908.] 

DEFINITION. — "Person  of  unsound  mind"  in  any  statute 
means,  "any  idiot,  non  compos,  lunatic,  monomaniac,  or  distracted 
person. " 5 

CARE  AND  CUSTODY. — On  information  of  any  person  the  pro- 
bate court  may  inquire  as  to  the  sanity  of  an  inhabitant  of  the 
county,  by  the  court  or  by  a  jury.  The  prosecuting  attorney  ap- 
pears for  the  person.6 

Personal  appearance  may  be  dispensed  with  for  cause.7 
A  guardian  may  be  appointed,  and  for  a  non-resident  also.8 
The  guardian  has  the  usual  powers  and  duties.8 
"Every  contract,  sale,  or  conveyance"  (after  such  adjudica- 
tion) "of  any  person  while  of  unsound  mind  shall  be  void." 

On  complaint  that  any  person  is  insane  and  dangerous  to  the 
community  if  at  large,  a  justice  of  the  peace  may  apprehend  the 
person  and  try  his  insanity  by  a  jury  of  six.  If  they  find  him 

1  Revised  Stats.,  s.  37-10.  •  Ibid.,  s.  3.101. 

2  Ibid.,  c.  85,  s.  1.  7  Ibid.,  s.  3,103. 

8  Ibid.,  c.  38,  s.  284.  »  Ibid.,  s.  3,102.  3,105. 

4  Ibid.,  c.  38,  s.  285.  •  Ibid.,  s.  3.107,  252. 

s  Indiana  Stats.,  s.  3,100.  10  Ibid.,  s.  3,110. 


644  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

dangerously  insane  the  proceedings  are  certified  to  the  circuit, 
which  again  inquires  by  a  jury  of  twelve.  A  guardian  of  the 
.  estate  may  be  appointed,  and  a  person  to  care  for  the  incompetent 
shall  be  appointed,  or  he  may  be  sent  to  the  hospital  for  the 
insane.  If  the  justice's  court  jury  find  him  sane  any  person 
may  appeal.1 

The  Central  (near  Indianapolis),  Northern  (nearLogansport), 
Southern  (near  Evansville),  Eastern  (near  Eichmond),  and 
Southeastern  hospitals  for  the  insane  are  managed  by  boards  of 
trustees  of  four  members  appointed  by  the  governor.2 

They  appoint  a  superintendent  and  other  principal  officers.3 

All  insane  persons  residing  in  Indiana  and  having  a  legal  set- 
tlement in  any  county  "  shall  be  entitled  to  be  maintained  and  to 
receive  medical  treatment "  in  the  State  hospitals.  But  if  not 
adjudged  insane,  a  citizen  of  the  county  must  make  a  statement 
before  a  justice  of  the  peace  showing  history,  symptoms,  etc., 
and  an  examination  by  physicians  and  an  inquiry  must  be  held 
by  the  justice.4 

Preference  in  admission  is  given  to  recent  and  curable  cases. 

Idiots  are  not  admitted.5 

Incurably  insane  paupers  may  be  cared  for  in  county  asylums 
for  the  insane  in  counties  having  a  population  of  150,000.° 

The  writ  of  habeas  corpus  is  available  to  secure  a  discharge 
from  detention.7 

CRIMINAL,  INSANE. —  [Convicts  becoming  insane  are  sent  to 
the  hospital  for  the  insane  upon  the  report  of  the  prison  wardens 
and  the  finding  of  a  commission,  appointed  by  the  Governor — 
probably  obsolete.8] 

The  Indiana  Hospital  for  the  Criminal  Insane,  at  Jefferson- 
ville,  is  governed  by  the  board  of  managers  of  the  Indiana  Ee- 
formatory,  and  the  superintendent  thereof.9 

Convicts  are  sent  there  after  an  inquest  and  examination  by 
physicians  appointed  by  a  judge  of  the  circuit  court  on  informa- 
tion of  the  prison  or  reformatory  physician.10 

The  defence  of  insanity  is  set  up  by  a  special  plea  in  writing. 

1  Penal  Code,  s.  7,879-7,887.  8  Ibid.   s.  3,760-3,766. 

2  Ibid.,  s.  3,433,  3,434,  3,435,  3,437,          7  Ibid.   s.  3,729. 
3,682  8  Ibid.   s.  3,713-3,718. 

3  Ibid.,  s.  3,682,  3,688-3,689.  •  Ibid.   s.  3,741-3,745. 
1  Ibid.,  s.  3,691-3702.                                 w  Ibid.   s.  3,746-3,759. 
'  Ibid.,  s.  3,703-3,705,  3,731. 


STATUTES   OF   IOWA.  6-15 

If  the  jury  acquit  on  that  ground  they  must  so  specify.  The 
person  must  be  proceeded  against  on  this  ground  as  above.  The 
verdict  is  prima  facie  evidence  of  his  insanity.1 

When  a  defendant  appearing  for  judgment  is  believed  to  be 
insane,  the  question  shall  be  determined  by  a  jury  of  twelve,  and 
if  he  is  so  found,  he  shall  be  confined  in  a  State  hospital.2 

IOWA. 

[The  references  are  to  Code  of  Iowa,  1897;  Supplement, 
1907.] 

DEFINITION. — The  words  "insane  person"  include  idiots, 
lunatics,  distracted  persons,  and  persons  of  unsound  mind.3 

The  term  "insane, "as  used  in  this  chapter,  includes  every 
species  of  insanity  or  mental  derangement.  The  term  "  idiot "  is 
restricted  to  persons  foolish  from  birth  supposed  to  be  natur- 
ally without  mind.4 

GUARDIANS  OF  DRUNKARDS,  SPENDTHRIFTS,  AND  LUNA- 
TICS.— Appointment  of  guardians  vested  in  the  circuit  court. 

When  a  petition  is  presented  to  the  circuit  court  verified  by 
affidavit  that  any  inhabitant  of  the  county  is — 

1.  An  idiot,  lunatic,  or  person  of  unsound  mind ; 

2.  An  habitual  drunkard,  incapable  of  managing  his  affairs ; 

3.  A  spendthrift  who  is  squandering  his  property ;  and  the 
allegations  of  the  petition  are  satisfactorily  proved  upon  trial, 
the  court  may  appoint  a  guardian  of  the  property  who  shall  also 
be  a  guardian  of  the  minor  children. 

Petition  to  set  forth  the  facts  upon  which  the  application  is 
based,  to  be  answered  as  in  ordinary  actions.  The  applicant 
recorded  as  plaintiff,  the  other  party  as  defendant,  and  either 
party  may  demand  a  trial  by  jury.5 

CUSTODY. — Priority  of  claim  to  the  custody  of  any  such  per- 
son shall  be — 1.  The  legally  appointed  guardian.  2.  The  hus- 
band or  wife.  3.  The  parents.  4.  The  children.6 

POWERS  AND  DUTIES  OF  GUARDIANS. — The  provisions  of 
this  code  relating  to  guardians  for  minors  and  regulating  or 
prescribing  the  powers,  duties,  or  liabilities  of  each  and  of  the 
court  so  far  as  the  same  are  applicable,  shall  be  held  to  apply 

1  Penal  Code,  s.  2,070-2,071.  4  Ibid.,  s.  2,298. 

2  Ibid.,  s.  2,177-2,180.  •  Ibid.,  s.  3,219-3,220. 
8  Iowa  Code,  s.  48,  sub.  6.  •  Ibid.,  B.  3,228. 


646  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

to  guardians  and  their  wards  appointed  under  the  foregoing 
sections. 

Guardian  may  sue  in  his  own  name  as  guardian  of  the 
ward  for  whom  he  sues.  Action  shall  not  abate  upon  the  ter- 
mination of  his  guardianship;  but  his  successor  or  the  person 
for  whom  he  was  guardian  shall  be  made  a  party  to  the  suit  in 
the  same  manner  as  an  executor  or  administrator  is  made  a  party 
to  a  proceeding  of  the  like  kind. 

Guardian  may  sell  real  estate  of  the  ward  for  the  support  of 
the  ward  or  his  family  and  for  the  payment  of  his  debts  under 
like  proceedings  as  required  .by  law  for  the  sale  of  real  estate  of 
minors.  The  court  shall,  if  necessary,  set  off  to  the  wife  and 
minor  children  or  to  either  sufficient  of  the  property  for  their 
support. 

If  the  estate  of  any  such  person  is  insolvent  a  like  proceeding 
may  be  had  as  is  required  by  law  for  the  settlement  of  the  in- 
solvent estate  of  a  deceased  person.1 

CONFINEMENT  OF  LUNATICS. — Hospitals  are  established  for 
the  care  of  the  insane  at  Mt.  Pleasant,  at  Independence,  at 
Clarinda,  and  at  Cherokee,  each  under  the  charge  and  manage- 
ment of  five  trustees,  two  of  whom  may  be  women. 2 

COMMISSIONERS  OF  INSANITY. — In  each  county  there  is  a 
board  of  three  commissioners  of  insanity  composed  of  the  clerk 
of  the  circuit  court  and  two  others  appointed  by  the  judge  of  the 
court,  one  of  whom  shall  be  a  physician  and  the  other  a  lawyer. 

Such  commissioners  have  cognizance  of  all  applications  for 
admission  to  the  hospital  or  for  the  safe-keeping  otherwise  of 
insane  persons  within  their  counties.  They  may  issue  subpoenas, 
compel  obedience  thereto,  administer  oaths,  and  do  any  act  of 
a  court  necessary  and  proper  in  the  premises.3 

COMMITMENT  TO  HOSPITAL  BY  COMMISSIONERS. — Applica- 
tion for  admission  to  a  hospital  must  be  made  by  information 
verified  by  affidavit  alleging  that  the  person  in  whose  behalf  the 
application  is  made  is  a  fit  subject  for  custody  and  treatment  in 
the  hospital;  that  such  person  is  a  resident  of  the  county  or 
lias  a  local  settlement  therein  if  such  is  known  to  be  the  fact,  and 
if  such  settlement  is  not  in  the  county  where  it  is,  if  known. 

'Iowa  Code,  s.  3,223-3,227;  Supp.,          2  Ibid.,  s.   2,254-2,260;    Supp.,   s. 
s.  3,225.  2,253a. 

3  Ibid.,  2,261-2,263. 


STATUTES  OF  IOWA.  647 

The  commissioners  shall  thereupon  examine  the  informant 
under  oath,  and  if  satisfied  that  there  are  reasonable  grounds  shall 
at  once  investigate.  They  may  require  the  person  for  whom 
such  admission  is  sought  to  be  brought  before  them.  They  may 
provide  for  the  suitable  custody  of  such  person  until  the  deter- 
mination of  their  investigation.  They  shall  hear  testimony  for 
and  against  such  application. 

Any  citizen  of  the  county  or  relative  of  the  person  alleged  to 
be  insane  may  appear  and  resist  the  application.  The  commis- 
sioners shall  appoint  some  regular  practising  physician  of  the 
county  to  make  a  personal  examination  of  the  person  alleged  to 
be  insane  touching  the  truth  of  the  information  and  report 
forthwith  to  them.  Such  physician  so  appointed  shall  certify 
that  he  has  made  a  careful  personal  examination,  that  he  finds 
the  person  in  question  insane  if  such  is  the  fact.  On  the  re- 
turn of  the  physician's  certificate  the  .  ommissiouers  shall 
conclude  their  investigation  and  shall  find  whether  the  person 
be  insane,  and  if  insane  whether  he  is  a  fit  subject  for  treat- 
ment and  custody  in  the  hospital.  If  they  find  such  person  is 
not  insane  they  shall  order  his  immediate  discharge.  If  found 
insane,  they  shall  order  such  person  to  be  committed  to  the 
hospital,  and  shall  forthwith  issue  their  warrant  and  a  du- 
plicate thereof  stating  such  finding  and  authorizing  the  super- 
intendent of  the  hospital  to  receive  and  keep  such  person  as  a 
patient  therein.  Such  warrant  and  duplicate  with  the  certifi- 
cate and  finding  of  the  physician  shall  be  delivered  to  the 
sheriff  of  the  county,  who  shall  execute  the  same  by  convey- 
ing such  person  to  the  hospital.  The  superintendent  of  the 
hospital  shall  acknowledge  such  delivery  on  the  original  warrant, 
which  the  sheriff  shall  return  to  the  clerk  of  the  commissioners. 
No  person  during  such  investigation  or  while  being  conveyed 
to  the  hospital  shall  be  confined  in  any  jail  or  prison  except  in 
cases  of  extreme  violence,  when  it  is  deemed  absolutely  necessary 
for  the  safety  of  such  insane  persons  and  of  the  public  that  he  be 
confined  in  such  jail  or  prison ;  but  at  no  time  shall  any  female 
be  placed  in  such  confinement  without  at  least  one  female  attend- 
ant remaining  in  charge  of  such  insane  person.1 

APPEAL  FROM  FINDING. — Any  person  found  insane  by 
the  commissioners  of  insanity  may  appeal  to  the  district  court 
1  Iowa  Code,  s.  2,264-2,266. 


648  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

within  ten  days  after  the  filing  of  the  finding  of  such  commis- 
sioners ;  the  case  when  thus  appealed  shall  stand  for  trial  anew 
in  such  court.  Upon  appeal  it  shall  be  the  duty  of  the  county 
attorney  to  prosecute  the  action  on  behalf  of  the  informant,  with- 
out additional  compensation. 

If  any  person  found  insane  takes  an  appeal  from  such  find- 
ing, such  person  shall  be  discharged  from  custody  pending 
such  appeal,  unless  the  commissioners  for  any  reason  find  that 
such  person  cannot  with  safety  be  allowed  to  go  at  large. 

If  upon  the  trial  of  such  an  appeal  such  person  is  found  not 
insane,  the  court  shall  order  the  immediate  discharge  of  such 
person  if  in  custody.  If  found  insane,  the  court  shall  order  such 
person  to  be  committed  to  the  hospital,  and  the  clerk  of  the  court 
shall  issue  a  warrant  to  carry  such  finding  and  order  into  effect.1 

CUSTODY  OUTSIDE  OF  HOSPITAL. — If  any  person  found  to 
be  insane  cannot  be  at  once  admitted  to  a  hospital  for  want 
of  room,  or  for  any  other  cause,  and  cannot  with  safety  be 
allowed  to  go  at  liberty,  the  commissioners  shall  provide  other- 
wise for  the  custody  of  such  patient  outside  of  the  hospital,  until 
the  occasion  therefor  no  longer  exists. 

DISCHARGE  FROM  HOSPITAL. — Upon  the  application  of 
the  relatives  or  friends  of  any  patient  in  the  hospital  who  is  not 
cured,  and  who  cannot  be  safely  allowed  to  go  at  liberty,  the 
commissioners  may  provide  for  the  care  of  such  patient  within 
the  county. 

Whenever  it  shall  be  shown  to  the  satisfaction  of  the  com- 
missioners that  cause  no  longer  exists  for  the  care  within  the 
county  of  any  particular  person  as  an  insane  patient,  they  shall 
order  the  immediate  discharge  of  such  person.2 

EXPENSES  OF  MAINTENANCE  AT  HOSPITAL. — The  county 
of  settlement  of  the  insane  person  is  liable  for  the  cost  and  ex- 
pense of  the  maintenance  of  such  patient  within  the  hospital.  Pa- 
tients in  the  hospital  having  no  local  settlement  within  the  State, 
or  whose  local  settlement  cannot  be  ascertained,  shall  be  sup- 
ported at  the  expense  of  the  State. 

All  patients  in  the  hospital  shall  be  regarded  as  standing  upon 
an  equal  footing,  and  the  several  patients  according  to  their  dif- 
ferent conditions  of  mind  and  body,  and  their  respective  needs, 

1  Iowa  Code,  8.  2,268-2,269;  Supp.,          2  Ibid.,  s.  2,271-2,277. 
s.  2,267,  2,270. 


STATUTES   OF  IOWA-  649 

shall  be  provided  for  and  treated  with  equal  care ;  but  if  the 
relatives  or  friends  of  any  patient  shall  desire  and  shall  pay 
the  expenses  therefor,  such  patient  may  have  special  care  and 
may  be  provided  with  a  special  attendant  as  may  be  agreed 
upon  with  the  superintendent.  In  such  case  the  charges  for 
such  special  care  and  attendance  shall  be  paid  quarterly  in 
advance.1 

DISCHARGED  WHEN  CUBED. —  Any  patient  who  is  cured 
shall  be  immediately  discharged  by  the  superintendent.  Upon 
such  discharge  the  superintendent  shall  furnish  the  patient,  unless 
otherwise  supplied,  with  the  suitable  clothing,  and  a  sum  of 
money  not  exceeding  twenty  dollars,  which  shall  be  charged 
with  the  other  expenses  in  the  hospital  to  such  patient.2 

VISITING  COMMITTEE. — The  governor  shall  appoint  a  visit- 
ing committee  of  three  to  visit  the  insane  asylums  of  the  State 
at  their  discretion,  and  without  giving  notice  of  their  intended 
visit.  They  may  go  through  the  wards  unaccompanied  by  any 
officer  of  the  institution,  may  send  for  persons  and  papers,  and 
examine  witnesses  on  oath  to  ascertain  whether  any  of  the 
inmates  are  improperly  detained  in  the  hospital  or  unjustly 
placed  there,  and  whether  they  are  kindly  treated,  with  full 
power  to  correct  any  abuses  found  to  exist.  They  may  dis- 
charge any  attendant  or  employee  who  has  been  guilty  of  inflict- 
ing any  injury  upon  the  inmates  of  the  hospital.3 

PRIVILEGES  OF  INMATES. — The  names  of  the  visiting  com- 
mittee and  their  post-office  address  shall  be  kept  posted  in  every 
ward  in  the  asylum,  and  every  inmate  in  the  asylum  shall  be 
allowed  to  write  once  a  week  to  this  committee,  and  any  mem- 
ber of  the  committee  neglecting  to  heed  the  call  of  the  patient 
to  him  for  protection,  when  proved  to  have  been  needed,  shall 
be  deemed  unfit  for  his  office  and  shall  be  removed  by  the 
governor. 

Every  person  confined  in  an  insane  asylum  shall  be  fur- 
nished by  the  superintendent,  or  party  having  charge  of  such 
person,  at  least  once  in  each  week,  with  suitable  materials  for 
writing  and  mailing  letters,  if  they  request  the  same,  unless 
otherwise  ordered  by  the  visiting  committee,  which  order  shall 
continue  in  force  until  countermanded  by  said  committee. 

1  Iowa  Code,  s.  2,281,  2,284-2,285;          2  Ibid.,  s.  2,288. 
Supp.,  s.  2,283.  3  Ibid.,  s.  2,299. 


650  INCOMPETENT   PERSONS — BROWN    AND   BECKER. 

The  superintendent  shall  receive,  if  requested  to  do  so  by 
the  person  so  confined,  at  least  one  letter  in  each  week,  addressed 
to  one  of  the  visiting  committee,  without  opening  or  reading 
the  same,  and  shall  without  delay  deposit  it  in  the  post-office  for 
transmittal  with  the  proper  postage-stamp  affixed  thereto ;  but 
all  other  letters  may  be  examined  by  the  superintendent,  and  if 
in  his  opinion  it  seems  proper  he  may  retain  the  same.1 

WRIT  OF  HABEAS  CORPUS. — All  persons  confined  as  insane 
shall  be  entitled  to  the  benefit  of  the  writ  of  habeas  corpus,  and 
the  question  of  insanity  shall  be  decided  at  the  hearing,  and  if 
the  judge  shall  decide  that  the  person  is  insane,  such  decision 
shall  be  no  bar  to  the  issuing  of  the  writ  a  second  time.2 

CRIMINAL  INSANE. — A  person  acquitted  on  the  ground  of 
insanity  may  be  committed.  ~No  person  shall  while  insane 
be  tried  or  sentenced.  An  inquest  shall  be  held  to  determine 
the  sanity  of  persons  convicted  of  a  capital  crime.  Proceed- 
ings may  be  held  before  trial  or  after  conviction  to  determine 
sanity.3 

KANSAS. 

[The  references  are  to  General  Statutes  of  Kansas,  1905.] 

Care  and  custody  of  the  person  and  property  of  idiots,  luna- 
tics, or  habitual  drunkards  is  vested  in  probate  court. 

INQUISITION  AS  TO  LUNACY. — Based  upon  information  to 
the  probate  court  that  the  person  is  an  idiot,  lunatic,  or  person 
of  unsound  mind,  or  habitual  drunkard,  and  incapable  of  manag- 
ing his  affairs.  If  satisfied  that  there  is  good  cause,  the  court 
shall  cause  the  facts  to  be  inquired  into  by  a  jury. 

The  court  shall  cause  the  person  to  be  given  reasonable  notice 
of  the  hearing. 

A  jury  of  six  persons  shall  be  empanelled  to  try  the  case. 
Person  alleged  to  be  insane  may  be  present  at  the  trial,  assisted 
by  counsel,  and  may  challenge  jurors.  If  he  has  no  counsel,  the 
court  shall  appoint  one. 

After  hearing  the  evidence  jury  to  render  verdict  in  writ- 
ing signed  by  them  embodying  the  substantial  facts  shown  by  the 
evidence  in  form  prescribed  by  statute.  If  it  be  found  that  the 

'Iowa  Code,  s.  2,300-2,302.  3  Ibid.,  s.  5,414,  5,436,  5,437,  5,540- 

2  Ibid.,  s.  2,306.  5,544,  4,736-4,738. 


STATUTES   OF   KANSAS.  G51 

person  is  incapable  of  managing  his  affairs  a  guardian  shall  be 
appointed  by  the  court  of  the  person  and  estate  of  such  person 
or  either.1 

COSTS. — If  the  person  is  found  insane  or  an  habitual  drunk- 
ard, costs  are  payable  out  of  his  estate,  or  if  that  be  insufficient 
by  the  county. 

If  the  person  be  discharged,  costs  shall  be  paid  by  the  person 
instituting  the  proceedings.2 

GUARDIAN. — Guardian  of  a  person  of  unsound  mind  or  a 
habitual  drunkard  shall  give  a  bond  approved  by  the  probate 
court  conditioned  for  the  proper  care  of  such  insane  person  or 
habitual  drunkard  and  the  proper  management  of  his  estate  and 
effects,  and  the  faithful  performance  of  all  matters  pertaining  to 
the  guardianship. 

The  court  may,  at  any  time,  require  the  guardian  to  give  a 
new  bond  or  additional  security  for  any  purpose. 

He  shall  take  charge  of  the  person  committed  to  his  charge 
and  provide  for  his  support  and  maintenance,  and  take  into  his 
possession  all  the  property  of  the  person. 

Within  thirty  days  after  his  appointment,  he  shall  make 
out  and  file  in  the  office  of  the  probate  court  a  true  inventory  of 
the  estate  of  his  ward,  containing  a  statement  of  the  income  and 
proceeds  thereof  and  the  debts,  credits,  and  effects.  Upon  the 
discovery  of  any  new  property,  he  shall  file  a  like  inventory. 
All  such  inventories  shall  be  verified  and  attested  by  three  ap- 
praisers. 

He  shall  prosecute  and  defend  all  actions  in  which  the  ward 
is  interested,  shall  collect  all  debts,  adjust  and  settle  all  demands 
due  or  becoming  due  from  his  ward.3 

SALE  OF  PROPERTY  OF  WARD. — The  property  of  the  ward 
may  be  mortgaged,  leased,  or  sold  upon  the  order  of  the  court,  for 
the  support  and  maintenance  of  the  ward's  family  and  the  edu- 
cation of  his  children. 

If  the  personal  property  of  the  insane  person  or  habitual 
drunkard  is  insufficient  for  the  payment  of  his  debts,  the  sup- 
port and  maintenance  of  his  family  and  himself,  and  the  educa- 
tion of  his  children,  the  guardian  shall  petition  the  probate 

1  Gen.  Stat.  of  Kan.,  c.  60,  s.  1-3,          *  Ibid.,  s.  4,  Stats.,  a.  4,151. 
Stats.,  s.  4,148-4,150.  '  Ibid.,  s.  6-9,  Stats.,  s.  4,153-4,156. 


652  INCOMPETENT   PERSONS — BROWN  AND  BECKER. 

court  praying  authority  to  mortgage,  lease,  or  sell  such  of  the 
real  estate  as  shall  be  necessary  to  supply  the  deficiency. 

If  it  appear  to  the  court  that  the  personal  estate  is  insuffi- 
cient, the  court  shall  make  an  order  directing  such  mortgage, 
lease,  or  sale.  Such  order  shall  contain  time  and  terms  of  sale, 
or  if  the  mortgage  or  lease  be  ordered  the  terms  of  such  mortgage 
or  lease,  and  the  manner  in  which  the  proceeds  shall  be  secured 
and  the  income  thereof  appropriated. 

Such  sale  shall  be  upon  notice  published  for  four  weeks. 
No  real  estate  shall  be  sold  at  private  sale  for  less  than  three- 
fourths  of  its  appraised  value. 

The  guardian  shall  sell  at  the  time  and  place  appointed  all 
such  lands  at  public  auction  to  the  highest  bidder  and  shall 
make  a  verified  report  of  the  proceedings  to  the  court,  which 
report  shall  also  state  that  the  guardian  did  not  directly  or  indi- 
rectly become  the  purchaser  of  the  property  sold  and  that  he 
was  in  no  wise  interested  in  the  purchase  thereof.  If  the  court 
approve  the  proceedings  a  deed  shall  be  executed  by  the  guardian 
to  the  purchaser. 

If  the  report  be  disapproved,  the  court  may  set  aside  the 
sale  and  order  all  moneys  paid  to  be  refunded.1 

EESTORATION  OF  PERSON  TO  SANITY.  — If  any  person  shall 
allege  in  writing,  verified  by  oath,  that  any  person  declared  in- 
sane or  a  habitual  drunkard  has  been  restored  to  his  right  mind 
or  to  temperate  habits,  the  court  by  which  the  proceedings  were 
had  shall  cause  the  facts  to  be  inquired  into  either  by  a  jury  or 
without  a  jury,  as  may  seem  proper. 

If  it  shall  be  found  that  such  person  has  been  restored,  the 
guardian  shall  be  discharged,  and  he  shall  immediately  settle 
his  accounts  and  restore  to  such  person  all  things  remaining  in 
his  hands  belonging  to  him.2 

TERMINATION  OF  GUARDIANSHIP. — In  case  of  the  death  of 
any  such  insane  person  or  habitual  drunkard,  the  power  of  the 
guardian  shall  cease  and  the  estate  shall  descend  and  be  distrib- 
uted in  the  same  manner  as  if  such  person  had  been  of  sound 
mind  and  temperate  habits,  and  the  guardian  shall  immediately 
settle  his  account  and  deliver  the  estate  and  effects. 

Guardian  may  be  removed  at  any  time  by  the  probate  court. 

'Gen.  Stat.  of  Kan. ,  c.  60,  s.  10-19,          2  Ibid.,  s.  26-27,  Stats.,  s.  4,173- 
Stats.,s.  4,157-4,166.  4,174. 


STATUTES   OF   KANSAS.  653 

When  removed,  guardian  shall  immediately  settle  his  accounts 
and  render  to  his  successor  the  estate  and  effects  of  his  ward.1 

CONFINEMENT  OF  INSANE  PERSON  IN  THE  STATE  INSANE 
ASYLUMS. — The  insane  hospitals  are  located  at  Topeka  and  Osa- 
watomie. 

The  definition  of  insane  persons  is  the  same  as  in  Illinois. 
Any  probate  judge  in  this  State  may  commit  an  insane  person  to 
the  State  insane  asylum.  The  practice  is  similar  to  that  of  Illi- 
nois. A  jury  of  four  may  be  demanded.2 

If  the  person  adjudged  insane  has  sufficient  means  for  his 
maintenance  and  that  of  his  family,  if  he  have  one,  the  court 
shall  order  his  guardian  to  pay  for  his  maintenance  out  of  the 
proceeds  of  the  estate  of  such  insane  person.  If  the  estate  be 
insufficient,  the  court  shall  deliver  to  the  board  of  county  com- 
missioners a  certificate  stating  such  facts,  and  thereupon  an 
order  shall  be  issued  for  the  payment  of  the  expenses  of  such 
maintenance  out  of  the  county  treasury. 

Private  patients  may  be  placed  in  the  asylum  at  private  ex- 
pense if  the  superintendent  can  conveniently  receive  them.  In 
such  cases,  the  superintendent  shall  be  presented  with  a  certifi- 
cate, signed  by  at  least  one  practising  physician,  and  also  a  cer- 
tificate of  the  probate  judge  of  the  proper  county  to  the  effect 
that  such  persons  are  insane. 

The  person  or  court  placing  a  patient  in  the  asylum  may  re- 
move him  at  any  time,  and  the  superintendent  may  discharge 
him  in  accordance  with  the  by-laws  of  the  asylum.  No  idiot  or 
person  laboring  under  any  infectious  or  contagious  disease  shall 
be  admitted  into  the  asylum. 

When  the  patient  is  ordered  discharged,  the  steward  of  the 
asylum  shall  immediately  notify  the  probate  judge.  In  case 
the  patient  is  discharged  not  restored,  he  shall  immediately 
issue  his  precept  to  the  guardian  of  such  person  to  remove  him 
from  the  asylum  at  the  expense  of  the  county  or  person  charged 
with  his  maintenance.  If  the  patient  is  not  removed  within 
thirty  days  after  discharged,  the  steward  shall  remove  him  at 
the  expense  of  the  county  or  person  charged  with  his  mainte- 
nance.3 Discharges  are  in  general  regulated  as  in  Illinois.4 

1  Gen.  Stat.  of  Kan.  ,s.  28-29  .State.,  'Ibid.,  c.  60,  s.  38-43,  Stats.,  a. 

s.  4,175-4,176,  4,185-4,190. 

3  Ibid.,  c.  99,  s.  493,  495,  497-503,  4  Ibid.,  c.  99,  s.  516-518,  Stats.,  s. 

Stats.,  s.  7,587,  7,589,  7,591-7,597.  7,610-7,612. 


654        INCOMPETENT  PERSONS — BROWN  AND  BECKER. 

KENTUCKY. 

[The  references  are  to  Kentucky  Statutes,  Russell,  1909.] 

CUSTODY  OF  PERSONS  AND  ESTATES  OF  IDIOTS  AND  LUNA- 
TICS.— Jurisdiction  vested  in  circuit  and  county  courts  of  the 
persons  and  estates  of  idiots,  lunatics,  or  those  who  from  con- 
firmed bodily  infirmity  are  unable  to  make  known  to  others 
by  speech,  sign,  or  otherwise  their  thoughts  or  desires,  and,  by 
reason  thereof,  incompetent  to  manage  their  estates,  or  those 
whose  minds  on  account  of  any  infirmity  or  weight  of  age  have 
become  so  imbecile  or  unsound  as  to  render  them  incompetent 
to  manage  their  estates.1 

SALE  OF  REAL  ESTATE. — Circuit  court,  upon  the  application 
of  the  committee,  may  order  the  sale  of  such  part  of  the  real 
estate  of  an  incompetent  person  as  is  necessary  for  the  mainte- 
nance of  such  person  and  his  family,  and  may  settle  and  dis- 
tribute the  estate  in  the  manner  provided  for  the  settlement  and 
distribution  of  the  estates  of  insolvent  decedents.2 

APPOINTMENT  OF  COMMITTEE. — Committee  not  to  be  ap- 
pointed before  the  inquest  of  a  jury  and  the  judgment  of  the 
circuit  or  county  court  declaring  the  persons  insane.3 

POWER  OF  COMMITTEE. — Power  and  duties  of  a  committee 
are  in  all  respects  the  same  as  those  of  the  guardian  of  an  infant, 
except  as  to  education.  But  the  court  may  appoint  a  person 
other  than  the  committee  to  take  charge  of  the  person,  idiot, 
lunatic,  or  incompetent  person  when  he  is  not  confined  in  the 
asylum.4 

CLAIMS  AGAINST  THE  ESTATE. — Claims  against  the  estate 
of  a  person  incompetent  to  manage  his  estate  shall  not  be  allowed 
or  paid  until  verified  and  proved  in  the  manner  prescribed  for 
the  proof  of  claims  against  the  estate  of  deceased  persons.5 

INQUEST,  How  HELD. — Inquest  to  inquire  into  the  question 
of  insanity  shall  be  held  only  in  the  circuit  court,  if  one  be  in 
session  at  the  time.  If  no  circuit  court  be  in  session,  the  in- 
quest may  be  held  by  any  judge  of  a  circuit  court  or  by  the 
presiding  county  judge.  No  order  shall  be  made  sending  the 
person  to  an  asylum  unless  the  jury  find  that  he  is  so  dangerous  or 

1  Ken.  Stats.,  a.  4,240.  « Ibid.,  s.  4,244. 

2  Ibid.,  s.  4,241.  B  Ibid.,  s.  4,245. 

3  Ibid.,  s.  4,242. 


STATUTES  OF  KENTUCKY.  655 

uncontrollable  that  he  cannot  safely  be  kept  by  a  committee  at 
home. 

No  inquest  shall  be  held,  unless  the  person  alleged  to  be  of 
unsound  mind  is  in  court  and  personally  in  the  presence  of  the 
jury.  Such  personal  presence  shall  only  be  dispensed  with  upon 
the  oath  of  two  regular  practising  physicians  that  they  have 
personally  examined  the  individual  charged  to  be  of  unsound 
mind,  and  that  they  verily  believe  him  to  be  an  idiot  or  lunatic 
or  incompetent  to  manage  his  affairs,  and  that  his  condition  is 
such  that  it  would  be  unsafe  to  bring  him  into  court. 

The  oath  prescribed  by  statute  shall  be  administered  to  the 
jury,  and  the  judge  shall  instruct  the  jury  so  as  to  enable  them 
to  decide  the  question  whether  the  defendant  is  an  idiot  or 
lunatic.  The  court  shall  appoint  an  attorney  for  him. 

If  on  the  return  of  the  verdict  the  court  is  satisfied  with  the 
inquest,  judgment  shall  be  entered  according  to  the  finding.  If 
a  judge  is  of  the  opinion  that  the  verdict  is  not  sustained  by 
evidence,  or  is  against  law,  he  shall  set  it  aside  and  award  a  new 
inquest. 

All  papers  pertaining  to  the  inquest  shall  be  delivered  to  the 
clerk  of  the  court  and  filed  by  him. 

Whenever  it  shall  appear  to  the  county  or  circuit  court, 
from  an  affidavit  filed,  that  the  insane  person  has  been  restored, 
or  that  the  inquest  was  false  or  fraudulent,  the  facts  shall  be 
inquired  into  by  jury  in  open  court  and  all  necessary  orders  and 
decrees  made  by  the  court.  If  the  lunatic  be  sent  to  an  asylum, 
the  judge  presiding  at  the  inquest  shall  ascertain  and  draw  up  a 
brief  history  of  the  patient's  case,  embracing  certain  points, 
which  shall  be  transmitted  with  a  record  of  the  inquest  to  the 
asylum. 

Inquests  shall  be  held  in  the  same  manner  every  fifth  year 
before  any  order  shall  be  granted  for  the  maintenance  of  an 
idiot,  out  of  his  own  estate  or  from  state  funds.1 

ASYLUM  FOR  THE  INSANE. — There  shall  be  for  each  asylum 
a  medical  superintendent,  and  a  first,  second,  and  third  assistant 
physician,  and  a  woman  physician,  each  of  whom  shall  be  skilful 
physicians,  and  a  steward.  These  officers  shall  reside  in  the 
asylum.  They  are  appointed  by  the  governor,  by  and  with  the 
advice  and  consent  of  the  senate. 

1  Ken.  Stats.,  a.  4,247-4,252,  4,259. 


656  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

The  medical  superintendent  shall  have  the  general  manage- 
ment, supervision,  and  control  of  the  patients,  subject  to  the 
regulation  of  the  board  of  commissioners,  and  shall  devote  his 
entire  time  thereto.  Mechanical  restraint  shall  not  be  applied 
in  any  case  without  express  direction  and  under  the  supervision 
of  one  of  the  physicians  in  charge  of  said  hospital,  nor  shall 
restraining  apparatus  be  kept  in  the  wards  when  not  in  use.1 

THE  BETURN  OF  IDIOTS  AND  HARMLESS  INCURABLE  LUNA- 
TICS.— All  pauper  idiots,  epileptics,  and  harmless  incurable 
lunatics  shall  be  returned  by  the  asylum  in  which  they  are  con- 
fined to  the  several  counties  from  whence  they  were  sent. 

The  president  of  the  board  of  commissioners,  or  the  super- 
intendent and  one  other  commissioner,  shall  act  as  a  commission 
to  pass  upon  such  case  as  the  superintendent  may  propose  to 
send  back.  They  shall  investigate  each  case  carefully,  and  if 
all  concur  that  the  inmate  can  be  safely  sent  back,  they  shall 
order  him  returned  to  the  county  from  whence  he  was  sent. 

The  cost  of  returning  pay  patients  shall  be  paid  by  their 
committee  or  relatives  willing  and  a.ble  to  pay,  and  the  cost  of 
returning  pauper  inmates  and  paying  inmates  where  the  money 
cannot  be  collected  from  the  committee,  shall  be  paid  by  the  au- 
ditor upon  the  certificate  of  the  superintendent.2 

LOUISIANA. 

[The  references  are  to  Constitution  and  Revised  Laws  of 
Louisiana,  Wolff,  1904.] 

STATE  ASYLUM. — The  asylum  for  the  insane,  located  in  the 
town  of  Jackson,  governed  by  a  board  of  administrators,  under 
the  name  and  style  of  the  "  Board  of  Administrators  of  the  In- 
sane Asylum  of  the  State  of  Louisiana. " 3 

ADMISSION  OF  LUNATICS  TO  ASYLUM. — Whenever  it  shall 
be  made  known  to  the  judge  of  the  district  or  parish  court  by 
the  petition  or  oath  of  any  individual,  that  any  lunatic  or  in- 
sane person  within  his  district  ought  to  be  sent  to  or  confined 
in  an  insane  asylum  in  this  State,  such  judge  shall  issue  a  war- 
rant .to  bring  such  lunatic  or  insane  person  before  him  and  if 
after  proper  inquiry  into  all  the  facts  and  circumstances  of  the 

1  Ken.  Stats.,  s.  4,213-4,219.  *  Louisiana     Statutes,     s.     1,760- 

2  Ibid.,  a.  4,223-4,224.  1,761. 


STATUTES  OF   MAINE.  657 

case,  he  deems  it  necessary  to  confine  such  person  in  the 
asylum,  he  shall  make  out  a  warrant  to  a  sheriff  of  the  parish 
commanding  him  to  convey  the  lunatic  or  insane  person  to  the 
insane  asylum.1 

EXAMINATION  BY  PHYSICIAN  OF  ASYLUM. — The  physician 
of  the  asylum  shall  professionally  examine  the  lunatic  or  insane 
person  sent  to  the  hospital  by  the  authority  of  the  district  or 
parish  judge,  and  if  in  his  opinion  said  person  is  only  feign- 
ing insanity,  being  a  person  charged  with  a  felonious  crime,  he 
shall  report  to  the  board,  who  shall  investigate  the  fact;  and 
if,  in  the  judgment  of  the  majority,  said  person  should  not  be 
admitted  as  an  inmate  of  the  asylum,  the  president  of  said  board 
shall  cause  such  person  feigning  insanity,  and  who  had  been 
previously  committed  to  prison  for  a  crime,  to  be  confined  in 
the  parish  jail,  and  shall  immediately  inform  the  president  of 
the  police  jury  of  the  parish,  or  the  proper  authority  in  the 
parish  of  Orleans  where  the  rejected  person  has  his  domicile, 
of  the  fact  and  the  reason  of  his  rejection.  The  provisions  of 
this  section  shall  also  apply  to  such  persons  charged  with  a 
crime  who  afterward  recover  and  become  sane  in  said  asylum.2 

MAINE. 

[The  references  are  to  Eevised  Statutesiof  Maine,  1903.] 
DEFINITION. — The  words  "insane  person"  may  include  an 
idiot,  non  compos,  lunatic,  or  distracted  person. 

GUARDIANS  OF  INSANE  AND  INCOMPETENT  PERSONS, 
SPENDTHRIFTS,  AND  CONVICTS. — The  judge  of  probate  may 
appoint  guardians  on  written  application  of  friends,  relatives,  or 
creditors,  or  of  the  municipal  officers  or  overseers  of  the  poor 
where  they  reside,  for — 

1.  Persons  insane  or  of   unsound  mind  who,  by    reason  of 
infirmity  or  mental  incapacity,  are  incompetent  to  manage  their 
own  estates  or  to  protect  their  rights. 

2.  Persons  who,  by  excessive  drinking,  gambling,  idleness, 
or  debauchery  of  any  kind  have  become  incapable  of  managing 
their  own  affairs  or  who  so  spend  or  waste  their  estate  as  to  ex- 
pose themselves  or  families  to  want  or  suffering  or  their  towns 
to  expense. 

'Louisiana  Statutes,  s.  1,768.  *lbid.,  a.  1,776. 

III.— 42 


658  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

Guardians  may  be  appointed  for  persons  committed  to  either 
insane  hospital  without  personal  notice  to  the  parties,  and  for 
insane  or  incompetent  married  women  after  personal  notice  and 
a  hearing  upon  proof  of  the  alleged  insanity  or  incompetency, 
without  inquisition  by  the  municipal  officers  of  the  town.  In 
all  cases  where  the  municipal  officers  or  overseers  of  the  poor 
are  applicants,  if  they  have  given  at  least  fourteen  days'  notice 
to  such  persons  by  serving  him  with  a  copy  of  their  application, 
the  judge  may  adjudicate  thereon,  without  further  inquisition, 
if  such  person  is  present,  or  on  such  further  notice,  if  any,  as 
he  thinks  reasonable. 

In  all  other  cases  the  judge  shall  hold  a  hearing  upon  notice, 
and  he  may  appoint  a  guardian. 

A  copy  of  the  application  and  the  order  of  the  court  thereon 
to  be  filed  in  the  registry  of  deeds  for  the  county. 

When  a  guardian  is  thus  appointed,  the  judge  shall  make 
an  allowance  from  the  ward's  estate  for  all  reasonable  expenses 
of  the  ward  in  defending  himself  against  the  complaint. 

Such  guardians  have  the  custody  of  the  person  of  their  ward, 
except  so  far  as  the  court  of  probate  may  from  time  to  time 
otherwise  order;  and  every  guardian  appointed  over  any  per- 
son for  gambling,  idleness,  drinking,  or  debauchery  shall  incul- 
cate upon  him  habits  of  sobriety  and  industry,  and  when  of 
sufficient  health  and  strength,  with  the  approbation  of  the 
judge,  may  bind  him  out  to  labor,  not  exceeding  six  months  at 
any  one  time,  or  employ  him  in  his  own  service.1 

POWERS  AND  DUTIES  OF  GUARDIANS. — For  the  bond  and 
the  duties  of  a  guardian  as  to  the  management  of  the  ward's  estate, 
and  the  powers  of  the  guardian  as  to  the  purchase  and  sale  of 
property  and  other  matters  pertaining  to  the  care  and  manage- 
ment of  the  property  of  the  ward,  see  Maine  Stats. ,  c.  69,  s.  10-26, 
relating  to  the  powers,  duties,  etc.,  of  guardians  of  minors. 

STATE  INSANE  HOSPITALS. — The  government  of  the  hospitals 
at  Augusta  and  Bangor  is  vested  in  a  committee  of  seven  trus- 
tees, one  of  whom  shall  be  a  woman.  Trustees  may  appoint  a 
superintendent  and  a  steward  and  treasurer  subject  to  the  ap- 
proval of  the  governor  and  council,  and  all  other  officers  neces- 
sary for  the  efficient  and  economic  management  of  the  business 
of  the  institution. 

'Maine  Stats.,  c.  69,  s.  4-9. 


STATUTES   OF   MAINE.  659 

There  shall  be,  monthly  by  two  of  the  trustees,  quarterly  by 
three,  and  aimually  by  a  majority  of  the  full  board,  a  thorough 
examination  of  the  hospital.  At  each  visit  a  written  account 
of  the  state  of  the  institution  shall  be  drawn  up  by  the  visitors, 
recorded  and  presented  at  the  annual  meeting  of  the  trustees, 
at  which  meeting  they  with  the  superintendent  shall  make  a 
particular  examination  into  the  condition  of  each  patient,  and 
discharge  any  one  so  far  restored  that  his  comfort  and  safety 
and  that  of  the  public  no  longer  requires  his  confinement.1 

DUTIES  OF  SUPERINTENDENT. — The  superintendent  shall 
be  a  physician,  reside  constantly  at  the  hospital,  have  general 
superintendence  of  the  hospital  and  grounds,  receive  all  pa- 
tients legally  sent  to  the  hospital,  unless  the  number  exceeds 
its  accommodations,  and  have  charge  of  them  and  the  direction 
of  all  persons  therein,  subject  to  the  regulation  of  the  board  of 
trustees. 

He  shall  apportion  the  number  of  patients  who  can  be  ac- 
commodated in  the  hospital  among  the  towns  according  to  their 
population  by  the  last  census ;  and  when  applications  for  admis- 
sion exceed,  or  are  liable  to  exceed,  that  number  of  patients,  he 
shall  give  preference  to  those  from  towns  that  have  not  their 
full  proportion  of  patients  in  the  hospital,  and  may  reject  others. 

When  a  person  has  been  unlawfully  committed,  the  super- 
intendent shall  report  the  case  to  the  trustees  at  their  next 
monthly  meeting,  and  they  may  cause  the  removal  of  such  per- 
son to  the  town  from  which  he  was  committed.  The  superin- 
tendent at  each  monthly  visit  of  the  trustees  shall  also  report 
to  them  the  name  of  any  inmate  who  was  idiotic  at  the  date  of 
his  commitment,  or  who  has  become  so  imbecile  as  in  his  judg- 
ment to  be  beyond  cure ;  and  if  he  thinks  that  such  inmate  may 
be  discharged  with  safety  to  himself  and  to  the  public,  the 
trustees  shall  order  his  discharge  and  cause  him  to  be  removed 
to  the  town  from  which  he  was  committed.2 

COMMITMENTS. — Parents  and  guardians  of  insane  minors  if 
of  sufficient  ability  to  support  them  at  a  State  hospital,  shall 
send  them  there  or  to  some  other  hospital  without  legal  exami- 
nation, within  thirty  days  from  the  attack.3 

As  to  other  insane  persons,  the  municipal  officers  of  towns, 

'Maine  Stats.,  c.  144,  s.  1-7.  *  Ibid.,  a.  15. 

2  Ibid.,  a.  8-14. 


6GO  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

constituting  a  board  of  examiners,  shall,  on  written  complaint 
of  any  blood  relative,  husband  or  wife  or  justice  of  the  peace, 
inquire  into  the  person's  condition.  Notice  shall  be  given  him, 
and  a  hearing  had.  If  the  board  think  him  insane  and  that  his 
comfort  and  safety  or  that  of  others  interested  will  be  promoted 
by  commitment,  they  may  send  him  to  either  of  the  State 
hospitals.1 

The  evidence  of  two  physicians  and  their  certificate  are  re- 
quired.2 

The  indigent  insane  are  partly  maintained  by  the  State.3 

If  the  municipal  officers  refuse  to  act  the  complaint  may  be 
made  to  two  justices  of  the  peace.4 

On  application  of  a  friend,  person,  or  town  liable  for  the  sup- 
port of  a  patient  who  has  been  confined  six  months,  any  person 
not  afflicted  with  homicidal  insanity  or  committed  by  the  supreme 
court  may  be  ordered  discharged  by  the  board  of  examiners.5 

When  the  overseers  of  the  town  are  notified  by  mail  by  the 
superintendent  that  a  person  supported  by  the  town  has  recov- 
ered, they  shall  cause  him  to  be  removed  to  their  town.6 

CRIMINAL  INSANE. — When  the  plea  of  insanity  is  made  or 
is  to  be  made,  a  justice  of  the  court  before  whom  the  prisoner  is 
to  be  tried  shall  order  such  person  into  the  care  of  the  superin- 
tendent of  either  insane  hospital;  to  be  detained  and  observed  by 
him  until  further  order  of  the  court,  that  the  truth  or  falsity  of 
the  plea  may  be  ascertained.7 

When  the  grand  jury  fails  to  indict,  or  the  trial  jury  ac- 
quits an  accused  because  of  insanity,  they  shall  state  that  fact, 
and  the  court  may  commit  him  to  the  insane  department  of  the 
State  prison  or  to  either  hospital.  He  shall  be  discharged  only 
on  proof  that  his  discharge  will  not  endanger  the  community, 
and  may  be  recommitted  by  the  supreme  court  if  again  found 
insane  and  dangerous.  His  support  is  at  his  own  expense,  if  he 
has  means,  otherwise  at  the  expense  of  the  State.8 

The  governor  appoints  in  each  county  a  physician  to  act  as 
examiner  of  insane  convicts  in  the  county  jail.  On  his  recom- 
mendation the  governor  and  council  may  remove  insane  convicts 
to  the  insane  department  of  the  State  prison  or  to  either  State 

'Maine  Stats.,  c.  144,  s.  16.  s  Ibid.,  s.  26. 

1  Ibid.,  s.  17.  •  Ibid.,  s.  27. 

1  Ibid.,  s.  18,  22-25.  7  Ibid.,  c.  138,  s.  1. 

4  Ibid.,  s.  19-21.  8  Ibid.,  &.  2-4. 


STATUTES   OF   MARYLAND.  601 

hospital.  Persons  insane  when  convicted  may  be  sentenced  to 
the  insane  department  of  the  State  prison,  if  the  crime  is  punish- 
able by  confinement  there;  otherwise  to  a  State  hospital.1 

After  the  expiration  of  a  term  of  sentence,  an  insane  convict 
may  be  removed  to  a  State  hospital.2 

MARYLAND. 

[The  references  are  to  Public  General  Laws  of  Maryland, 
Poe,  1903.] 

JURISDICTION  OF  COURTS  OF  EQUITY. — Courts  of  equity 
have  power  to  superintend  and  direct  the  affairs  of  persons  non 
compos  mentis  both  as  to  the  care  of  their  persons  and  the  man- 
agement of  their  estates;  and  may  appoint  a  committee  or 
trustee  for  such  persons  and  make  such  orders  and  decrees  re- 
specting their  persons  and  estates  as  to  the  court  may  seem 
proper.3 

SALE  OF  PROPERTY  OF  NON  COMPOS  MENTIS. — Property 
may  be  sold  on  application  of  any  creditor  if  the  court  is  satis- 
fied of  the  j  ustice  of  the  claim  and  there  is  no  other  means  of 
paying  the  claim.  The  court  may  upon  the  application  of  the 
guardian  decree  without  any  process  or  order  of  publication  the 
sale  of  property  and  order  the  money  arising  therefrom  to  be 
invested  as  the  court  may  deem  most  advantageous.  On  the 
death  of  such  non  compos  mentis  the  principal  sums  arising  from 
such  sale  shall  descend  to  the  persons  to  whom  the  property 
would  have  descended  if  the  same  had  not  been  sold. 

The  court  may  likewise  order  real  or  leasehold  property  to 
be  leased  for  any  term  of  years,  or  may  order  the  surrender  of 
any  lease. 

In  all  applications  to  sell  the  real  or  personal  property  of  such 
person,  if  the  court  shall  after  taking  proof  deem  it  for  the  inter- 
est and  advantage  of  such  person,  it  may  decree  a  sale,  lease,  or 
surrender  of  such  property  on  such  terms  and  conditions  as  the 
court  may  prescribe. 

No  sale,  lease,  or  surrender  shall  be  valid  unless  reported  to 
and  confirmed  by  the  court.4 

The  court  may  allow  to    the  committee    or    other  person 

1  Maine  Stats.,  c.  138,  s.  5,  7.  *  Maryland  Code,  art.  16,  s.  107. 

1  Ibid.,  s.  6,  8.  4  Ibid.,  a.  108-112. 


662  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

charged  with  the  care  of  the  person  or  estate  of  any  non  com 
pos  mentis,  a  sum  not  exceeding  ten  per  cent  of  the  income  or 
expenditures  for  the  care  and  trouble  of  such  trustee  or  person. 
The  court  may  decree  that  the  property  of  such  non  compos  men- 
tis be  sold  for  his  support,  or  for  the  payment  of  expenses  which 
the  trustee  may  have  incurred.1 

CONFINEMENT  OF  NON  COMPOS  MENTIS. — The  court  may 
on  the  application  of  any  trustee,  and  upon  receiving  proof  that 
it  is  necessary  and  proper  to  confine  such  person,  direct  such 
trustee  to  send  the  person  under  his  charge  to  any  hospital  in 
the  vicinity  of  the  city  of  Baltimore,  provided  he  can  be  there 
received,  to  remain  until  a  further  order  of  the  court.2 

DISCHARGE. — On  petition  of  the  person  to  have  the  commis- 
sion superseded  on  the  ground  of  recovery,  a  jury  trial  shall  be 
had.3 

INQUISITION  AS  TO  INSANE  PAUPER. — The  county  commis- 
sioners or  the  department  of  charities  of  Baltimore  upon  the 
written  certificate  of  two  physicians,  may  cause  an  insane 
pauper  to  be  sent  to  the  almshouse,  or  to  a  hospital.  A  county 
circuit  court  or  the  criminal  court  of  Baltimore,  when  any  person 
is  alleged  to  be  a  lunatic  or  insane  pauper,  shall  (when  the  same 
is  demanded  by  the  alleged  lunatic  or  any  of  his  relatives  or 
friends,  or  upon  the  notification  of  the  said  commissioners  or 
board  to  the  State's  attorney,  that  they  are  not  satisfied  that  the 
person  is  insane)  cause  a  jury  of  twelve  men  to  be  empanelled 
and  charge  the  jury  to  inquire  as  to  the  sanity  of  such  person, 
and  if  found  insane  the  court  shall  cause  such  person  to  be  sent 
to  the  almshouse  of  the  county  or  city  to  which  he  belongs,  or 
to  some  other  place  best  suited  in  the  judgment  of  the  court  to 
his  condition,  there  to  be  confined  at  the  expense  of  the  county 
or  city  until  he  shall  have  recovered  and  be  discharged.4 

CONFINEMENT  OF  LUNATIC  PAUPER. — The  county  com- 
missioners of  any  county  may  remove  from  the  almshouse  any 
lunatic  pauper  and  cause  him  to  be  sent  to  the  Maryland  hos- 
pital, and  levy  on  the  county  the  sum  necessary  to  defray  the 
expenses  incidental  to  the  removal  of  such  lunatic  and  his  main- 
tenance in  such  hospital.  Such  expenses  in  no  case  to  exceed 
the  sum  of  one  hundred  and  fifty  dollars  per  annum.5 

1  Maryland  Code,  art.  16,  s.  113-          3  Ibid.,  B.  116. 

114.  *  Ibid.,  art.  59,  s.  1. 

2  Ibid.,  B.  115.  •  Ibid.,  s.  2. 


STATUTES  OF   MARYLAND.  GG3 

WHO  DEEMED  A  LUNATIC  PAUPER. — No  person  shall  be 
deemed  a  lunatic  pauper  who  shall  possess  in  his  own  right  any 
property,  real  or  personal,  or  be  entitled  to  the  use  of  any 
property  by  last  will  and  testament,  or  deed  of  trust  for  his  use 
or  benefit.1 

LUNACY  COMMISSION.  — A  lunacy  commission  has  supervision 
over  all  institutions  in  which  insane  persons  are  detained.2 

If,  in  their  judgment,  any  person  confined  in  any  institution 
as  insane  be  not  insane,  the  commission  may  bring  the  matter 
to  the  attention  of  the  State's  attorney  of  any  county,  whose  duty 
it  shall  be  to  apply  to  the  proper  tribunal  for  a  writ  of  habeas 
corpus,  to  the  end  that  proper  inquiry  and  investigation  may  be 
had  at  once  as  to  the  mental  condition  of  such  person,  and  if  the 
court  shall  be  of  the  opinion  that  such  person  is  not  insane  then 
the  court  shall  discharge  such  person,  but  if  the  court  deter- 
mines that  such  person  is  insane  he  shall  be  returned  to  the 
institution. 

Free  access  to  all  institutions  shall  be  granted  to  the  mem- 
bers of  said  commission,  or  their  secretary,  and  the  officers  of 
such  institutions  shall  furnish  upon  request  all  necessary  infor- 
mation. The  lunacy  commission  may  issue  compulsory  proc- 
ess for  the  attendance  of  witnesses,  administer  oaths,  and 
examine  persons  under  oath.  The  managers  of  any  such  insti- 
tutions shall  have  the  right  to  appeal  from  the  determination  or 
action  of  said  commission.3 

No  asylum  for  the  care  or  custody  of  the  insane  to  be  kept 
without  a  license  from  said  commission.4 

No  person  shall  be  committed  to  or  confined  as  a  patient  in 
any  institution,  or  almshouse,  or  other  place  for  the  care  and 
custody  of  the  insane  or  idiotic,  except  upon  the  written  certifi- 
cate of  two  qualified  physicians,  made  within  one  week  after 
separate  examination  by  them  of  the  alleged  lunatic.  No  phys- 
ician connected  with  any  institution  shall  certify  to  the  insanity 
of  any  person  for  the  purpose  of  committing  such  person  to  such 
institution.5 

Persons  confined  in  such  places  to  be  furnished  with  writing 
material,  and  may  correspond  with  some  person  chosen  by  them- 
selves without  restriction.6 

1  Maryland  Code,  art.  59,  a.  3.  •  Ibid.,  s.  28. 

9  Ibid.,  s.  12.  •  Ibid.,  s.  31-32. 

3  Ibid.,  s.  20-27.  •  Ibid.,  8.  35-36. 


664  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

Any  person  may  voluntarily  commit  himself  to  an  aslyuin 
for  a  period  not  exceeding  three  months.  If  at  the  end  of  that 
time  he  is  unfit  to  be  discharged,  the  lunacy  commission  shall 
be  notified  and  shall  examine  the  case,  and  may  authorize 
further  treatment.1 

CRIMINAL  INSANE. — When  insanity  is  interposed  as  a  de- 
fense the  trial  jury  shall  ascertain  also  whether  the  accused  still 
is  insane.  If  so  found  he  may  be  committed.  The  insanity  of 
accused  persons  is  tried  by  a  special  jury  of  twelve.  If  com- 
mitted and  he  has  an  estate,  it  may  be  applied  to  his  support.2 

MASSACHUSETTS. 

[The  references  are  to  Eevised  Laws  of  Massachusetts,  1902, 
Supplement,  1906.] 

Jurisdiction  over  the  person  and  estate  of  insane  person 
vested  in  the  Probate  Court. 

DEFINITION. — The  words  "insane  person"  and  "lunatic" 
shall  include  every  idiot,  non  compos,  lunatic,  and  insane  and 
distracted  person.3 

GUARDIANS. — The  probate  court  may  appoint  a  guardian 
of  the  person  and  estate  of  an  insane  person  or  one  incompetent 
by  reason  of  advanced  age  or  mental  weakness,  upon  the  applica- 
tion of  the  relatives  or  friends,  or  the  mayor  and  aldermen  or 
selectmen  of  the  city  or  town,  upon  fourteen  days'  notice  of  the 
time  and  place  appointed  for  the  hearing,  to  be  given  to  the  al- 
leged insane  person. 

Guardians  of  spendthrifts  and  habitual  drunkards  may  be 
appointed  in  the  same  way  and  upon  the  same  notice  by  pro- 
bate courts. 

The  guardian  of  an  insane  person  or  spendthrift  shall  have 
the  care  and  custody  of  the  person  of  his  ward,  and  the  manage- 
ment of  all  his  estate ;  shall  give  a  bond  in  the  manner  pre- 
scribed for  guardians  of  minors. 

A  guardian  may  be  discharged  by  the  probate  court  on  the 
application  of  the  ward  or  otherwise,  when  it  appears  that  the 
guardianship  is  no  longer  necessary.4 

1  Maryland  Code,  art.  59,  s.  37.  4  Ibid., c.  145,  s.  6-11, 40  (asamend- 

2  Ibid.,  s.  4-9.  ed,  Supp.  p.  780). 
8  Mass.  Rev.  Laws,  c.  8,  s.  5,  subd.  6. 


STATUTES   OF   MASSACHUSETTS.  665 

POWERS  AND  DUTIES  OF  GUARDIANS.— Powers  and  duties 
of  guardians  for  insane  persons  and  habitual  drunkards  are  the 
same  as  those  prescribed  for  the  guardians  of  minors.1 

COMMITMENT  OF  INSANE  PERSON. — Either  judge  of  probate 
for  Suffolk  County,  the  judge  of  probate  for  Nantucket  County, 
or  a  justice  of  a  police,  district,  or  municipal  court,  except  the 
municipal  court  of  Boston,  may  commit  any  insane  person  to 
either  of  the  State  lunatic  hospitals. 

No  person  to  be  committed  without  a  certificate  of  two  phys- 
icians and  an  order  signed  by  one  of  the  judges.  Such  order  or 
certificate  to  state  that  the  person  is  insane  and  is  a  fit  person  for 
treatment.  The  judge  shall  see  and  examine  the  person  alleged 
to  be  insane,  or  state  in  his  final  order  why  it  was  not  deemed 
necessary  or  advisable  to  do  so.  The  physicians  examining  must 
make  oath  that  they  are  graduates,  etc.  They  must  not  be  con- 
nected with  any  hospital  or  establishment  for  the  treatment  of 
the  insane  to  which  the  person  may  be  committed.  Each  must 
personally  examine  the  person  alleged  to  be  insane  within  five 
days  of  signing  the  certificate,  and  each  shall  certify  that  in  his 
opinion  the  person  is  insane  and  a  proper  subject  for  treatment. 
A  copy  of  the  certificate  attested  by  the  judge  shall  be  delivered 
by  the  officer  making  the  commitment  to  the  superintendent  of 
the  hospital  where  the  person  is  committed.2 

Application  for  commitment  of  insane  person  to  be  accom- 
panied by  a  statement  containing  facts  as  to  the  condition  of  the 
person  alleged  to  be  insane.  Relatives  and  two  friends  to  be 
notified  of  commitment.8 

The  judge  upon  hearing  the  evidence  may  issue  his  warrant 
for  the  apprehension  and  bringing  before  him  of  the  alleged 
lunatic,  if,  in  his  judgment,  the  condition  or  conduct  of  such  per- 
son renders  it  necessary  or  proper  to  do  so.4 

INQUISITION. — The  judge  may  summon  a  jury  of  six  lawful 
men  to  hear  and  determine  whether  the  alleged  lunatic  is  insane. 

The  jury  shall  be  selected  as  the  judge  shall  direct. 

The  judge  shall  preside  at  such  trial,  and  administer  to  the 
jury  an  oath  faithfully  and  impartially  to  try  the  issue,  and  the 
verdict  of  the  jury  shall  be  final  on  the  complaint.5 

'Mass.  Rev.  Laws,  c.  145,  a.  25-27,          *  Ibid.,  s.  39. 
29-31.  4  Ibid.,  s.  41. 

2  Ibid.,    c.    87,    s.    33-35.     As    to          •  Ibid.,  a.  42-47. 
necessity    of    notice,    see    Dowdell, 
Petitioner.  169  Mass.,  387. 


G66  INCOMPETENT   PERSONS— BROWN   AND    BECKER. 

STATE  BOARD  OF  INSANITY. — Consists  of  five  persons,  at 
least  two  experts  in  insanity,  appointed  by  the  governor.  The 
board  shall  appoint  an  executive  officer,  agents,  etc.,  who  may 
execute  its  powers.  It  shall  make  an  annual  report  to  the  gov- 
ernor and  council.  The  board  shall  encourage  and  publish  the 
results  of  scientific  investigations  by  the  hospital  staffs.  It  has 
general  supervision  of  the  State  colony  for  the  insane,  the  State 
hospitals  and  asylums  for  the  insane,  and  all  private  institutions, 
the  Massachusetts  Hospital  for  Epileptics,  the  hospital  for  dip- 
somaniacs and  inebriates  (Foxborough  State  Hospital),  the 
Massachusetts  school  for  the  feeble-minded,  and  the  hospital 
cottages  for  children.  It  shall  have  power  to  investigate  the 
condition  of  all  persons  in  the  State  who  are  in  custody  as 
insane. 

The  State  has  the  care,  control,  and  treatment  of  all  in- 
sane persons ;  except  that  the  city  of  Boston  may  establish  an 
asylum.1 

STATE  COLONY  FOR  THE  INSANE  AND  STATE  HOSPITALS.— 
The  colony  occupies  a  tract  of  land  in  the  towns  of  Westminster 
and  Gardner.  The  hospitals  are  the  Worcester,  Taunton,  Dan- 
vers,  and  Westborough  Insane  Hospitals,  the  Northampton  State 
Hospital,  the  Foxborough  State  Hospital  (for  dipsomaniacs  and 
inebriates),  the  Medfield  Insane  Asylum,  and  the  Massachusetts 
Hospital  for  Epileptics.  They  are  governed  by  boards  of  trus- 
tees, consisting  of  seven  members,  five  men,  and  (except  in  the 
case  of  Foxborough  State  Hospital)  two  women.  The  trustees 
appoint  a  superintendent,  assistant  physicians,  and  a  treasurer. 

The  State  is  divided  into  districts,  from  which  the  insane  are 
committed  to  the  specified  hospital. 

Voluntary  patients  may  be  received  at  any  hospital  for  the 
insane,  and  may  leave  at  will.2 

CARE  OF  CHRONIC  INSANE  IN  PRIVATE  FAMILIES. — The 
chronic  insane  of  a  quiet  class  may  be  boarded  in  families,  if 
deemed  expedient,  by  the  State  Board  of  Insanity.  The  cost  of 
boarding  such  insane  person  shall  be  paid  from  the  appropriation 
for  the  support  of  State  paupers  in  lunatic  hospitals ;  but  the 
rate  paid  shall  not  exceed  $3. 25  a  week.  It  shall  be  the  duty  of 
the  board  to  visit  by  an  agent  at  least  once  in  three  months  all 
such  insane  persons  boarded  in  families  at  the  expense  of  the 
lMass.  Rev.  Laws,  c.  87,  s.  1-12.  2  Ibid.,  Supp.,  s.  13-32,  53-54. 


STATUTES   OP   MASSACHUSETTS.  667 

State ;  and  all  insane  persons  boarded  at  the  expense  of  other 
institutions,  at  least  once  in  six  months.1 

COMMITMENT  OF  HABITUAL  DRUNKARDS  OR  DIPSOMANIACS 
TO  STATE  LUNATIC  HOSPITALS. — Person  suffering  from  dipso- 
mania or  habitual  drunkenness  may  be  committed  to  the  State 
Foxborough  Hospital  upon  satisfactory  evidence  furnished  to 
the  judge  before  whom  the  proceedings  for  commitment  are  had, 
that  such  person  is  not  of  bad  repute  or  of  bad  character  apart 
from  his  habits  of  inebriety.  Laws  relative  to  persons  committed 
on  the  ground  of  insanity  apply  to  persons  committed  under  the 
provisions  of  this  act.  They  may  be  detained  for  two  years. 
Voluntary  patients  are  admitted  and  may  depart  at  will.2 

DISCHARGE  OF  INMATES  OF  HOSPITALS.  —Two  of  the  trus- 
tees of  any  of  the  State  lunatic  hospitals  or  a  justice  of  the  su- 
preme judicial  court,  or  a  judge  of  probate,  or,  in  the  case  of 
hospitals  other  than  insane  hospitals,  the  State  Board  of  Insanity, 
may  discharge  there  from  any  inmate  there  of  committed  as  an 
insane  person,  upon  such  notice  as  they  may  deem  proper.  The 
superintendents  may  be  given  like  authority  by  the  trustees. 

Said  superintendent  may,  when  advisable,  permit  any  such 
inmate  to  leave  the  hospital  for  a  period  not  exceeding  six 
months  and  receive  him  when  returned  without  any  further  order 
of  commitment.3 

COUNTY  EECEPTACLES.  —In  each  county  a  place  shall  be  pro- 
vided, within  the  precincts  of  the  house  of  correction,  for  the 
confinement  of  insane  persons  not  furiously  mad.4 

PRIVATE  ASYLUMS. — Must  be  licensed  by  the  Board.5 

CRIMINAL  INSANE. — Persons  under  indictment,  found  by  the 
court  to  be  insane,  and  to  require  observation,  or  under  impris- 
onment and  becoming  insane,  may  be  removed  to  a  State  hos- 
pital. If  a  person  is  acquitted  by  reason  of  insanity,  the  jury 
shall  so  state,  and  if  the  court  is  satisfied  that  he  is  insane  he 
may  be  committed.  In  the  case  of  a  person  indicted  for  murder 
or  manslaughter  so  acquitted  he  shall  be  committed  for  life, 
but  the  governor,  the  council  consenting,  may  discharge  him. 
Vicious  persons  of  the  above  classes  may  be  committed  or  trans- 
ferred by  the  court  to  the  State  asylum  for  insane  criminals.6 

1  Mass.  Rev.  Laws  and Supp., c.  87,          4  Ibid.,  s.  106-108. 
B.  102-105.  •  Ibid.,  s.  111-112. 

2  Ibid.,  s.  59-65a.  •  7Wrf.,c.219,s.  11-12, 15-17, c.  220, 
» Ibid.,  B.  91-95.                                     a.  41-42,  c.  225,  s.  101-102. 


668          INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

MARRIAGE. — An  insane  person  or  an  idiot  shall  not  be 
capable  of  contracting  marriage ;  the  validity  of  a  marriage  shall 
not  be  questioned  by  reason  of  idiocy  or  insanity  collaterally,  but 
only  in  a  process  instituted  in  the  lifetime  of  both  parties  to  test 
such  validity.1 

MICHIGAN. 

[The  references  are  to  Compiled  Laws  of  Michigan,  1897.] 

The  words  "insane  person  "  shall  be  construed  to  include  an 
idiot,  a  non  compos,  lunatic,  and  distracted  person.  As  used  in 
the  act  relating  to  commitments,  they  include  every  species  of 
derangement,  except  idiocy.2 

GUARDIAN. — The  judge  of  probate  may  appoint  a  guardian 
for  an  insane  person  or  any  person  mentally  incompetent  to  have 
the  charge  and  management  of  his  property,  upon  the  appli- 
cation of  relatives  or  friends  of  such  person,  or  if  such  person 
is  a  county  charge,  upon  the  application  of  the  directors  of  the 
poor.  Notice  shall  be  given  such  person  not  less  than  fourteen 
days  before  the  time  appointed  for  the  hearing. 

If  the  judge  finds  that  the  person  in  question  is  incapable 
of  taking  care  of  himself  and  managing  his  property,  he  shall 
appoint  a  guardian.  Pending  the  application  for  the  appoint- 
ment of  a  general  guardian,  a  special  guardian  may  be  ap- 
pointed who  shall  hold  office  until  the  question  of  appointment 
of  a  general  guardian  be  decided,  or  until  he  shall  be  discharged 
by  the  judge  of  probate.3 

POWERS  AND  DUTIES  OF  GUARDIAN. — Such  guardian  shall 
have  the  care  and  custody  of  the  person  and  management  of  the 
estate  of  the  ward.  He  shall  give  a  bond  to  the  judge  of  pro- 
bate in  the  manner  and  form  prescribed  for  the  guardian  of  a 
minor.4 

GUARDIAN  FOR  SPENDTHRIFT. — When  any  person,  by  ex- 
cessive drinking,  gaming,  idleness,  or  debauchery  of  any  kind, 
shall  so  waste  his  estate  as  to  expose  himself  or  his  family  to 
want  or  suffering  or  the  county  to  charge  or  expense,  any 
superintendent  of  the  poor  of  the  county,  or  director  of  the  poor, 
or  a  justice  of  the  peace  in  which  such  spendthrift  resides, 

'Mass.  Rev.  Laws  and   Supp.,  c.          3  Ibid.,  s.  8,709,  8,7M),  p.  2.683. 
151,  s.  5.  4  Ibid.,  s.  8,711,  p.  2^684. 

2  Michigan  Comp.  Laws,  a.  50,  subd. 
7,  p.  163;  s.  1,940,  p.  670. 


STATUTES   OP   MICHIGAN.  669 

may  present  a  complaint  to  the  judge  of  probate  setting  forth 
the  facts  and  circumstances  of  the  case,  and  praying  for  the  ap- 
pointment of  a  guardian. 

Notice  shall  be  given  to  such  supposed  spendthrift  of  the 
time  and  place  of  hearing,  not  less  than  fourteen  days  before  the 
time  appointed ;  but  if,  after  a  full  hearing,  it  appears  to  the 
court  that  the  facts  of  the  complaint  are  true,  he  shall  appoint 
a  guardian  of  his  person  and  estate.1 

POWERS  AND  DUTIES  OF  GUARDIAN  OF  SPENDTHRIFT.— 
Such  guardian  shall  have  the  care  and  custody  of  the  person 
and  the  management  of  the  estate  of  the  ward,  and  shall  give  a 
bond  in  the  manner  prescribed  in  respect  to  the  guardian  of  an 
insane  person.2 

IN  GENERAL. — Every  guardian  whether  of  an  insane  per- 
son or  a  spendthrift  shall  be  under  the  direction  and  control  of 
the  probate  court  and  shall  have  the  same  powers  as  to  the  es- 
tate of  the  ward  as  the  guardian  of  a  minor.3 

As  to  the  appointment  of  guardians  for  drunkards  and  in- 
temperate persons,  it  is  prescribed  that  the  guardian  may  be  ap- 
pointed for  such  a  person  upon  the  petition  of  the  husband  or 
wife,  or  some  relative  by  blood,  of  the  person  for  whom  the 
guardian  is  asked. 

In  such  proceedings,  the  probate  judge  may  take  the  testi- 
mony of  witnesses  and  examine  the  respondent,  and  shall  deter- 
mine whether  such  guardian  should  be  appointed.4 

CONFINEMENT  OF  THE  INSANE. — When  a  person  in  indigent 
circumstances,  and  not  a  pauper,  becomes  insane,  an  application 
may  be  made  to  the  judge  of  probate  of  the  county  where  he 
resides,  and  the  judge  shall  immediately  notify  such  alleged 
insane  person  of  the  time  and  place  of  hearing.  He  shall  call 
two  legally  qualified  physicians  and  other  credible  witnesses, 
whose  duty  it  shall  be  to  attend  and  act  in  such  case.  Such 
judge  shall  fully  investigate  the  facts,  and,  either  with  or  with- 
out the  verdict  of  the  jury,  determine  the  question  of  insanity 
and  the  question  of  his  indigence.  If  the  judge  certifies  that 
such  person  is  in  indigent  circumstances  and  his  estate  is  in- 
sufficient to  support  him  and  his  family,  he  shall  be  admitted 

'Michigan  Comp.  Laws,  s.  8,712,          »  Ibid.,  s.   8,717,  8,735,  p.  2,685- 
8.713,  p.  2,684.  2,688. 

2  Ibid. ,s.  8,711,  p.  2,684.  «  Ibid.,  a.    8,739-8,743,  p.  2,689- 

2.690. 


670          INCOMPETENT   PERSONS — BROWN  AND  BECKER. 

into  the  asylum  and  supported  there  at  the  expense  of  the  county 
to  which  he  belongs,  or  if  he  has  no  legal  settlement,  at  the  ex- 
pense of  the  State.  Relatives  liable  to  support  him  may  be  com- 
pelled to  do  so. 

If  an  insane  person  in  indigent  circumstances  shall  have 
been  maintained  by  his  friends  in  the  asylum  as  a  private 
patient  for  three  months,  and  the  superintendent  shall  certify 
that  he  is  insane  and  requires  further  treatment,  the  judge  may 
without  further  evidence  of  the  insanity,  and  if  the  indigence  be 
established,  make  a  certificate  authorizing  the  admission  of 
said  patient  into  the  asylum  as  a  county  charge  or  State  charge 
as  provided  above.1 

QUALIFICATIONS  OF  PHYSICIANS  CERTIFYING  TO  INSANITY. 
—Physician  must  be  of  reputable  character,  a  graduate  of 
some  incorporated  medical  college,  a  permanent  resident  of  the 
State,  not  related  to  the  alleged  insane  person  nor  to  the  person 
applying  for  the  certificate,  and  shall  have  been  in  the  actual 
practice  of  his  profession  for  at  least  three  years.2 

ADMISSION  OF  PRIVATE  PATIENTS  TO  ASYLUMS. — No  pri- 
vate patient  shall  be  admitted  to  any  insane  asylum  except 
upon  the  certificate  of  two  reputable  physicians  under  oath,  ap- 
pointed by  the  judge  of  probate  of  the  county  where  such  per- 
son resides,  to  conduct  an  examination,  and  upon  an  order  from 
said  judge,  setting  forth  that  such  person  is  insane  and  direct- 
ing his  removal  to  an  asylum  or  institution  for  the  care  of  the 
insane.3 

INQUEST. — The  judge  may  institute  an  inquest  and  take 
proofs  as  to  the  alleged  insanity  before  granting  such  order. 
He  may  in  his  discretion  or  on  the  demand  of  the  person  call  a 
jury  of  twelve  persons  to  determine  the  question  of  sanity.  If 
satisfactory  evidence  is  adduced  showing  the  alleged  insane  per- 
son to  be  of  unsound  mind,  he  shall  grant  an  order  for  the  re- 
moval of  such  insane  person  to  such  institution,  there  to  be  sup- 
ported as  a  private  patient.4 

PROCEEDINGS  FOR  THE  COMMITMENT  OF  PAUPER  INSANE. 
—If  any  person  being  a  pauper  shall  become  insane,  the  county 
superintendent  of  the  poor  or  any  supervisor  of  any  city  or  town 

'Michigan  Comp.  Laws,  a.  1,915-          3  Ibid.,  a.  1,913,  p.  655. 
1,917,  p.  661-662.  4  Ibid.,  a.  1,913. 

2  Ibid.,  a.  1,914,  p.  657. 


STATUTES  OF  MINNESOTA.  671 

may  make  application  to  the  probate  judge,  who  shall  proceed 
to  inquire  into  the  question  of  the  insanity  of  said  person. 

He  may  call  upon  and  compel  the  attendance  of  one  or  more 
legally  qualified  physicians  and  such  other  witnesses  as  he  may 
deem  necessary,  and  if  satisfied  of  the  insanity  of  such  person  he 
shall  make  the  same  certificate  and  order  for  admission  into  the 
insane  asylum  as  is  provided  in  the  case  of  persons  in  indigent 
circumstances.1 

MAINTENANCE  OF  INSANE. — The  cost  of  the  maintenance  in 
the  asylum  of  any  indigent  or  pauper  patient,  received  upon  the 
order  of  any  court  or  officer,  shall  be  paid  by  the  county  from 
which  he  was  sent  to  the  asylum,  except  of  those  termed  "State 
patients. " 2 

MINNESOTA. 

[The  references  are  to  Revised  Laws  of  Minnesota,  1905.] 

COMMITMENT  OF  INSANE  PERSONS. — Warrant  may  issue 
from  the  probate  judge  or  court  commissioner  of  any  county, 
upon  sworn  information  showing  that  there  is  an  insane  person 
in  the  county  needing  care  and  treatment,  and  that  it  is  danger- 
ous for  him  to  be  at  large,  to  apprehend  such  person. 

Upon  the  filing  of  such  information,  the  court  shall  make 
an  order  directed  to  two  reputable  persons,  one  at  least  of  whom 
shall  be  a  duly  qualified  physician,  and  such  persons  with  the 
judge  shall  constitute  a  jury  to  examine  the  person  alleged  to  be 
insane,  and  they  shall  ascertain  the  fact  of  sanity  or  insanity. 

Each  of  such  persons  shall  be  sworn  to  examine  the  patient 
impartially  and  to  the  best  of  his  ability.  The  probate  court 
may  summon  such  witnesses  as  are  necessary.  The  county  attor- 
ney shall  have  notice  and  appear  for  the  accused. 

Certain  questions  which  are  prescribed  by  statute  shall  be 
asked  iu  the  examination. 

Upon  the  completion  of  such  examination,  the  jury  shall  re- 
port their  findings  in  writing.  Such  findings  shall  be  that  the 
person  is  sane,  or  insane,  and  a  fit  subject  for  hospital  treatment. 

If  such  person  is  found  to  be  insane,  he  may  be  committed 
by  order  of  the  judge  to  one  of  the  hospitals  for  the  insane,  pub- 
lic or  private. 

'Michigan  Comp.  Laws,  s.   1,919,          » Ibid.,  s.  1,921,  p.  663-664. 
p.  663. 


672  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

If  the  person  committed  is  a  female,  she  shall  be  accompanied 
to  the  hospital  by  a  woman  or  by  her  husband.1 

GUARDIANS  OF  INCOMPETENTS. — The  probate  court  may 
appoint  a  guardian  or  guardians  of  any  person  who,  by  reason 
of  old  age  or  loss  or  imperfection  of  mental  faculties,  is  incom- 
petent to  have  the  charge  or  management  of  his  property,  or 
a  person  who,  by  excessive  drinking,  gaming,  idleness,  or  de- 
bauchery, so  spends  or  wastes  his  estate  as  to  be  likely  to  ex- 
pose himself  or  his  family  to  want  or  suffering,  either  upon  the 
application  of  the  county  commissioners  of  the  county  where 
such  person  resides  or  upon  the  petition  of  any  relative  or  friend 
of  such  person ;  which  petition  shall  set  forth  the  facts  and  be 
verified  by  the  affidavit  of  the  petitioner  to  the  effect  that  he  be- 
lieves the  facts  as  so  stated  are  true.  Upon  the  presentation  of 
the  application,  the  probate  court  shall  fix  a  time  for  a  hearing 
and  shall  cause  a  notice  to  be  given  to  the  person  proposed  to  be 
put  under  guardianship,  at  least  fourteen  days  prior  to  the  time 
fixed  for  the  hearing. 

All  competent  evidence  shall  be  considered  at  the  hearing, 
and  if  it  appear  that  the  person  is  such  an  incompetent,  the 
court  shall  appoint  a  guardian  or  two  guardians  of  his  person 
and  estate. 

POWERS  AND  DUTIES  OF  GUARDIAN. — Every  guardian  so 
appointed  shall  have  the  care  and  custody  of  the  person  of  his 
ward  and  the  management  of  all  his  estate  until  such  guardian 
is  discharged.  The  provisions  relating  to  the  bond  of  guardians 
of  minors  as  prescribed  in  section  3,833,  apply  to  guardians  of  in- 
competents.2 

RESTORATION  TO  CAPACITY. — The  fact  of  the  restoration  of 
an  incompetent  person  shall  be  judicially  determined  upon  the 
application  of  such  insane  person  or  his  guardian,  relative,  or 
friend. 

Notice  shall  be  given  of  a  hearing  to  the  guardian  of  the 
person.  On  the  hearing  the  guardian,  relative,  or  friend  may 
contest  the  right  to  the  relief  demanded.  Witnesses  may  be 
summoned  and  examined  by  the  court  of  its  own  motion.  If 

'Minnesota Stats., s. 3,851-3,860, as  Blaisdell  v.  Billings,  57   N.W.,  794; 

amended  chap.  119, Gen.  Lawsof  1895,  55  Minn.,  467. 

and  chaps.   47,  85,  341,  Gen.  Laws          2  Minn.  Stats.,  s.  3,826-3,830, 3,833, 

of  1905,  to  meet  objections  to  con-  3,841. 
stitutionality  raised  in  State  ex  rel. 


STATUTES   OF    MINNESOTA.  673 

it  be  found  that  the  person  be  of  sound  mind  and  capable  of  tak- 
ing care  of  himself  and  property,  his  restoration  to  capacity 
shall  be  adjudged  and  the  guardianship  shall  cease.1 

HOSPITALS  FOB  THE  INSANE  AND  COMMITMENT  THERETO. 
—"Insane"  is  defined  as  including  every  species  of  insanity 
except  idiocy  or  imbecility.2  The  three  State  hospitals  (one 
homeopathic)  and  two  State  asylums  are  under  the  charge  of  a 
State  Board  of  Control  and  Charities  composed  of  three  members 
appointed  by  the  governor,  by  and  with  the  advice  and  consent 
of  the  senate. 

The  Board  has  the  general  control  of  the  State  institutions 
and  may  make  all  by-laws  necessary  for  the  government  of  the 
same,  appoint  for  each  hospital  a  medical  superintendent,  fix  all 
salaries  not  otherwise  determined  by  law,  and  remove  all  officers 
appointed  by  them,  except  the  superintendent,  who  shall  only 
be  removed  for  good  cause  shown. 

He  shall  give  immediate  notice  to  the  next  of  kin  of  each 
patient  under  his  charge  of  the  death,  serious  illness,  or  any 
special  change  in  the  condition  of  such  patient,  and  answer 
promptly  and  fully  all  letters  of  inquiry  received  from  the  rela- 
tive of  any  patient  in  said  hospital.3 

ADMISSION  TO  HOSPITAL. — Only  insane  persons,  legal  resi- 
dents of  the  State,  recommended  for  commitment  as  prescribed 
by  law  may  be  admitted  and  maintained  at  one  of  the  State 
hospitals  at  public  expense.4 

ARRESTS  OF  INSANE  PERSONS. — No  alleged  insane  person 
shall  be  arrested  except  to  prevent  his  doing  harm  and  until  an 
adjudication  may  be  obtained.5 

PRIVILEGES  OF  INSANE  IN  HOSPITAL. — Every  inmate  com- 
mitted to  any  hospital  for  the  insane,  upon  entering  the  institu- 
tion, may  choose  as  a  correspondent  an  individual  not  connected 
with  the  institution,  with  whom  he  shall  be  allowed  to  communi- 
cate freely  without  censorship.  Each  inmate  may  choose  a  new 
correspondent  every  three  months.  The  superintendent  shall 
keep  registered  and  posted  in  some  public  place  at  the  institu- 
tion the  name  and  post-office  address  of  each  correspondent  and 
the  name  of  the  inmate  choosing  such  correspondent.  When 

1  Minn.  Stats.,  a.  3,831.  '  Ibid.,  s.  1,898. 

1  Ibid.,  s.  3,851,  5,514  (7).  '  Ibid.,  s.  4,906  (6),  4,941. 

3  Ibid.,  s.  1,861,  1,915-1,926,  1,865, 
1,866,  1,871. 

III.— 43 


674  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

any  person  is  chosen  as  a  correspondent,  the  superintendent 
shall  notify  him  within  three  days  that  he  has  been  chosen  and 
inquire  whether  he  will  act.  Each  inmate  of  any  hospital  may 
communicate  in  writing  with  the  governor  and  the  board  of  con- 
trol, in  the  same  manner  as  with  the  correspondent.  Every  vio- 
lation of  the  above  shall  be  a  misdemeanor.1 

CRIMINAL  INSANE. — The  provisions  as  to  responsibility  are 
substantially  the  same  as  in  the  New  York  Penal  Code.2 

Persons  accused  or  convicted  of  crime  and  found  insane  may 
be  committed  by  the  judge.3 

MISSISSIPPI. 

[The  references  are  to  Mississippi  Code  of  1906.] 

WRIT  DE  LUNATICO  INQUIRENDO. — The  chancery  courts 
have  jurisdiction  of  writs  of  lunacy,  to  be  exercised  by  the 
clerks  at  any  time  subject  to  the  approval  of  the  court.  Any 
relative  of  a  lunatic  or  insane  person  may  procure  him  to  be 
so  adjudged.  If  the  relatives  or  friends  of  any  insane  person 
allow  him  to  go  at  large,  the  clerk  of  the  chancery  court  may, 
upon  application  of  any  citizen,  direct  the  sheriff  by  v/rit  of 
lunacy  to  summon  the  alleged  lunatic  or  insane  person  to  con- 
test the  application,  and  six  freeholders  to  make  inquiry  thereof. 
If  the  person  shall  be  adjudged  insane  by  the  jury,  the  clerk 
shall  direct  the  sheriff  by  writ  to  arrest  him  and  place  him  in 
one  of  the  asylums,  if  there  be  a  vacancy,  and  if  not  to  confine 
him  in  the  county  jail  until  there  be  room  in  the  asylum. 

If  the  person  be  adjudged  harmless  and  indigent  and  not  in 
need  of  special  treatment,  he  shall  be  sent  to  the  poorhouse.4 

ADMISSION  INTO  ASYLUMS. —The  superintendent  of  each 
asylum  shall  admit  and  receive  therein  all  persons  ordered  to 
be  confined  therein  in  the  order  of  application,  if  there  be  a 
vacancy  in  the  asylum.  The  expenses  of  the  inquiry  and  of  the 
removal  to  and  from  the  asylum  shall  be  borne  by  the  estate  of 
the  lunatic,  if  he  have  any,  and  if  not  by  the  person  required 
by  the  pauper  laws  to  support  him — but  in  the  first  instance  the 
expenses  are  to  be  paid  by  the  county.5 

LUNATIC  ASYLUMS. — The  control  and  management  of  the 

1  Minn.  Stats.,  s.  1,918-1,919.  held  constitutional,  Fant  v.  Buchan- 

2  Ibid.,  s.  4,754-4,756.  an,  17  So.,  371. 

'  Ibid.,  s.  5,375-5.376.  s  Ibid.,  s.  3,222-3,224. 

4  Miss.  Code,  s.   532,  3,219-3,221; 


STATUTES    OF   MISSISSIPPI.  675 

asylums  for  the  insane  is  vested  in  a  board  of  five  trustees  ap- 
pointed by  the  governor,  with  the  advice  and  consent  of  the 
senate,  who  have  charge  of  the  interests  of  the  asylum,  and 
manage  and  direct  its  affairs,  and  make  all  proper  by-laws  and 
regulations  for  its  control  and  government.  The  trustees  are 
required  to  make  regular  and  frequent  inspection  of  the  asylum, 
for  which  purpose  one  or  more  of  them  shall  visit  the  asylums 
at  least  once  in  every  month.  Superintendents  of  the  asylums 
are  appointed  by  the  governor,  and  are  required  to  be  skilful 
physicians.  The  superintendent  has  the  supervision  of  the 
buildings,  with  their  furniture,  fixtures,  and  stock,  and  the  di- 
rection and  control  of  all  persons  and  officers  therein.  The 
white  and  colored  races  are  kept  separate  in  the  asylums.1 

GUARDIANS. — The  chancery  court  may  appoint  guardians 
of  persons  adjudged,  upon  inquisition,  to  be  of  unsound  mind, 
upon  its  own  motion  or  on  the  application  of  a  relative  or  friend 
or  of  a  member  of  the  board  of  supervisors.  If  the  person  has 
not  been  adjudged  insane,  the  writ  de  luuatico  inquirendo  shall 
issue  upon  any  such  application,  and  if  upon  such  inqui- 
sition the  person  be  adjudged  of  unsound  mind  and  incapable  of 
taking  care  of  himself  or  property,  the  court  may  appoint  a 
guardian.  The  chancery  court  may  also  appoint  guardians  for 
drunkards  and  opium-eaters  on  the  application  of  a  relative  or 
friend.  In  such  case  the  court  shall  examine  the  question  and 
determine  whether  the  person  be  an  habitual  drunkard  or  opiuiu- 
or  morphine-eater,  and  for  that  purpose  may  summon  and  hear 
witnesses  and  hear  the  parties  and  their  evidence,  and  if  the 
court  be  satisfied  that  the  person  is  an  habitual  drunkard, 
opium- or  morphine-eater,  it  shall  appoint  a  guardian  of  his  per- 
son and  estate.  The  court  of  chancery  may  direct  the  confine- 
ment of  any  person  adjudged  an  habitual  drunkard  or  an  hab- 
itual opium-  or  morphine-eater  in  an  asylum. 

POWERS  AND  DUTIES  OF  GUARDIANS. — Guardians  shall 
make  an  inventory  of  the  estate  and  account  with  the  court  as 
often  and  in  the  same  manner  as  guardians  of  minors  are  re- 
quired to  return  inventories  and  account.  Guardians  shall  im- 
prove the  estate  committed  to  their  charge  and  apply  so  much  of 
the  income  as  may  be  necessary  to  the  comfortable  maintenance 
and  support  of  the  ward  and  his  household  or  family,  sue  for 

1  Miss.  Code,  a.  3,187-3,197,3,211-3,217. 


676     INCOMPETENT  PERSONS — BROWN  AND  BECKER. 

and  collect  debts  due  the  ward,  and  on  order  of  the  court  may 
sell  the  real  estate  to  pay  indebtedness.1 

CRIMINAL  INSANE. — Persons  charged  with  crime  and  not 
prosecuted  on  account  of  present  insanity  must  be  reported  to 
the  chancery  court  in  order  that  an  inquisition  may  be  held; 
but  persons  acquitted  of  crime  on  the  ground  of  insanity  and 
certified  by  the  jury  to  be  still  insane  and  dangerous  shall  be 
forthwith  committed  to  a  State  asylum.2 

MISSOURI. 

[The  references  are  to  Missouri  Annotated  Statutes,  1906.] 

INQUIRY  AS  TO  INSANITY. — If  information  in  writing  be 
given  to  the  probate  court  that  any  person  in  its  county  is  an 
idiot,  lunatic,  or  a  person  of  unsound  mind  and  incapable  of  man- 
aging his  affairs,  and  praying  that  an  inquiry  thereinto  be  had, 
the  court,  if  satisfied  that  there  is  good  cause  for  the  exercise  of 
its  jurisdiction,  shall  cause  the  facts  to  be  inquired  into  by  a 
jury.  Provided,  that  the  probate  court  shall  not  have  juris- 
diction to  inquire  into  the  insanity  of  any  person  who  is  the 
owner  of  no  property.  The  alleged  insane  person  must  be  noti- 
fied of  the  proceeding  unless  such  person  is  ordered  to  be  brought 
before  the  court,  or  notice  is  dispensed  with  for  cause  spread  on 
the  record.  Any  judge  of  the  county  court,  or  justice  of  the 
peace,  sheriff,  coroner,  or  constable  may  make  application  to 
the  probate  court  for  the  exercise  of  its  jurisdiction.3 

APPOINTMENT  OF  GUARDIAN. — If  the  person  be  found  by 
the  jury  of  unsound  mind  and  incapable  of  managing  his  affairs 
the  court  shall  appoint  a  guardian  of  his  person  and  estate.  If 
the  lunatic  be  a  public  officer  his  office  shall  be  deemed  vacant. 
Every  guardian  so  appointed  is  required  to  give  a  bond  for  the 
due  and  proper  care  of  such  person  and  the  management  of  his 
estate  to  the  best  advantage.  The  court  may  provide  for  the 
restraint  and  keeping  of  the  ward  and  family. 

Every  such  guardian  shall  take  charge  of  the  person  and 
provide  for  his  support  and  maintenance.  He  shall  collect  and 
take  into  his  possession  all  the  personal  property  and  within 
sixty  days  after  his  appointment  file  a  just  and  true  inventory 
of  the  real  and  personal  estate  of  his  ward.  An  additional  in- 

1  Miss.  Code,  s.  2,430-2,438.  J  Missouri  Statutes,  s.  3,650-3,653. 

1  Ibid.,  a.  1,538-1.540. 


STATUTES   OF   MISSOURI.  677 

ventory  may  be  required  from  time  to  time  whenever  any  property 
belonging  to  such  estate  shall  be  discovered,  and  all  such  inven- 
tories shall  be  attested  and  verified.  The  guardian  has  the  usual 
powers  to  sue,  to  collect  or  pay  debts,  etc. 

The  real  estate  may  be  sold  on  the  petition  of  the  guardian 
when  the  personal  property  is  insufficient  for  the  discharge  of  the 
debts  and  the  maintenance  of  the  ward  and  his  family.  Every 
such  sale  shall  be  made  under  the  direction  of  the  probate  court.1 

Contracts  may  be  made  by  the  ward  with  the  consent  of  the 
guardian ;  without  such  consent  they  are  void.2 

CONFINEMENT  OF  THE  INSANE. — If  any  person  shall  be 
furiously  mad,  or  so  far  disordered  in  his  mind  as  to  endanger 
his  own  person  or  the  person  or  property  of  others,  it  shall  be 
the  duty  of  the  guardian  or  other  person  under  whose  care  he 
may  be,  and  who  is  bound  to  provide  for  his  support,  to  con- 
fine him  until  the  next  sitting  of  the  probate  court,  which  shall 
make  such  order  for  the  restraint,  support,  and  safe-keeping 
of  such  person  as  the  circumstances  of  the  case  shall  require. 
If  such  person  shall  not  be  confined  by  the  person  having  charge 
of  him,  or  if  there  be  no  person  having  such  charge,  any  judge 
of  the  court  of  record  or  any  two  justices  of  the  peace  may  cause 
such  insane  person  to  be  apprehended,  pending  an  inquisition. 

If  any  insane  person  be  admitted  to  the  State  lunatic  asylums 
as  a  patient,  the  guardian  shall  pay  for  his  support  and  expense 
at  such  asylum  out  of  the  estate  of  such  ward.  If  such  insane 
person  comes  under  the  class  of  insane  poor  persons,  such  person 
shall  be  supported  and  maintained  by  the  county  in  the  manner 
provided  by  law. 

The  above  sections  relate  to  idiots,  lunatics,  and  persons  of 
unsound  mind  and  incapable  of  managing  their  affairs.* 

INSANE  ASYLUMS. — The  asylums  are  under  the  general  con- 
trol of  the  State  Board  of  Charities  and  Corrections,  and  boards 
of  managers.  They  are  intended  for  every  species  of  insanity  or 
mental  derangement.  The  managers  appoint  the  superintendent, 
assistants,  etc. 

The  superintendent  of  each  asylum  shall  be  a  physician  of 
knowledge,  skill,  and  ability  in  his  profession  and  of  experience 
in  the  management  and  treatment  of  the  insane.  He  shall  not 

'  Missouri  Statutes,  s.  3,654-3,660,          »  Ibid.,  s.  3,682. 
3,071-3,680,  3,684.  »  Ibid.,  s.  3,694-3,697,  3,702. 


078  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

while  superintendent  engage  in  the  practice  of  his  profession,  but 
shall  devote  himself  exclusively  to  the  supervision  and  care  of 
the  asylum  and  its  inmates. 

He  shall  be  the  chief  executive  officer  of  the  asylum  and  have 
the  care  and  control  of  everything  connected  therewith.1 

ADMISSION  INTO  ASYLUM. — Persons  afflicted  with  any  form 
of  insanity  may  be  admitted  into  the  asylum,  and  any  patient 
may  be  discharged  by  the  superintendent  whenever  he  may  be- 
lieve that  the  reason  of  such  patient  is  restored.  The  superin- 
tendent may  parole  patients.  Paying  patients  not  sent  to  the 
asylum  by  order  of  the  court  may  be  admitted  in  accordance 
with  the  statutes  and  the  by-laws  of  the  asylum. 

The  several  county  courts  may  send  to  the  asylum  such  of 
their  insane  poor  as  may  be  entitled  to  admission  thereto.  The 
counties  thus  sending  shall  pay  semi-aunually  in  cash,  in  advance, 
such  sums  for  the  support  and  maintenance  of  their  insane  poor 
as  the  board  of  managers  may  deem  necessary.  The  indigent 
insane  of  the  State  always  have  the  preference  over  those  who 
have  the  ability  to  pay  for  their  support  in  the  asylum,  and  if 
there  be  no  provision  in  the  asylum  for  the  accommodation  of 
all  the  insane  persons  in  the  State,  recent  cases  of  insanity — 
meaning  cases  of  less  than  one  year's  standing — shall  have  the 
preference  over  cases  of  more  than  one  year's  standing.2 

CRIMINAL  INSANE. — A  person  indicted  for  crime  deemed  in- 
sane may  be  committed  pending  recovery  after  an  inquisition  by 
jury.3  When  an  accused  is  acquitted  on  account  of  insanity 
found  by  the  jury  to  still  continue,  he  shall  be  sent  to  an  asylum.4 

Insanity  of  convicts  is  determinable  by  the  governor ;  of  one 
sentenced  to  death  by  a  jury.5 

MONTANA. 

[The  references  are  to  Montana  Codes,  Annotated,  1895.] 
JURISDICTION. — The  care  and  custody  of  the  property  and 

person  of  insane  and  other  incompetent  persons  is  vested  in  the 

district  court  (of  probate). 

APPOINTMENT  OF   GUARDIAN. — Upon  the  verified  petition 

1  Missouri  Statutes,  s.  5,059,  4,894,  4  Ibid.,  s.  4,885,  4,886;  cf.  s.  2,605, 
4,849-4.855.  2,606. 

2  Ibid.,  s.  4,856-4,869.  5  Ibid., s. 2,666-2,669,  4,889, 4,889a. 

3  Ibid.,  s.  2,603-2.606. 


STATUTES  OF  MONTANA.  679 

of  a  relative  or  friend  that  the  person  is  insane  or  mentally  in- 
competent to  manage  his  property,  the  judge  must  give  notice 
to  the  alleged  incompetent  person  of  the  time  and  place  of  hear- 
ing the  case,  not  less  than  five  days  before  the  time  so  appointed, 
and  such  person,  if  able,  must  be  in  attendance  before  him  on 
the  hearing. 

If,  after  a  full  hearing  and  examination,  it  appears  to  the 
judge  that  the  person  is  incapable  of  taking  care  of  himself  and 
managing  his  property,  he  must  appoint  a  guardian  of  his  person 
and  estate. 

Every  such  guardian  has  the  care  and  custody  of  the  person 
of  his  ward,  and  the  management  of  all  his  estate,  until  he  is 
legally  discharged.  He  must  give  a  bond  to  such  ward  in  the 
manner  prescribed  to  the  guardian  of  a  minor. 

Every  such  guardian  has  all  the  usual  powers  and  duties  as 
specified  in  the  act  relating  to  guardians  in  general.1 

KESTORATION  OF  INSANE  PERSON. — Any  person  declared 
insane,  or  his  guardian  or  any  relative  within  the  third  degree, 
or  any  friend,  may  petition  the  district  court  to  have  the  fact  of 
his  restoration  to  capacity  judicially  determined.  Upon  receiving 
the  petition,  the  judge  shall  appoint  a  day  for  the  hearing,  and 
upon  the  petitioner's  request,  order  an  investigation  before  the 
jury,  which  shall  be  summoned  and  empanelled  in  the  same 
manner  as  juries  in  civil  actions.  A  notice  shall  be  given  to  the 
guardian,  husband,  or  wife,  if  there  be  one,  or  father  or  mother 
if  living  in  the  county.  On  the  trial  any  person,  in  the  discre- 
tion of  the  judge,  may  contest  the  right  and  the  relief  demanded. 
Witnesses  may  be  subpoenaed  and  examined  as  in  other  cases. 
If  it  be  found  that  the  insane  person  be  of  sound  mind  and 
capable  of  taking  care  of  himself  and  his  property,  his  restora- 
tion shall  be  adjudged  and  the  guardianship  shall  cease.2 

COMMISSIONERS  OF  THE  INSANE. — The  governor,  secretary 
of  state,  and  attorney -general  constitute  the  State  Board  of 
Commissioners  of  the  Insane. 

Such  commissioners  have  power  to  provide  by  contract  for 
the  proper  custody,  maintenance,  and  treatment  of  the  insane  in 
what  is  to  be  called  the  State  asylum. 

The  board  is  authorized  to  contract  for  the  care  and  mainte- 

1  Montana  Code  of  Civil  Procedure,          *  Ibid.,  a.  2,973. 
s.  2,970-2,988. 


680  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

nance  of  the  indigent  insane,  letting  the  contract  to  the  lowest 
bidder. 

The  commissoners  have  power  to  control,  inspect,  and  pro- 
vide rules  for  the  State  asylum. 

The  contract  made  shall  require  the  person  entering  into  it  to 
provide  suitable  apartments  for  the  safe-keeping  of  the  insane, 
and  to  furnish  all  attendance  and  treatment.  The  contractor  is 
required  to  give  bond. 

Patients  may  also  be  sent  to  friends  or  institutions  outside  of 
the  State. 

The  above  provisions  apply  to  idiots.1 

EXAMINATION  AND  COMMITMENT. — Any  magistrate  of  the 
county  may,  upon  the  verified  application  of  any  person  setting 
forth  that  a  person  endangers  health,  person,  or  property  by 
reason  of  mental  derangement,  cause  such  person  to  be  brought 
before  the  district  judge.  Such  judge  shall  summon  two  wit- 
nesses best  acquainted  with  the  person,  and  shall  also  summon 
two  graduates  in  medicine,  who  shall  examine  ttie  person  and 
also  hear  the  testimony.  If  the  physicians  certify  the  person  to 
be  insane,  and  the  judge  is  of  the  opinion  that  he  endangers 
health,  person,  or  property  by  reason  of  mental  derangement,  he 
shall  be  sent  to  the  State  asylum.2 

CORRESPONDENTS  OF  INMATE  OF  ASYLUM. — Every  inmate 
of  any  insane  asylum  is  allowed  to  choose  one  individual  to  whom 
he  may  write  whenever  he  desires,  and  over  these  letters  there  is 
to  be  no  censorship  exercised  by  any  of  the  asylum  officials. 
They  are  to  be  furnished  with  writing  materials,  and  all  such 
letters  shall  be  dropped  in  the  post-office  box  by  the  writers,  ac- 
companied by  the  attendant,  when  necessary. 

A  true  copy  of  the  name  of  every  individual  chosen  as  the 
inmate's  correspondent,  and  by  whom  chosen,  shall  be  registered 
and  posted  in  some  public  place  in  the  insane  asylum.3 

CRIMINAL  INSANE. — A  special  jury  may  be  called  to  deter- 
mine the  sanity  of  any  person  whose  case  is  called  for  trial  or 
during  the  trial,  or  after  conviction.  If  he  be  found  insane  he 
shall  be  committed  to  the  State  asylum.  The  accused  has  the 
affirmative  of  the  issue. 4 

1  Montana  Political  Code,  s.  2,260-          *  Ibid.,  B.  2,285-2,289. 
2,269.  2,280-2,284.  *  Penal  Code,  s.  2,521-2,526. 

2  Ibid.,  a.  2.300-2,311. 


STATUTES  OP  NEBRASKA.  681 

The  present  insanity  of  one  acquitted  on  the  ground  of  insanity 
shall  be  tried  by  a  special  jury.1 

NEBRASKA. 

[The  references  are  to  Cobbey's  Annotated  Statutes  of 
Nebraska,  1903,  Supplement,  1905,  and  to  Brown  and  Wheeler's 
Compiled  Statutes,  1907.  Both  editions  are  authorized.] 

DEFINITIONS. — The  term  "insane"  includes  every  species  of 
insanity  or  mental  derangement.  The  term  "  idiot "  is  restricted 
to  persons  supposed  to  be  naturally  without  mind. 

Idiots  are  not  kept  in  the  State  asylums,  but  maintained  the 
same  as  other  poor.2 

GUARDIANS. — The  probate  court  may  appoint  a  guardian 
for  an  insane  or  incompetent  person,  from  age  or  otherwise,  upon 
the  application  of  relatives  or  friends  of  such  person  and  after 
a  notice  given  to  the  supposed  insane  person  of  the  time  and 
place  of  hearirig,  not  less  than  fourteen  days.3 

If,  after  a  hearing,  the  court  determine  that  such  person  is 
incapable  of  managing  his  property  or  taking  care  of  himself, 
he  shall  appoint  a  guardian.  Such  guardian  shall  have  the  care 
and  custody  of  the  person  and  the  management  of  all  of  the  es- 
tate of  his  ward.  Upon  a  like  application,  a  guardian  may  be 
appointed  for  a  spendthrift  after  due  notice  and  a  full  hearing. 

The  powers  and  duties  of  guardians  as  to  the  management  of 
the  estates  of  their  wards  are  similar  in  all  respects  to  those  of 
guardians  of  minors.4 

INSANE  ASYLUMS. — The  insane  asylum  located  at  Lincoln 
known  as  the  Nebraska  Hospital  for  the  Insane  is  under  the 
charge  of  three  trustees,  who  have  the  general  control  and  man- 
agement of  the  hospital,  with  full  power  to  make  all  by-laws 
necessary  for  its  government.  It  is  the  duty  of  a  majority  of  the 
board  to  visit  the  hospital  quarterly. 

The  governor  shall  appoint  a  superintendent,  who  may  ap- 
point two  assistant  physicians  for  the  hospital  of  the  insane,  one 
of  whom  shall  be  a  woman,  whose  term  of  office  shall  be  six 
years,  and  who  may  be  removed  at  any  time  by  the  governor. 

1  Penal  Code,  s.  2,159.  J  B.  and  W.,  s.  3,691,  Cobbey,  B. 

1  B.  and  W.,  s.  3,844,  Cobbey,  s.      5,384. 

9,643.  4  B.  and  W.,  s.  3, 692-3,698, Cobbey, 

s.  5,385-5,391. 


682  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

The  superintendent  shall  be  a  physician  of  acknowledged 
skill  and  ability  and  a  graduate  of  a  regular  medical  college. 
He  is  the  chief  executive  officer  of  the  hospital,  and  holds  his 
office  for  a  term  of  six  years.  He  has  the  entire  control  of  the 
medical,  moral,  and  dietetic  treatment  of  the  patients,  and  shall 
see  that  the  several  officers  of  the  institution  faithfully  and  dili- 
gently discharge  their  respective  duties.1 

There  are  also  an  insane  hospital  at  Norfolk,  and  the  asylum 
for  the  incurable  insane  at  Hastings.  They  are  under  the  control 
of  the  board  of  public  lauds  and  buildings.  Officers  are  ap- 
pointed by  the  governor.2 

COUNTY  COMMISSIONERS  OF  INSANITY. — There  is  in  each 
county  a  board  of  commissioners,  consisting  of  three  persons, 
styled  the  commissioners  of  insanity.  The  clerk  of  the  district 
court  is  ex  officio  a  member  of  the  board,  and  the  clerk  of  the 
same.  The  other  members  are  appointed  by  the  judge  of  the 
district  court,  one  of  whom  shall  be  a  respectable  practising 
physician,  and  the  other  a  respectable  practising  lawyer.  Such 
commissioners  have  cognizance  of  all  applications  for  admission 
into  the  State  hospital  or  for  the  safe -keeping  otherwise  of  insane 
persons,  within  their  respective  counties.  Also,  of  persons  ad- 
dicted to  the  use  of  narcotics.3 

ADMISSION  INTO  THE  HOSPITAL.  — Application  for  admission 
to  the  State  hospital  must  be  made  in  writing  in  the  nature  of  an 
information  verified  by  affidavit,  stating  that  the  person  in  whose 
behalf  the  application  is  made  is  believed  by  the  informant  to 
be  insane  and  a  fit  subject  for  custody  and  treatment  in  the  hos- 
pital. 

On  the  filing  of  such  information,  the  commissioners  of  in- 
sanity shall  investigate  the  grounds  of  the  information.  For  this 
purpose  they  may  require  the  person  alleged  to  be  insane  to  be 
brought  before  them  and  provide  them  with  suitable  custody, 
until  their  investigation  shall  be  concluded.  They  shall  hear 
the  testimony  for  and  against  such  application  if  any  is  offered. 
The  commissioners  shall  appoint  some  regular  practising  physi- 
cian of  the  county  to  visit  or  see  such  person  and  make  a  personal 
examination  touching  the  truth  of  the  allegations  in  the  informa- 

1  B.  and  W.,  s.  3,794-3,807,Cobbey,    3  B.  and  W.,  s.  3,808-3,811,Cobbey, 
s:  9,590-9,605.  s.  9,606-9,609;  Cobbey,  Supp.,  s. 

2  B.  and  W.,  s.  3,852-3,854, Cobbey,  9,650a-9,650h. 
s.  9,651-9,656. 


STATUTES   OF   NEVADA.  683 

tion.  Such  physician  shall  certify  that  he  has  in  pursuance  of 
his  appointment  made  a  careful  personal  examination,  and  on 
such  examination  he  finds  the  person  in  question  insane  if  such 
be  the  fact. 

On  the  return  of  the  physician's  certificate  the  commissioners 
shall  conclude  their  investigations,  and  having  done  so,  shall  find 
whether  the  person  alleged  to  be  insane  is  insane,  and  if  insane, 
whether  a  fit  subject  for  treatment  and  custody  in  the  hospital. 
If  they  find  such  person  insane  and  a  fit  subject  for  custody  and 
treatment  in  the  hospital,  they  shall  issue  their  warrant  stating 
such  finding,  authorizing  the  superintendent  of  the  hospital  to 
receive  such  person  as  a  patient  therein.  Such  warrant  and  a 
duplicate  with  finding  and  certificate  of  the  physician  shall  be 
delivered  to  the  sheriff  of  the  county,  who  shall  execute  the  same 
by  conveying  such  person  to  the  hospital  and  delivering  him 
with  such  duplicate  and  physician's  certificate  and  finding  to  the 
superintendent. l 

DISCHARGES. — Discharges  are  under  the  control  of  the  super- 
intendent. The  writ  of  habeas  corpus  is  available  to  secure  dis- 
charge.2 

NEVADA. 

[The  references  are  to  Compiled  Laws  of  Nevada,  Cutting, 
1900.] 

JURISDICTION. — The  district  courts  have  jurisdiction  over  the 
person  and  estates  of  idiots  and  insane  persons.3 

COMMITMENT.  — Upon  the  application  under  oath  of  any  per- 
son that  any  indigent  person  is  dangerously  insane  or  mentally 
deranged,  or  that  any  bona  fide  resident  for  five  years  is  an  idiot 
or  feeble-minded,  the  district  judge  shall  cause  such  person  to 
be  brought  before  him,  and  summon  witnesses;  and  also  summon 
one  or  more  graduates  of  medicine  to  appear  and  examine  the 
person,  and  if  after  such  examination  and  a  careful  hearing  they 
certify  on  oath  that  the  indigent  person  is  insane,  or  idiotic  or 
feeble-minded,  and  if  the  district  judge  be  satisfied  of  the  exist- 
ence of  insanity  and  that  it  would  be  dangerous  for  such  insane 
person  to  be  at  large,  or  that  the  person  is  an  idiot  or  feeble- 

1  B.  and  W.,s.  3,812-3,814, Cobbey,          »  B.  and  W.,  s.  3 ,833, 3, 831,  Cobbey, 
s.  9,610-9,612.  s.  9,631 ,  9,629. 

3  Nevada  Compiled  Laws,  a.  2,520. 


684  INCOMPETENT   PERSONS— BROWN   AND   BECKER. 

minded,  he  shall  direct  such  person  to  be  conveyed  to  the  State 
insane  asylum.1 

APPOINTMENT  OF  GUARDIAN. — When  the  insane  person  is 
able  by  the  possession  of  property  to  pay  the  expenses  attendant 
to  his  commitment  and  maintenance  at  the  State  asylum,  the 
judge  shall  appoint  a  guardian,  who  shall  be  subject  to  the  gen- 
eral law  in  relation  to  guardians  as  far  as  the  same  may  be  ap- 
plicable. If  there  is  not  sufficient  money  in  hand,  the  judge 
shall  order  the  sale  of  the  property  of  such  person,  or  so  much 
thereof  as  may  be  necessary,  and  the  guardian  shall  appoint  trus- 
tees to  pay  all  proper  costs  and  charges  incidental  to  the  care 
and  support  of  such  insane  person.  If  such  insane  person  has 
no  property,  but  has  relatives  in  the  degree  of  husband  or  wife 
or  father  or  mother  of  sufficient  means  to  support  such  insane 
person,  the  judge  shall  order  all  such  expenses  to  be  paid  by 
them  and  may  assess  the  same  among  such  kindred  as  he  may 
deem  just  and  equitable.2 

On  petition  under  oath  by  any  relative  or  friend,  the  district 
judge  may  appoint  a  guardian  of  any  incompetent  person,  after 
an  examination.  Such  guardian  has  the  usual  powers.3 

COMMISSIONERS  FOR  THE  CARE  AND  MAINTENANCE  OF 
THE  INDIGENT  INSANE. — The  governor,  State  comptroller,  and 
State  treasurer  constitute  a  board  of  commissioners  for  the  pur- 
pose of  providing  for  the  care  and  maintenance  of  the  indigent 
insane. 

Such  board  has  full  power  and  control  of  the  State  asylum 
and  may  establish  such  rules  and  regulations  for  the  care  thereof 
as  they  may  deem  proper.  They  shall  elect  one  resident  physi- 
cian who  shall  be  general  superintendent,  subject  to  the  order 
and  direction  of  such  board.4 

CRIMINAL  INSANE. — Before  trial  or  before  sentence  the  ques- 
tion of  sanity  may  be  tried  by  a  special  jury.5 

The  insanity  of  convicts  is  tried  by  a  commission.8 

1  Nevada  Compiled  Laws,  s.  1,469,          *  Ibid.,  s.  572-574. 

1,473.  •  Ibid.,  s.  4,410,  4,423-4,427, 4,536- 

2  Ibid.,  s.  1,465.  4,545. 

1  Ibid.,  s.  1,467, 1,468.  6  Ibid.,  a.  1,459-1,460. 


STATUTES  OF  NEW    HAUrsillKK.  (  >.< 

NEW  HAMPSHIRE. 

[The  references  are  to  Public  Statutes  of  Now  Hampshire, 
1901.] 

DEFINITION. — Th6  words  "insane  poison  "shall  includcovery 
idiot,  lion  compos,  lunatic,  insane,  or  distracted  j>erson. 

The  word  "spendthrift"  shall  include  every  one  liable  to  U» 
put  under  guardianship  on  account,  of  excessive  drinking,  gani 
ing,  idleness,  debauchery,  or  vicious  habits  of  any  kind.1 

JURISDICTION.  — The  euro  and  custody  of  the  person  and 
property  of  insane  persons  is  vested  in  the  supremo  court. 

GUARDIANS  OF  INSANE  PERSONS  AND  SIM-:NDTIIKII*TS.     Ar 
POINTMENT. — On  the  application  of  a  relative  or  friend  of  an 
insane  person,  or  of  the  overseer  of  the  poor  of  the  town  where 
he  lives,  the  probate  judge  shall  cause  inquisition  with  notice,  to 
bo  made  by  three  suitable  persons. 

If,  upon  the  return  of  the  inquisition  and  due  examination, 
it  is  decreed  that  the  person  is  insane,  the  MI<I  •••  shall  appoint  a 
guardian  over  him. 

The  person  who  by  excessive  drinking,  etc.,  HO  wastes  his 
estate  or  neglects  his  business  «w  to  expose  him  or  his  family  to 
want  or  Buffering  shall  l>o  deemed  a  spendthrift,  and  upon  com 
plaint  in  writing  made  to  the  judge  of  probate  the  judge  shall 
appoint  a  day  of  hoaring,  and  if  upon  duo  notice  and  examlna 
tion  it  appears  that  such  person  is  a  spendthrift,  the  judge  shall 
appoint  a  suitable  person  to  be  his  guardian. 

Every  guardian  so  appointed  shall  immediately  give  public 
notice  thereof  in  some  newspaper  circulated  in  the  vicinity,  or 
in  such  newspaper  as  the  court  shall  direct.3 

Upon  his  own  application,  a  person  who  shall  oVnn  himself 
unfitted  by  reason  of  age  or  other  mental  or  physical  disability 
may  have  a  guardian  appointed  by  the  court  of  probate." 

POWERS  OF  GITAUDIANH.  — The  guardians  of  a  spendthrift 
may  employ  him  or  his  children  in  any  suitable  lalxir,  or  bind 
them  out  by  written  contract  for  a  term  not  exceeding  one  year. 

If  the  judge  is  satisfied  that  the  estate  of  the  ward  Is  not 
sufficient  to  discharge  his  just  debts,  lie  may  decree  that  the  e* 

1  New  HnmpHhim  Htntutfw,  title  2,          •  Law*   of    IH1HI,    <-hii|».   M;    Pul>, 
c.  2,  H.  18,  19.  HtntH.,  I!M)I,  p.  <KM. 

1  Ibid.,  title  24,  c.  179. 


686  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

tate  be  settled  as  insolvent,  and  thereupon  such  proceedings  may 
be  had  as  in  the  case  of  insolvent  estates  of  deceased  persons. 

Such  guardians  possess  all  the  powers  of  guardians  of  minors, 
and,  subject  to  the  direction  of  the  probate  judge,  shall  have  the 
management  and  control  of  the  property  of  the  ward. 

COMMITMENT  TO  ASYLUM.  — The  parent,  guardian,  or  friends 
of  any  insane  person  may  cause  him  to  be  committed  to  an  asylum 
with  the  consent  of  the  trustees,  and  there  supported  on  such 
terms  as  they  may  agree. 

An  insane  pauper  supported  by  the  town  may  be  committed 
to  an  asylum  by  order  of  the  overseers  of  the  poor,  and  there 
supported  at  the  expense  of  the  town.  If  the  overseers  neglect 
to  make  such  order,  the  supreme  court  or  any  judge  thereof  may 
order  such  pauper  to  be  committed. 

If  any  insane  person  is  in  such  condition  as  to  render  it 
dangerous  for  him  to  be  at  large,  the  judge  of  probate  on  the 
petition  of  any  person,  and  upon  notice  to  a  selectman  of  his 
town  or  to  his  guardian,  may  commit  such  insane  person. 

No  person  shall  be  committed  to  the  asylum,  except  by  an 
order  of  the  supreme  court  or  the  judge  of  probate,  without  the 
certificate  of  two  reputable  physicians  that  such  person  is  insane, 
given  after  a  personal  examination  made  within  one  week  of  the 
committal.  The  court  may  appoint  two  physicians  to  make  the 
examination.1 

SUPPORT  AT  ASYLUM. — Any  insane  person  thus  committed 
who  has  no  means  of  support  and  no  relatives  of  sufficient  ability 
chargeable  therewith,  and  no  settlement  in  any  town  of  this 
State,  shall  be  supported  by  the  county  from  which  he  was  com- 
mitted. Insane  persons  charged  writh  crime,  the  punishment  for 
which  is  death  or  confinement  in  the  State  prison,  shall  be  sup- 
ported at  the  expense  of  the  State. 

The  county  or  town  paying  the  expenses  of  the  support  of  an 
inmate  may  recover  the  amount  paid  of  the  inmate  if  of  sufficient 
ability  to  pay.2 

DISCHARGE  FROM  ASYLUM.  — Any  person  may  be  discharged 
from  such  asylum  by  any  three  of  the  trustees,  by  the  commis- 
sion of  lunacy,  or  by  the  justices  of  the  supreme  court,  wheu- 

1  New  Hampshire  Statutes,  title  3,          2  Ibid.,  s.  20-23. 
c.  10,  s.  14-19.     Laws  of  1895,  chap. 
14,  sec.  1;    Pub.  Stats.,  1901,  p.  89. 


STATUTES   OP  NEW   JERSEY.  687 

ever  a  further  detention  at  the  asylum  is  in  their  opinion  un- 
necessary. The  supreme  court  or  a  justice  thereof  may  investi- 
gate and  discharge  summarily  without  the  intervention  of  a  writ.1 

TRUSTEES  TO  VISIT  ASYLUM. — One  of  the  trustees,  at  least 
twice  every  month  and  without  previous  notice,  shall  visit  the 
asylum  and  give  opportunity  to  every  inmate  to  make  to  him  in 
private  any  statements  he  may  wish.  If,  in  their  judgment,  a 
further  detention  is  unnecessary,  it  shall  be  their  duty  to  dis- 
charge such  inmate.2 

COMMISSION  OF  LUNACY. — All  persons  deprived  of  their 
liberty  by  being  committed  to  custody  as  insane  persons  shall  be 
wards  of  the  State  and  subject  to  State  supervision. 

The  State  board  of  health  shall  constitute  a  commission  of 
lunacy.  The  commission,  or  one  or  more  of  their  members, 
shall,  without  previous  notice,  visit  and  thoroughly  inspect  all 
institutions  for  insane  persons  as  often  as  once  in  four  mouths. 

The  commission  shall  keep  a  correct  record  of  the  number  of 
commitments,  discharges,  and  deaths  at  each  asylum,  and  of  the 
age,  sex,  and  nationality  of  each  person  committed,  discharged, 
or  deceased  and  report  the  same  annually  to  the  governor  and 
counsel. 

The  superintendent  of  every  asylum  shall,  within  three  days 
after  the  commitment  thereof  of  any  person,  notify  the  commis- 
sion, and  such  superintendent  shall  at  all  times  furnish  to  the 
board  such  information  as  they  may  request.3 

NEW  JERSEY. 

[The  references  are  to  General  Statutes  of  New  Jersey,  1895.] 
INQUEST  OF  IDIOCY  AND  LUNACY. — All  cases  of  idiocy  and 
lunacy  are  determined  by  inquest  and  a  commission  of  idiocy 
and  lunacy  issued  out  of  the  court  of  chancery  and  returnable 
thereto.  If,  upon  such  inquest,  idiocy  or  lunacy  be  found,  the 
chancellor  shall  cause  to  be  transmitted  to  the  orphans'  court 
of  the  county  where  such  lunatic  or  idiot  resides  a  certified  copy 
of  all  proceedings. 

The  commission  is  to  be  tried  by  jury  composed  of  twelve 
jurors.4 

1  New  Hampshire   Statutes,  s.  27.          3  Ibid.,  B.  31-35. 

Laws  of  1895,  chap.  14,  sec.  2;  Pub.          4  New  Jersey  General  Statutes,  p. 
Stats.  1901,  p.  90.  1,696,  s.  1,  p.  1,709,  s.  59. 

2  Ibid.,  s.  28. 


688  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

APPOINTMENT  OF  GUARDIAN. — Upon  return  made  and  ap- 
plication therefor  to  the  orphans'  court,  such  court  shall  appoint 
a  guardian  of  such  idiot  or  lunatic,  who  shall  have  the  care  and 
safe-keeping  of  his  person  and  property.1 

COURT  MAY  ORDER  SALE  OF  LANDS. — If  any  such  idiot  or 
lunatic  who  owns  lauds  or  real  estate,  is  justly  indebted  beyond 
his  ability  to  pay,  or  if  his  personal  estate  is  insufficient  for  the 
support  and  maintenance  of  such  lunatic  or  idiot  and  his  house- 
hold, or  if  a  sale  will  be  to  his  advantage,  the  chancellor  or  the 
orphans'  court  may  order  the  guardian  to  sell  such  part  of  the 
lunatic's  real  property  as  the  court  may  deem  sufficient  to  pay 
his  debts  and  the  necessary  expense  for  the  support  and  mainten- 
ance of  the  idiot  or  lunatic  or  his  household.  The  guardian 
shall  make  a  deed  to  the  purchaser  for  the  real  estate  so  sold, 
which  shall  set  forth  the  order  at  large,  and  shall  vest  in  the  pur- 
chaser as  good  a  title  to  the  estate  as  the  idiot  or  lunatic  pos- 
sessed at  the  time  of  the  making  of  the  order.2 

BOND  OF  GUARDIAN. — Every  guardian  ordered  to  sell  lands 
shall,  before  or  at  the  time  of  making  the  report  of  the  sale, 
enter  into  a  bond  in  such  security  as  the  chancellor  shall  deem 
sufficient  for  the  faithful  discharge  of  the  trust  committed  to 
him.3 

PROCEEDS  OF  SALE. — All  moneys  arising  from  any  sale  shall 
be  put  out  at  interest  on  good  and  sufficient  security  of  unen- 
cumbered real  estate,  or  if  the  chancellor  shall  so  direct,  in  pub- 
lic stock  of  United  States  or  of  this  State,  but  in  no  other  way 
whatever. 

Whenever  after  a  sale  so  made  it  shall  become  necessary  to 
apply  any  of  the  proceeds  to  the  support  of  such  idiot  or  lunatic, 
the  guardian  shall  apply  to  the  orphans'  court,  who  shall,  on 
due  proof  in  addition  to  the  oath  of  such  guardian  that  such  ap- 
plication is  necessary,  order  and  direct  the  appropriation  of  so 
much  of  such  proceeds  as  is  necessary  for  such  support,  specify- 
ing in  their  order  the  amount  per  year.4 

NEW  SURETIES  TO  BOND. — Whenever  the  orphans'  court 
shall  suspect  that  the  sureties  of  the  guardian  or  any  of  them 
are  failing  or  in  dubious  circumstances,  they  may  require  such 

1  General  Statutes,  pp.  1,696,  1,697.          *  Ibid.,  p.  1,698,  s.  10. 
s.  1-3.  *  Ibid.,  p.  1,698,  s.  13. 

2  Ibid.,  p.  1,703,  s.  31,  p.  1,698,  s. 
6-6,  p.  1,701,  s.  26. 


STATUTES  OF  NEW   JERSEY.  689 

guardian  to  give  additional  sureties,  and  upon  refusal  or  neglect 
may  displace  such  guardian  and  appoint  another  in  his  place.1 

DEATH  OF  GUARDIAN. — In  case  of  the  death  of  any  guardian, 
the  orphans'  court  shall  forthwith  appoint  another. 

Whenever  a  new  guardian  is  appointed  the  representatives 
of  the  deceased  guardian  shall  account  to  such  new  guardian  for 
all  property  in  their  possession  or  under  their  control  belonging 
to  such  idiot  or  lunatic.2 

ACCOUNT  OF  GUARDIANS. — Guardians  of  idiots  or  lunatics 
shall,  once  in  three  years  or  oftener,  in  case  the  orphans'  court 
shall  so  order  and  direct,  render  to  the  court  from  whom  the  ap- 
pointment was  received  a  true  account  of  the  administration  of 
the  estate  of  such  idiot  or  lunatic  and  on  the  death  of  such  idiot 
or  lunatic,  or  upon  his  restoration,  the  guardian  may  be  com- 
pelled to  render  an  account  of  his  administration  of  the  estate  in 
the  same  manner  as  executors  and  administrators.3 

IDIOT  OR  LUNATIC  NOT  TO  BE  IMPRISONED. — No  lunatic  or 
idiot  during  the  time  of  his  lunacy  shall  be  committed  or  detained 
in  prison  for  want  of  bail  or  his  body  in  execution  in  any  civil 
action ;  and  in  case  any  idiot  or  lunatic  shall  be  so  arrested  in 
any  civil  suit,  he  shall  be  discharged  on  motion  by  the  court  out 
of  which  the  process  issued,  or  upon  a  writ  of  habeas  corpus, 
issued  out  of  the  court  of  chancery  or  of  the  supreme  court.4 

DANGEROUS  LUNATIC  AT  LARGE. — Any  two  justices  of  the 
peace  of  any  county  in  which  any  lunatic  furiously  mad  or 
dangerous  shall  be  found,  may,  by  warrant,  cause  such  person 
to  be  apprehended  and  kept  safely  locked  up  and  chained  if 
necessary,  in  any  place  provided  in  such  county  for  the  recep- 
tion of  maniacs  or  lunatic  persons,  and  if  there  be  no  such  place, 
in  the  jail  of  such  county. 

If  such  lunatic  be  possessed  of  property,  the  expense  incurred 
by  such  detention  shall  be  paid  therefrom ;  but  if  he  possess  no 
property,  then  such  expense  shall  be  charged  upon  the  city  or 
township  in  which  such  person  is  legally  settled  in  the  same 
manner  as  other  poor  persons.5 

COUNTY  LUNATIC  ASYLUMS. — There  may  be  maintained  in 
each  of  the  counties  where  the  expense  of  the  maintenance  of 

1  General  Statutes,  p.  1,699,  s.  16.  4  Ibid.,  p.  1,700,  s.  20. 

*  Ibid.,  p.  1,699,  s.  17,  18.  « Ibid.,  p.  1,700,8.  21, p.  1,706,8.41, 

1  Ibid.,  p.  1,699,  s.  19.  44,  p.  1,707,  s.  49. 
III.— 44 


INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

insane  paupers  is  a  county  charge,  a  county  insane  asylum.  Such 
asylum  is  under  the  care  and  management  of  the  board  of  free- 
holders of  the  county.  All  insane  paupers  having  a  legal  settle- 
ment in  the  county  are  committed  to  such  county  asylums.1 

STATE  HOSPITALS. — The  State  hospitals  are  located  at  Morris 
Plains  and  at  Trenton.  The  management  and  control  of  both 
asylums  is  in  the  non-partisan  State  board  of  managers,  consist- 
ing of  eight  persons  appointed  by  the  governor,  by  and  with  the 
advice  of  the  senate,  and  holding  office  for  the  term  of  five 
years. 

They  are  required  to  make  an  annual  visit  to  each  county 
asylum  receiving  State  aid,  at  least  once  in  each  year. 

They  are  authorized  to  make,  adopt,  and  enforce  rules  and 
regulations  for  the  distribution  between  the  two  hospitals  of  all 
patients  sent  thereto,  and  for  the  removal  of  patients  from  one 
to  the  other.  They  also  have  power  to  appoint  medical  directors 
for  each  hospital,- and  as  many  assistant  physicians  as  they  deem 
necessary. 

Medical  directors  have  charge,  direction,  and  control  of  all 
patients  and  of  all  persons  engaged  in  the  care  of  such  patients, 
subject  to  the  rules,  regulations,  and  by-laws  adopted  by  the 
board.  Such  managers  must  maintain  an  effective  inspection 
of  such  hospitals,  for  which  purpose  one  or  more  of  them  shall 
visit  each  of  them  at  least  once  in  every  week,  two  or  more  at 
least  once  in  every  month,  a  majority  at  least  once  in  every  three 
mouths,  and  the  total  board  once  a  year.  They  shall  annually 
report  to  the  governor  the  year's  operations  and  the  actual  state 
of  the  hospitals.2 

COMMITMENT  OF  INSANE  PAUPERS  TO  STATE  HOSPITALS. 
—The  overseer  of  the  poor  of  the  town  where  the  insane  pauper 
resides  shall  make  application  to  a  judge  of  the  court  of  common 
pleas  of  the  county,  and  such  judge  shall  call  one  reputable 
physician  and  fully  investigate  the  facts  of  the  case ;  and  if  satis- 
fied after  such  examination  of  the  insanity  of  the  pauper,  he 
shall  issue  an  order  requiring  him,  without  delay,  to  take  such 
insane  pauper  to  the  proper  hospital. 

If  such  insane  person  is  in  indigent  circumstances,  but  not  a 
pauper,  the  same  proceedings  shall  be  had ;  and  if  the  said  judge 

'General  Statutes,  p.  1,993,  s.  67-          2  Ibid.,  p.  1,990,  s.  54-58,  p.  1,982, 
94.  s.  1,  4-12. 


STATUTES   OF   NEW    YORK.  691 

shall  make  a  certificate  that  satisfactory  proof  has  been  adduced, 
showing  his  estate  to  be  insufficient  to  support  him  and  his  family, 
he  shall  then  be  admitted  into  one  of  such  hospitals  and  supported 
there  at  the  expense  of  the  county.1 

NEW  YORK. 

Note:  The  New  York  statutes  relating  to  lunacy  are  most  elaborate  and 
numerous;  different  enactments  are  extant  unrepoaled,  which  seem  to  cover 
more  or  less  the  same  ground.  The  greater  number  of  the  statutes  relating 
to  the  care  and  custody  of  the  insane  have  been  codified  in  the  Insanity  Law, 
originally  enacted  as  chapter  545  of  the  laws  of  1896,  but  much  amended. 
It  is  now  Chapter  27  of  the  Consolidated  Laws  of  1909.  Inasmuch  as  the 
system  of  control,  protection,  and  administration  under  the  provisions  of 
the  Insanity  Law  has  on  the  whole  been  found  satisfactory,  we  give  a  full 
digest  as  a  specimen  of  legislation  for  the  insane. 

THE  STATE  COMMISSION  IN  LUNACY. — The  State  Commission 
in  Lunacy  consists  of  three  commissioners :  the  president,  a  phy- 
sician, graduate  of  medical  college,  of  experience  in  the  manage- 
ment of  institutions  for  the  insane ;  another,  an  attorney-at-law ; 
the  third,  a  reputable  citizen.  President's  salary,  $7,500,  and 
$1,200  for  expenses;  salary  of  others,  $5,000,  and  $1,200  for  ex- 
penses. The  president  holds  office  during  good  behavior;  others, 
term  of  six  years.  The  commissioners  are  appointed  by  the 
governor.2  The  commission  is  to  appoint  an  office  force,  and  a 
medical  inspector  to  visit  State  hospitals  and  other  institutions.3 

The  commission  is  charged  with  execution  of  laws  relating  to 
the  custody,  care,  and  treatment  of  the  insane,  "not  including 
feeble-minded  persons  and  epileptics  as  such  and  idiots."  They 
have  supervision  of  all  institutions  public  and  private,  and  may 
examine  all  books,  papers,  etc.  They  may  permit  any  religious 
or  missionary  corporation  or  body  to  erect  a  building  on  any 
State  hospital  grounds  for  religious  services  for  inmates.4  They 
shall  have  general  oversight  of  State  hospitals  and  control  of  the 
property  thereof;  may  accept  and  hold  in  behalf  of  the  State 
devises  and  bequests  for  the  insane,  and  invest  and  manage  the 
same  each  as  a  separate  fund.5  They  shall  visit  every  State  hos- 

1  General  Statutes,  s.  29,  30.  4  Sec.  6  as  amended,  c.  107,  Laws  of 

*  Insanity  Law,  sec.  3  as  amended,       1906. 

c.  490,  Laws  of  1905.  Also  State  'See.  7,  amended,  c.  462,  Laws 
Constitution,  art.  8,  s.  11,  12,  13,  15.  of  1907. 

*  Sec.  4  as  amended,  c.  490,  Laws 
of  1905. 


G92  INCOMPETENT  PERSONS — BROWN   AND   BECKER. 

pital  by  a  majority  and  every  private  institution  at  least  singly 
at  least  twice  each  year,  make  thorough  investigation,  and  report 
recommendations  at  the  next  meeting  of  the  commission.  A 
conference  with  the  managers  of  such  institutions  shall  be  held 
at  least  once  each  year.1 

Any  member  of  the  commission  or  the  medical  inspector  may 
visit  any  sanitarium  or  other  institution  for  the  sick  and  any 
poorhouse,  etc.,  to  ascertain  whether  insane  persons  are  unlaw- 
fully confined  there.2 

The  commission  may  make  regulations  as  to  correspondence 
of  the  insane  in  custody.  All  such  insane  may  correspond  with- 
out restriction  with  the  county  judge  and  district  attorney  of  the 
county  from  which  they  were  committed.  (For  regulations 
adopted,  see  Form  40  of  the  commission  in  lunacy. )  Books  of 
record  and  blank  forms  in  the  hospitals  shall  be  uniform  and 
approved  by  the  commission.3 

The  commission  shall  report  to  the  legislature  annually,  with 
estimates  of  expenditures.  It  shall  fix  the  capacity  of  the  State 
hospitals  in  the  report.4 

The  commission  and  each  State  hospital  shall  make  monthly 
financial  reports  to  the  State  comptroller. 

The  commission  shall  divide  the  State  into  hospital  districts, 
in  proportion  to  the  capacity  of  the  hospitals.  Changes  are  to 
be  made  only  after  opportunity  given  managers  of  hospitals 
affected  to  be  heard.  Such  changes  are  to  be  filed  with  secre- 
tary of  state  and  county  officers.5 

Physicians  who  receive  certificates  as  medical  examiners  are 
to  file  same  with  county  clerk  and  commission.6 

The  commission  shall  keep  on  file  in  its  office  a  private  record 
of  all  patients  in  State  hospitals  and  private  institutions,  showing 
name,  residence,  dates,  etc.,  etc.  Institutions  shall  furnish  data 
for  this  record,  and  other  information  when  required.7 

The  commission  shall  provide  for  the  wants  of  poor  and  in- 
digent insane,  recommending  to  legislature  the  establishment  of 
•other  State  hospitals  when  needed.  It  shall  furnish  estimates  of 

1  Insanity  Law,  sec.  8,  amended,          *  Sec.  11,  amended,  c.  490,  Laws  of 
c.  490,  Laws  of  1905.  1905. 

2  Sec.  9,  amended,  c.  497,  Laws  of          8  Sees.    12-13,    amended,    c.    490, 
1905,  s.  72,  74.  Laws  of  1905. 

3  Sec.  10.  •  Sec.  14. 

7  Sees.  15-16. 


STATUTES  OP  NEW   YORK.  693 

the  probable  number  of  patients  and  necessary  expenses.  The 
cost  of  buildings  and  equipment  is  not  to  exceed  $550  per  capita 
for  persons  to  be  confined  therein,  except  that  for  the  care  of  the 
acute  and  curable  class  the  same  may  cost  $1,000  per  capita.1 

The  commission  shall  appoint  after  civil  service  examination 
a  director  of  the  pathological  institute  and  laboratory  in  New 
York  City.2 

The  commission  shall  appoint  an  attorney  for  each  State  hos- 
pital (one  attorney  for  Manhattan  and  Central  Islip  hospitals).3 

A  board  of  alienists  for  the  examination  of  insane,  idiotic, 
imbecile,  and  epileptic  immigrants,  and  alien  and  non-resident 
insane,  shall  consist  of  three  physicians,  graduates,  of  ten  years' 
practice  and  five  years'  experience  in  care  of  insane  in  State  hos- 
pitals ;  salary,  $5,000 ;  appointed  by  the  commission.  The  board 
is  to  examine  immigrants  entering  this  country  at  the  port  of 
New  York,  and  shall  have  charge  under  supervision  of  the  com- 
mission in  lunacy  of  the  removal  of  non-resident  insane.4 

THE  STATE  HOSPITALS. — There  are  thirteen  State  hospitals, 
two  of  them  homeopathic  and  two  for  the  criminal  insane.5 
Each  hospital  is  under  the  control,  subject  to  the  statutory  pow- 
ers of  the  commission,  of  a  non-salaried  board  of  managers  of 
seven  members,  of  whom  at  least  two  are  women.  A  committee 
of  one  member  from  each  of  the  boards  shall  establish  by-laws, 
rules,  and  regulations  governing  the  appointment  and  duties  of 
officers  and  employe's  of  hospitals,  and  the  internal  government 
of  the  same,  uniform  for  all  hospitals.  At  monthly  meetings 
the  board  shall  make  an  inspection  of  the  hospital  and  report  the 
same  to  the  governor  together  with  its  minutes.  The  board  shall 
hear  and  determine  the  truth  of  all  charges  made  against  the 
superintendent  or  any  other  officer  or  employe"  of  the  hospital, 
and  may  issue  subpoenas  and  take  testimony.6 

The  commission  in  lunacy  shall  appoint  superintendents  of 
hospitals  subject  to  the  approval  of  the  board  of  managers.  The 
superintendent  is  to  be  a  well-educated  physician,  a  graduate, 
having  five  years'  experience  in  an  institution  for  the  care  of  the 

1  Insanity  Law,  sec.   17,  amended,  4  Sec.  19,  amended,  c.  213,  Laws  of 

c.  284,  Laws  of  1906.  1908. 

*  Sec.  170-173,   amended,   c.    490,  •  Sec.  40,  amended,  c.  490,  Laws  of 

Laws  of  1905.  1905;  s.  90,  c.  520,  Laws  of  1899;  cf. 

3  Sec.  18,  amended,  c.  490,  Laws  of  c.  524,  Laws  of  1907. 

1905.  '  Sec.  43,  amended,  c.  490,  Laws  of 

1905. 


694  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

iiisane.  He  shall  be  the  treasurer  unless  another  is  designated 
by  the  commission.  He  may  be  removed  by  a  majority  of  the 
board  of  managers  for  cause  stated  in  writing  after  a  hearing  and 
approved  by  the  commission  and  suspended  pending  the  hearing.1 

The  superintendent  shall  be  the  chief  executive  officer.  He 
has  the  power  to  employ  and  discharge  for  cause  after  a  hearing, 
officers  and  employes.  The  superintendent,  assistant  physicians, 
including  a  woman  physician  (graduates),  the  steward,  and 
matron,  shall  reside  on  the  grounds  (except  on  approval  of  com- 
mission).2 He  may  appoint  employes  as  special  police. 

The  superintendent  shall  establish  and  supervise  a  training- 
school  for  attendants  and  nurses. 

He  shall  hold  at  least  two  conferences  weekly  with  the  medi- 
cal staff.  He  shall  cause  a  complete  clinical  record  of  each 
patient  to  be  kept,  and  complete  records  of  business  and  accounts 
of  the  hospital  and  of  patients,  etc.3 

The  superintendents  shall  meet  at  least  once  in  three  mouths 
at  the  State  capital  for  conference.  Each  board  of  managers  may 
send  one  of  its  members.4 

The  commission  with  the  approval  of  State  officers  shall  fix 
the  wage  scale  of  all  officers  and  employes,  uniform  for  like  ser- 
vice and  grade.  Food  supplies  shall  be  allowed  for  officers,  em- 
ploy 6s,  etc.5 

SALARY  AND  WAGE  SCALE. 

The  salary  and  wage  scales  as  fixed  by  orders  of  the  commission  of  Feb- 
ruary 13,  1906,  and  February  23,  1905,  are  as  follows:  Resident  officers — 
(1)  superintendent  and  medical  director,  appointed  in  institutions  having  a 
population  of  4,000,  salary  $6,000;  (2)  medical  superintendents,  $3,500  to 
$4,500,  $100  added  each  year;  (3)  first  assistant  physicians,  $2,000  to  $2,500. 
$100  added  each  year;  (4)  second  assistant  physicians,  $1,500  to  $2,000,  $100 
additional  each  year;  (5)  assistant  physicians,  $1,200  to  $1,500,  $100  added 
each  year;  (6)  junior  physicians,  $900  to  $1,200,  $100  added  each  year;  (7) 
women  physicians,  $1,000  to  $1,500,  $100  added  each  year;  (8)  medical  internes, 
$600;  (9)  stewards,  outside  of  Manhattan  and  Long  Island  State  hospitals, 
$1,500  to  $2,000,  $100  added  each  year,  and  where  manufacturing  department 
with  output  of  $65,000  per  annum,  $500  additional;  (10)  resident  stewards, 
in  hospitals  where  there  is  a  purchasing  steward,  $1,500;  (11)  purchasing 
steward,  one  non-resident  purchasing  steward,  for  Manhattan  and  Long 

1  Insanity  Law,  sec.  44,  amended,  c.  *  Sec.  48,  amended,  c.  490,  Laws  of 
490.  Laws  of  1905.  1905. 

2  Sec.  49.  5  Sees.  49-50,  amended,  c.  714,  Laws 

3  Sec.  45,  amended,  c.  490,  Laws  of  of  1904. 
1905. 


STATUTES   OF   NEW   YORK.  095 

Island  State  hospitals,  $4,000  and  maintenance;  (12)  assistant  steward,  non- 
resident assistant  steward  for  Manhattan  State  Hospital,  $2,000  and  main- 
tenance; (13)  matrons,  $65  to  $75  per  month,  $2  per  month  added. 

Employees  who  are  graduates  of  a  training  school  receive  increased  sal- 
aries provided  they  pass  an  examination  conducted  by  a  board  appointed 
at  conference  of  superintendents  with  commission.  They  are  known  as 
nurses,  the  non-graduates  as  attendants.  Nurses  in  charge  of  wards  receive 
per  month,  men,  $35.00  to  $41.25;  women,  $28.75  to  $35.00.  Nurses,  men, 
$31.25  to  $37.50;  women,  $25.00  to  $31.25.  Attendants  in  charge  of  wards, 
men,  $31.25  to  $37.50;  women,  $25.00  to  $31.25.  Attendants,  men,  $22.00 
to  $30.00;  women,  $16.00  to  $22.50.  Skilled  attendants,  men,  $37.50  to 
$43.75;  women,  $31.25  to  $37.50. 

[The  wage  scale  is  too  long  to  quote  in  full.  It  is  Form  394  of  the  New- 
York  State  commission  in  lunacy.] 

The  superintendent  has  power  to  maintain  an  action  in  the 
name  of  the  hospital  upon  any  cause  of  action  accruing  to  the 
hospital,  including  any  liability  for  the  care  of  the  insane.1 

No  civil  action  may  be  brought  against  a  -commissioner  in 
lunacy  or  officer  or  manager  of  hospital  on  account  of  his  official 
duties  except  by  permission  of  a  justice  of  the  supreme  court. 
Any  just  claim  against  one  of  these  or  an  employe*  for  which  the 
State  would  be  legally  or  equitably  liable  may  be  paid  from  funds 
appropriated  for  the  care  of  the  insane.2 

PRIVATE  INSTITUTIONS. — No  private  institution  for  the  care, 
custody,  or  treatment  of  the  insane  for  compensation  or  hire  may 
be  kept  without  a  license  of  the  commission  in  lunacy.  The 
commission  shall  have  visitatorial  power.3 

Justices  of  the  supreme  court  may  appoint  visitors  to  State 
hospitals  upon  nomination  of  the  State  Charities  Aid  Association.4 

The  commission  may  exercise  the  power  of  eminent  domain 
to  take  land  for  State  hospitals.5 

No  public  street  or  railroad  shall  be  extended  through  hos- 
pital grounds.8 

COMMITMENT,  CUSTODY,  AND  DISCHARGE  OF  THE  INSANE. 
— An  insane  person  not  in  confinement  on  a  criminal  charge  may 
upon  petition  therefor  be  committed  to  an  institution  on  an 
order  of  a  judge  of  a  court  of  record  of  the  city  and  county,  or 
of  a  justice  of  the  supreme  court  of  the  district,  where  such 

1  Insanity  Law,  sec.  54,  amended,  4  Sec.  61. 

c.  490,  Laws  of  1905.  *  Sec.  64,  amended,  c.  490,  Laws  of 

*  Sec.  58,  amended,  c.  490,  Laws  of  1905. 

1905.  •  Sec.  66,  amended,  c.  26.  Laws  of 

1  Sees.  59-60.  1902. 


696  INCOMPETENT   PERSONS  —  BROWN   AND   BECKER. 

person  resides  or  may  be,  upon  a  certificate  of  lunacy  made  by 
two  qualified  medical  examiners  in  lunacy.  Forms  for  the  cer- 
tificate and  petition  are  to  be  furnished  by  the  commission  in 
lunacy.  No  idiot  shall  be  confined  in  a  State  hospital,  but  an 
epileptic  or  feeble-minded  person  becoming  insane  may  be.1 

The  certificate  must  be  made  by  two  reputable  physiciaus, 
graduates  of  an  incorporated  medical  college,  who  have  filed  with 
the  commission  in  lunacy  their  certificates  as  prescribed.2  Nei- 
ther of  such  examiners  shall  be  a  relative  of  the  person  applying 
for  the  order,  or  of  the  person  alleged  to  be  insane,  or  be  con- 
nected with  the  institution  to  which  it  is  proposed  to  commit 
him.3 

Form  of  the  medical  certificate  of  lunacy  as  prescribed  by 
the  State  commission  in  lunacy  pursuant  to  sec.  60,  chap.  545, 
Laws  of  1896  (sec.  81,  chap.  27,  Consol.  Laws  of  1909)  : 

STATE   OF   NEW   YORK—  STATE  COMMISSION   IN   LUNACY 

The  following  should  befitted  out  only  by  two  medical  examiners  qualified  ac- 

cording to  section  60: 

CERTIFICATE  OF  LUNACY 

8TATE  OF  NEW  YORK, 

County  of  __  -  -  ps: 

City,  Town  or  Village  _  J 


STATEMENT   OF   FACTS 


1.  Patient  resides  at  _  ,    county  of 


age  _  years;  nativity  (if  foreign,  how  long  in  U.S.) 


color  _  ;  occupation 


single,  married,  widowed,  divorced.     (Strike  out  words  not  required.) 
2.  Birthplace  of  father  _  ;  of  mother. 


3.  Number  of  previous  attacks —  — ;  present  attack  began 190—. 

(//  the  patient  has  ever  been  an  inmate  of  an  institution  for  the  insane,  state 
when  and  where,  and  whether  discharged  recovered  or  otherwise.) 

4.  Was  the  present  attack  gradual  or  rapid  in  its  onset? . 

5.  What  is  the  patient's  general  physical  condition? (If 

afflicted  with  any  infirmity  or  disease  other  than  insanity,  state  it.) 

6.  Is  the  patient  cleanly  or  uncleanly  in   personal  habits? 

7.  Is  the  patient  violent,  dangerous,  destructive,  excited  or  depressed, 
homicidal  or  suicidal?      (//  either  homicide  or  suicide  has  been  attempted  or 
threatened,  it  should  be  so  stated.) 

8.  What  is  the  supposed  cause  of  the  insanity?     (State  both  predisposing 
and  exciting  causes,  if  known.) 

1  Insanity  Law,  sec.  80.  *  Sec.  81.  *  Sec.  81. 


STATUTES  OF  NEW   YORK.  697 

9.  Has  the  patient  insane  relatives?     If  so,  state  the  degree  of  consan- 
guinity, and  whether  paternal  or  maternal 

10.  State  the  patient's  habits  as  to  the  use  of  liquor,  tobacco,  opium,  or 
other  drug,  and  whether  excessive  or  moderate. 

We, ,  a  legal  resident  of 

county,  of  ,  State  of  New  York,  and 

a  legal  resident  of ,  county  of and 

State  aforesaid,  being  severally  and  duly  sworn,  do  severally  certify  and  each 
for  himself  certifies,  with  the  exceptions  which  are  hereinafter  noted,  as 
follows: 

1.  I  am  a  graduate  of  an  incorporated  medical  college,  and  a  qualified 
medical  examiner  in  lunacy;   a  certificate  of  my  qualifications  as  such  exam- 
iner, or  certified  copy  thereof,  is  on  file  in  the  office  of  the  State  Commission 
in  Lunacy,  and  I  have  received  from  its  secretary  an  acknowledgment  of  the 
receipt  of  the  same. 

2.  I  have  with  care  and  diligence  personally  observed  and  examined  on 

the  date  of  this  certificate,  namely,  on  the day  of , 

190 , ,  now  residing  or  being  at 

in  the  county  of ,and  as  a  result 

of  such  joint  examination  find,  and  hereby  certify  to  the  fact,  that    he  is 
insane  and  a  proper  subject  for  custody  and  treatment  in  some  institution  for 
the  insane,  as  an  insane  person  under  the  provisions  of  the  statute. 

3.  I  have  formed  the  above  opinion  upon  the  subjoined  facts: 

a.  facts  indicating  insanity  personally  observed  by  me,  as  follows: 
The  patient  said  (State  what  the  patient  said,  if  anything,  in  presence  of 
the  examiners') : 


The  patient  (State  what  the  patient  did  in  presence  of  the  examiners  and 
also  describe  his  or  her  appearance  and  manner) : 


b.  Other  facts  indicating  insanity,  including  those  communicated  to  me 
by  others,  as  follows:  (State  what,  if  any,  significant  change  there  has  been  in 
the  patient's  disposition  mental  condition,  business  or  social  habits,  or  bodily 
health.) 


4.  That  the  facts  stated  and  information  contained  in  this  certificate 
are  true  to  the  best  of  my  knowledge  and  belief. 

,  M.D. 

,  M.D. 

Severally  subscribed  and  sworn  to  before  me  this 

day  of ,  190 


698  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

The  petition  may  be  made  by  any  person  with  whom  the 
alleged  insane  person  resides,  or  at  whose  house  he  may  be,  or 
by  a  brother  or  sister  or  nearer  relative ;  by  an  overseer  of  the 
poor  of  the  town,  or  the  superintendent  of  the  poor  in  the  county 
where  he  may  be.  The  petition  shall  be  accompanied  by  the 
certificate  of  lunacy.  Notice  of  the  application  shall  be  served 
personally  at  least  one  day  before  the  application  upon  the  per- 
son alleged  to  be  insane,  and  if  the  petition  is  made  by  an  over- 
seer or  superintendent  of  the  poor,  also  upon  the  husband  or 
wife,  father  or  mother,  or  next  of  kin.  The  judge  to  whom  ap- 
plication is  made  may  dispense  with  personal  service  or  direct 
service  on  another  for  cause  stated.  If  no  demand  for  a  hearing 
is  made  the  judge  may  commit,  requiring  additional  proofs  in 
his  discretion.  If  it  appears  that  the  insane  person  is  harmless 
the  judge  may  order  him  placed  in  the  care  and  custody  of  his 
relatives  or  a  committee  of  his  person,  upon  their  written  consent.1 

Upon  the  demand  of  any  relative  or  near  friend  the  judge 
shall,  or  on  his  own  motion  he  may,  order  a  hearing  within  five 
days.  The  order  shall  be  served  on  such  persons  as  he  may 
direct.  The  judge  may,  if  he  cannot  hear  the  application,  ap- 
point a  referee  to  report  the  testimony  with  his  opinion.  The 
judge  shall,  if  commitment  be  made  to  a  State  hospital,  report 
in  writing  the  financial  condition  of  the  insane  person  and  of  the 
persons  legally  liable  for  his  maintenance.2 

The  petition,  certificate  in  lunacy,  order  directing  a  hearing, 
if  any,  decision,  and  order  of  commitment,  shall  be  presented  to 
the  superintendent  in  charge  of  the  institution,  who  shall  file 
copies  with  the  commission  in  lunacy.  Unless  the  papers  are  in 
order,  and  in  case  the  superintendent  deems  the  person  sane,  he 
may  refuse  to  receive  him,  or  if  received  the  commission  may 
discharge  him.  ~No  person  shall  be  admitted  under  an  order  of 
commitment  after  five  days  from  the  date  thereof.3 

Upon  the  petition  and  certificate  aforesaid,  any  person  shown 
by  the  certificate  to  be  dangerously  insane  or  needing  immediate 
treatment  may  be  received  in  a  State  institution  without  a  court 
order,  but  for  five  days  only.  The  superintendent  may  refuse 
to  receive  such  person'if  in  his  judgment  such  condition  does  not 
exist.4 

1  Insanity  Law,  gee.  82.  8  Sec.  82. 

3  Sec.  82.  <  Sec.  82,  amended,  Laws  of  1903. 


STATUTES   OF   NEW    YORK.  699 

A  person  ordered  committed  or  any  friend  in  his  behalf  may 
apply  to  (another)  justice  of  the  supreme  court  who  shall  con- 
vene a  jury  as  in  proceedings  for  the  appointment  of  a  commit- 
tee. A  bond  for  costs  must  be  given.  If  the  verdict  is  that  the 
person  is  insane  an  order  of  commitment  shall  be  made  and  the 
procedure  shall  be  as  before.  There  shall  be  no  stay  pending 
the  appeal  except  upon  an  order  of  a  justice  of  the  supreme 
court  upon  notice  after  a  hearing.  If  a  judge  shall  refuse  to 
grant  an  order  of  commitment  of  a  person  dangerous  to  himself 
or  others,  if  at  large,  he  shall  state  his  reasons  in  writing,  and 
any  person  aggrieved  may  appeal.1 

The  costs  are  a  charge  upon  the  town,  city,  or  county  pro- 
curing the  commitment,  under  this  act  or  chapter  446,  Laws  of 
1874,  sec.  26  (see  below).  If  the  person  be  not  poor  or  indigent, 
costs  are  payable  from  his  estate  or  by  the  persons  liable  for  his 
maintenance. 2 

All  poor  and  indigent  insane  persons  are  to  be  supported  by 
the  State  in  a  State  hospital.  The  commission  shall  either  di- 
rectly or  through  the  treasurer  of  the  hospital  obtain  reimburse- 
ment in  whole  or  in  part  from  the  patient's  estate  and  from  rela- 
tives or  friends  liable  or  assuming  payment.3 

The  rate  of  payment  by  relatives,  etc.,  shall  be  fixed  by  the 
commission,  sufficient  to  pay  a  proper  proportion  of  the  cost  of 
maintenance  and  necessary  repairs  and  improvements.4 

Any  person  committed  to  a  State  hospital  in  a  criminal  pro- 
ceeding shall  be  maintained  by  the  county  from  which  he  was 
committed,  except  in  Matteawan  Hospital.5 

"The  father,  mother,  husband,  wife,  and  children  of  an  in- 
sane person,  if  of  sufficient  ability,  and  the  committee  or  guardian 
of  his  person  and  estate,  if  the  estate  is  sufficient  for  the  pur- 
pose, shall  cause  him  to  be  properly  and  suitably  cared  for  and 
maintained."8 

[For  provisions  of  law  whereby  they  can  be  compelled  to  do 
so,  see  Code  of  Criminal  Procedure,  Sees.  914-920.] 

Any  person  not  properly  cared  for  or  dangerously  insane  may 
be  committed  upon  application  of  the  commission  or  superiu- 

1  Insanity  Law,  sec.  83.  4  Sec.  85. 

-  Sec.  84'  amended,  c.  428,  Laws  of          '  Sees.  85,  122. 
1904.  •  Sec.  86. 

s  Sec.  85,  amended,  c.  546,  Laws  of 
1901. 


700  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

tendent  or  overseer  of  the  poor.  Costs  are  to  be  paid  by  persons 
liable  to  support  him.1 

"In  all  claims  of  the  State  upon  relatives  liable  for  the  sup- 
port of  a  patient  or  upon  moneys  or  property  held  by  said  patient 
the  State  shall  be  deemed  a  preferred  creditor. " 2 

County,  city,  or  town  authorities  shall  attend  to  the  commit- 
ment of  the  poor  and  indigent,  and  see  that  they  are  clean  and 
comfortably  clothed.3 

Each  patient  shall  be  sent  to  a  hospital  within  the  district, 
etc.,  except  as  ordered  by  the  commission,  and  unless  homoeo- 
pathic treatment  desired,  in  which  case,  to  one  of  the  two 
homoeopathic  hospitals.  The  hospital  shall  send  a  trained  attend- 
ant to  conduct  the  patient  to  the  hospital. 4 

Where  an  insane  person  has  sufficient  estate  or  relatives 
able,  and  is  dangerous,  the  committee  or  relatives  must  provide 
a  suitable  place  for  his  confinement.  The  superintendent  or 
overseer  of  poor,  etc.,  are  charged  with  the  enforcement  of  this 
provision.  They  may  apply  for  a  court  order  to  apprehend  such 
a  person  pending  an  application  for  his  commitment.  In  no 
case  shall  such  person  be  confined  elsewhere  than  in  a  State  hos- 
pital or  licensed  institution  more  than  ten  days;  or  ever  be  com- 
mitted as  a  disorderly  person  to  a  jail,  etc.,  unless  he  is  violent 
and  there  is  no  other  place ;  or  ever  be  confined  in  the  same  room 
with  a  person  charged  with  or  convicted  of  crime.5 

Any  disorderly  person  apparently  insane  may  be  arrested  by 
any  peace  officer  and  confined  pending  inquiry.  In  New  York 
City  arrests  are  to  be  made  on  information  and  warrant,  and 
person  to  be  committed  to  Bellevue  Hospital,  in  Manhattan, 
or  Bronx,  or  to  care  of  commissioner  of  public  charities,  in 
Brooklyn,  Queens,  and  Eichmond,  pending  determination  of 
insanity.6 

Insane  patients  residents  of  the  State  may,  when  there  is  room, 
be  admitted  to  State  hospitals  under  special  agreement.7 

The  superintendent  of  every  institution  for  the  insane  shall 
keep  a  case-book,  etc.8 

1  Insanity  Law,  sec.  86.  6  Sec.  88,  amended,  c.  487,  Laws  of 

2  Sec.  86.  1908. 

*  Sec.  87,  amended,  c.  146,  Laws  of  7  Sec.  89,  amended,  c.  26,  Laws  of 

1903.  1902. 

4  Sec.  87.  8  Sec.  90. 
8  Sec.  88. 


STATUTES   OF  NEW   YORK.  701 

When  any  State  hospital  is  overcrowded,  etc.,  the  commis- 
sion may  transfer  patients  to  another. 1 

Illegal  confinement  or  improper  care  of  any  person  may  be 
investigated  by  the  commission,  summoning  witnesses.  It  may 
order  institutions  to  treat  as  directed,  and  when  said  order  is 
approved  by  a  justice  of  the  supreme  court,  wilful  disobedience 
is  a  criminal  contempt.  The  commission  shall  give  notice  to  the 
attorney -general  before  general  investigation  of  an  institution, 
who  shall  examine  witnesses.  Commissioners  may  visit  any 
county  or  city  almshouse  to  ascertain  if  insane  persons  are  kept 
there.2 

DISCHARGE  AND  PAROLE  OF  PATIENTS. — Any  person  con- 
fined or  any  friend  may  obtain  a  writ  of  habeas  corpus,  for  inquiry 
as  to  the  fact  of  insanity.3 

The  superintendent  of  a  State  hospital  may  discharge  any 
patient,  not  committed  in  a  criminal  proceeding,  who  in  his  opin- 
ion (1)  has  recovered;  (2)  is  a  dotard,  not  insane;  (3)  who 
though  not  recovered  may  safely  be  discharged  and  has  friends 
to  care  for  him.  Upon  his  refusal  to  discharge  an  unrecovered 
patient  the  court  may  after  a  hearing  order  such  discharge, 
upon  security  being  given.  The  superintendent  may  grant 
a  parole  not  exceeding  six  months.  The  commission  may 
order  discharged  any  person  improperly  detained  in  any  in- 
stitution. A  poor  and  indigent  person  discharged  because  an 
idiot,  dotard,  or  epileptic,  not  insane,  shall  be  cared  for  by  the 
superintendent  of  the  poor,  etc.,  of  the  county  from  which  he 
was  committed. 

A  patient  committed  in  a  criminal  proceeding  may  be  dis- 
charged upon  the  superintendent's  certificate,  approved  by  any 
such  court  or  judge.4 

Clothing  and  money  not  exceeding  $25  are  to  be  furnished  a 
discharged  patient,  if  necessary.5 

MISCELLANEOUS. — The  commission  shall  transfer  to  his  own 
county  or  State  any  poor  and  indigent  non-resident  committed 
to  a  State  hospital.8 

Commitment  of  insane  Indians  is  in  same  manner.7 

1  Insanity  Law,  sec.  91.     See  Form          4  Sec.  94,  amended,  c.  261,  Laws  of 

112  of  the  Commission  in  Lunacy.  1908. 

*  Sec.  92.  •  Sec.  95. 

•  Sec.  93  •  Sec.  96. 

7  Sec.  97. 


702  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

Unclaimed  personal  effects  of  discharged  or  deceased  patients 
may  be  sold  at  auction. l 

VOLUNTARY  PATIENTS  IN  STATE  HOSPITALS. — Pursuant  to 
rules  of  the  commission  the  superintendent  of  any  State  hospital 
except  Matteawan  and  Dannemora  (which  are  for  criminal  in- 
sane) "may  receive  and  retain  therein  as  a  patient  any  person 
suitable  for  treatment,  and  who  voluntarily  makes  written  appli- 
cation therefor,  and  whose  mental  condition  is  such  as  to  render 
him  competent  to  make  such  application. "  Such  person  shall 
not  be  detained  more  than  five  days  after  giving  notice  in  writing 
of  his  intention  to  leave.2 

STATE  HOSPITALS  FOR  INSANE  CRIMINALS. — Matteawan 
State  Hospital  is  for  persons  committed  by  courts  in  criminal 
proceedings,  or  male  convicts  becoming  insane  while  undergoing 
sentence  for  one  year  or  less  for  a  misdemeanor,  or  all  female 
convicts.3 

The  medical  superintendent  is  appointed  by  the  superintend- 
ent of  State  prisons.  His  qualifications  and  duties  are  similar 
to  those  of  superintendents  of  other  State  hospitals.4 

Insane  convicts  liable  to  be  sent  to  Matteawan  Hospital  shall 
be  transferred  there  upon  petition,  certificate,  and  order  of  the 
court,  substantially  as  above  (sec.  82  et  seq.}.5 

When  any  insane  convict's  term  of  imprisonment  expires,  he 
may  be  detained,  discharged  upon  recovery,  or  into  custody  of 
friends,  or  transferred  to  another  institution.6 

Upon  recovery  before  expiration  of  his  sentence,  a  convict 
shall  be  transferred  to  the  prison  or  reformatory  whence  he 
came.7 

Any  inmate  not  a  convict  who  recovers  shall  be  discharged 
upon  certificate  of  the  superintendent,  approved  by  the  court  or 
judge.8 

The  commission  may  transfer  to  Matteawan  any  person  con- 
fined in  another  State  hospital  by  an  order  in  a  criminal  pro- 
ceeding ;  or  any  insane  person  who  has  previously  ever  been  sen- 
tenced to  a  term  of  imprisonment  and  still  manifests  criminal 
tendencies. 

1  Insanity  Law,  sec.  98,  amended,  c.          4  Sees.  112-117. 

391,  Laws  of  1902.  5  Sec.  118,  amended,  c.  525, Laws  of 

2  Sec.  99,  added  by  c.  461,  Laws  of  1904. 
1908.  8Sec.  119. 

3  Sec.  110,  amended,  c.  525,  Laws  of          7  Sec.  120. 
1904.  8Sec.  120. 


STATUTES    OF   NEW   YORK.  703 

From  October  1st,  1904,  all  persons  in  Matteawan  State  Hos- 
pital shall  be  a  charge  upon  the  State.1 

Correspondence  of  patients  in  Matteawan  Hospital  and  visits 
are  limited  as  provided  in  sec.  125. 

Dannemora  State  Hospital  is  for  male  convicts  declared  in- 
sane while  confined  in  State  prisons  or  reformatories  or  in  peni- 
tentiaries under  sentence  of  more  than  one  year.2 

The  medical  superintendent  is  appointed  by  the  superintend- 
ent of  State  prisons.  His  qualifications  and  duties  are  similar 
to  those  of  the  superintendent  of  Matteawan  State  Hospital,  and 
of  superintendents  of  other  State  hospitals.3 

Upon  the  certificate  of  the  physician  of  a  State  prison,  re- 
formatory, or  penitentiary  that  a  male  prisoner  confined  therein 
and  sentenced  thereto  foi  a  felony  is,  in  his  opinion,  insane,  such 
prisoner  shall  be  transferred  to  Dannemora  Hospital.4 

At  the  expiration  of  the  convict's  term,  if  he  is  still  insane, 
the  superintendent  shall  apply  for  an  inquiry  and  an  order  of  a 
judge  authorizing  him  to  retain  the  convict.5 

After  expiration  of  his  term,  any  convict  still  insane  but  safe 
to  be  at  large  may  be  discharged  to  custody  of  friends,  etc.,  or 
upon  order  of  commission  to  another  institution.6 

Upon  recovery  before  expiration  of  his  term  an  insane  con- 
vict shall  be  transferred  to  prison.7 

Correspondence  of  prisoners  and  visits  are  limited,  as  pro- 
vided in  sec.  153. 

INSANE  PERSONS  UNDER  DEATH  SENTENCE. — Any  person 
under  sentence  of  death  found  insane  by  a  commission  may  be 
ordered  removed  by  the  Governor  to  the  State  lunatic  asylum  for 
insane  criminals  (Matteawau  or  Danuemora  hospital)  and  con- 
fined there  until  recovery.  When  recovery  is  certified  by  the 
commission  in  lunacy,  and  a  justice  of  the  supreme  court  in 
the  county  where  the  asylum  is  located,  the  convict  shall  be  re- 
turned to  the  sheriff  to  be  dealt  with  according  to  law.8 

If  any  person  in  confinement  under  indictment  or  sentence  of 
imprisonment,  or  under  any  other  than  civil  process,  appears  to 
be  insane,  the  county  judge  shall  make  investigation.  The  pro- 

1  Insanity  Law,  sec.  122,  amended,          8  Sec.  149. 
c.  ">25,  Laws  of  1904.  •  Sec.  141. 

2  Sec.  140.  '  Sec.  142. 

*Sec.  141-147.  "Chap.  440.  Laws  of  1874,  s.  21, 

*  Sec.  148.  amended,  c.  267,  Laws  of  1876. 


704  INCOMPETENT  PERSONS — BROWN  AND   BECKER. 

cedure  is  provided  for.  A  commitment  to  a  State  hospital  may 
follow.1 

SERVICE  OF  LEGAL  PROCESS  UPON  AND  EXECUTION  OF 
LEGAL  PAPERS  BY  INMATES  OF  INSTITUTIONS. — It  is  provided 
by  Form  27  of  the  State  Commission  in  Lunacy  that  the  superin- 
tendent or  officer  in  charge  of  each  institution  for  the  care  and 
treatment  of  the  insane  shall  not  permit  service  of  legal  process 
upon  any  inmate,  other  than  citations  for  probate  of  wills,  let- 
ters of  administration,  or  final  accountings  in  surrogate  courts, 
or  such  as  may  be  instituted  for  the  appointment  of  committees, 
without  an  order  of  the  court.  The  superintendent  must  make  a 
record  of  any  service  of  papers,  file  a  copy  thereof,  and  forward 
a  copy  to  the  committee  or  the  nearest  relative  or  friend.  Per- 
sons intending  to  serve  papers  on  an  inmate  should  provide  two 
copies,  one  to  serve,  the  other  for  the  superintendent's  files. 

No  inmate  shall  be  permitted  to  sign  any  bill,  check,  contract, 
instrument,  etc.,  except  on  an  order  of  the  court,  and  a  similar 
procedure  shall  be  observed  to  that  described  above. 

INSANE  POOR. — If  any  inmate  of  any  State  almshouse  be- 
comes insane,  the  superintendent  of  State  and  alien  poor  shall 
cause  his  removal  to  the  State  asylum.2 

INSANE  VETERANS,  ETC. — If  any  inmate  of  the  State  Soldiers' 
and  Sailors'  Home  be  insane,  he  may  be  transferred  to  any  State 
hospital,  there  to  be  maintained  by  the  Home ; 3  also  any  mem- 
ber of  his  family.4 

APPOINTMENT  OF  COMMITTEE  OF  LUNATIC,  ETC. — "The 
jurisdiction  of  the  supreme  court  extends  to  the  custody  of  the 
person,  and  the  care  of  the  property,  of  a  person  incompetent  to 
manage  himself  or  his  affairs,  in  consequence  of  lunacy,  idiocy, 
habitual  drunkenness,  or  imbecility  arising  from  old  age  or  loss 
of  memory  and  understanding  or  other  cause."  "When  the 
county  court  has  concurrent  jurisdiction  of  those  matters,  the 
court  first  exercising  it  retains  it  exclusively.  In  all  proceedings 
for  the  appointment  of  a  committee,  the  person  shall  be  desig- 
nated as  "an  alleged  incompetent  person,"  and  after  such  ap- 
pointment as  "an  incompetent  person." 5 

1  Chap.  446,  Laws  of  1874,  a.  62,  1893,  c.  227,  Consol.  Laws  of  1909, 
amended,  c.  417,  Laws  of  1898.  c.  44,  s.  65. 

2  Poor  Law,  Laws  of  1896,  c.  225,  4  Poor  Law,  Laws  of  1896,  c.  225, 
Consol.  Laws  of  1909,  c.  42,  s.  97.  Consol.  Laws  of  1909,  c.  42,  s.  82. 

8  Public  Buildings   Law,   Laws  of          5  Code  of  Civil  Pro.,  s.  2,320. 


STATUTES   OF   NEW    YORK.  705 

DEFINITION. — In  the  construction  of  every  New  York  statute, 
unless  circumstances  indicate  a  different  meaning,  "the  terms 
lunatic  and  lunacy  include  every  kind  of  uusouuduess  of  mind 
except  idiocy. " 1 

The  court  must  preserve  the  incompetent's  "  property  from 
waste  or  destruction,  and,  out  of  the  proceeds  thereof,  must  pro- 
vide for  the  payment  of  his  debts,  and  for  the  safe-keeping  and 
maintenance,  and  the  education,  when  required,  of  the  incom- 
petent person  and  -his  family. " : 

Such  jurisdiction  must  be  exercised  by  means  of  a  committee 
of  the  person,  or  property,  or  a  portion  of  the  property.  The 
two  may  be  the  same  or  different  individuals.3 

Any  person  may  present  a  petition  for  the  appointment  of  a 
committee,  to  the  special  term  of  the  supreme  court  or  a  justice 
of  the  court,  within  the  district  where  the  alleged  incompetent 
resides,  unless  the  incompetent  is  confined  in  a  State  hospital ;  if 
he  be  not  a  resident  or  his  residence  cannot  be  ascertained,  then 
within  the  district  where  some  of  his  property  is  situated.4 

"Where  the  incompetent  has  been  committed  to  a  State  insti- 
tution, a  State  officer  or  the  superintendent  may  apply,  in  the 
district  where  the  hospital  is  located,  or  where  the  incompetent 
resided.  The  court  may,  on  notice  to  the  person  and  the  hus- 
band or  wife  if  any,  or  the  next  of  kin,  appoint  a  committee.5 

Costs  not  exceeding  $25  and  necessary  disbursements  may  be 
awarded  to  the  petitioner.8 

When  the  incompetent  has  property  and  no  other  person  pe- 
titions, the  overseer  or  superintendent  of  the  poor,  etc.,  where  he 
resides,  shall  apply.7 

The  petition  must  be  verified  and  show  the  names  and  resi- 
dences of  husband  or  wife,  next  of  kin  and  heirs  of  the  alleged 
incompetent,  the  probable  value  of  his  property,  and  any  con- 
veyances during  the  alleged  incompetency.  Proof  by  affidavit 
of  the  essential  facts  must  accompany  it.  Notice  of  the  petition 
shall  be  required,  unless  dispensed  with  for  cause,  to  the  hus- 
band or  wife,  or  one  or  more  relatives,  or  an  officer  specified  in 
the  last  section.8 


1  General  Construction  Law,  Laws  '  Ibid. 

of  1892,  c.  677,  Consol.  Laws  of  1909,  •  Ibid. 

c.  22,  s.  28.  •  Ibitl. 

1  Code  of  Civil  Pro.,  s.  2,321.  '  Ibid. 

1  Ibid.,  s.  2,322.  *Ibid. 


s.  2,323. 
s.  2,323a. 


s.  2,325. 


706  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

A  committee,  etc.,  appointed  in  a  foreign  country  or  State 
may  be  appointed  committee  of  the  property  within  the  State  of 
a  non-resident  on  giving  security.1 

The  court  must,  if  a  proper  case  appears,  either  direct  that  a 
commission  issue  to  one  or  more  persons,  or  direct  a  trial  by  jury 
before  the  court.  If  it  appears  that  property  has  been  trans- 
ferred without  adequate  consideration  the  court  may  restrain  the 
persons  who  have  received  it  from  disposing  of  it.2 

If  a  commission  is  issued  the  commissioners  shall  be  directed 
thereby  to  procure  a  jury  and  inquire  into  the  matters  set  forth 
in  the  petition,  the  alleged  incompetent's  property,  and  other 
matters  that  may  be  specified.3 

The  commissioners  shall  be  sworn,  and  carry  out  such  direc- 
tions. The  jury  shall  consist  of  twelve  to  twenty-four  persons. 
Upon  the  hearing  the  commissioners  or  a  majority  shall  have  the 
powers  of  the  court.  Twelve  jurors  must  concur.  The  inquisi- 
tion must  be  signed  by  the  jurors  concurring  and  by  the  com- 
missioners or  a  majority  and  filed,  annexed  to  the  commission, 
with  the  clerk.  The  commissioners'  compensation  shall  be  fixed 
by  the  court;  the  jurors'  shall  be  the  same  as  trial  jurors';  ex- 
penses shall  be  paid  by  the  petitioner.4 

When  the  trial  is  by  a  jury  at  a  trial  term  of  the  court,  dis- 
tinct issues  must  be  framed  in  the  order.  The  procedure  on  the 
trial  and  the  review  of  the  trial  are  the  same  as  in  the  case  of  the 
trial  of  an  issue  of  fact  in  an  action.  Collateral  issues  may  be 
inquired  into  by  reference.  The  expenses  must  be  paid  by  the 
petitioner.5 

"When  the  petition  alleges  that  the  person,  with  respect  to 
whom  it  pays  for  the  appointment  of  a  committee,  is  incompetent 
by  reason  of  lunacy,  the  inquiry  with  respect  to  his  competency, 
upon  the  execution  of  a  commission,  or  the  trial  at  a  trial  term, 
as  prescribed  in  this  title,  must  be  confined  to  the  question, 
whether  he  is  so  incompetent  at  the  time  of  the  inquiry ;  and 
testimony  respecting  anything  said  or  done  by  him  or  his  de- 
meanor or  state  of  mind  more  than  two  years  before  the  hear- 
ing or  trial,  shall  not  be  received  as  proof  of  lunacy,  unless  the 
court  otherwise  specially  directs,  in  the  order  granting  the  com- 
mission, or  directing  the  trial  by  jury."6 

'Code  of  Civil  Pro.,  s.  2,326.  4  Ibid.,  s.  2,329-2,333. 

2  Ibid.,  s.   2.327.  5  Ibid.,  s.  2,334. 

'*  Ibid.,  s.  2,328.  '  Ibid.,  s.  2,335. 


STATUTES  OF  NEW   YORK.  707 

Upon  the  return  of  the  commission  or  the  verdict  of  the  jury, 
the  court  must  either  direct  a  new  trial  or  make  a  final  order. 
Costs  not  exceeding  $50  and  disbursements  may  be  awarded 
to  successful  party,  payable  when  a  committee  is  appointed 
from  any  funds  in  his  hands;  and  the  committee  may  be 
required  to  pay  an  attorney's  fee  not  exceeding  $50,  and  dis- 
bursements.1 

Sections  2,325  to  2,336  do  not  apply  to  an  application  for  a 
committee  made  on  behalf  of  the  State  to  secure  reimbursement 
for  maintenance  in  a  State  institution.2 

Security  must  be  given  by  a  committee  of  the  property,  and 
may  be  required  of  a  committee  of  the  property.3 

A  committee  of  the  property  is  entitled  to  the  same  com- 
pensation as  an  executor  or  administrator,  with  additional  com- 
pensation when  his  services  exceed  those  of  such  persons.  The 
compensation  of  a  committee  of  the  person  shall  be  fixed  by  the 
court.4 

A  committee  is  under  the  control  of  the  court.  He  can- 
not dispose  of  real  property  except  to  lease  it  for  a  term  of 
not  exceeding  five  years  except  by  special  direction  of  the 
court.5 

A  committee  of  the  property  may  maintain  any  action  in  his 
own  name  as  committee  that  the  incompetent  might  otherwise 
have  maintained.6 

In  actions  by  or  against  a  committee,  the  plaintiff  may  be 
required  to  give  security  for  costs.7 

A  committee  of  the  property  must  file  an  inventory  and  ac- 
count in  January  of  each  year,  etc.8 

When  the  incompetent  person  becomes  competent  the  com- 
mittee must  be  discharged  and  his  property  restored  to  him." 

The  powers  of  the  committee  cease  with  the  death  of  the  in- 
competent.10 

A  trust  company  may  act  as  a  committee  of  the  property." 

The  lunacy  of  a  party  to  an  arbitration  with  appointment  of 
a  committee  revokes  the  submission.12 

1  Code  of  Civil  Pro.,  s.  2,336.  8  Ibid.,  s.  2,341-2,342. 

Ibid.  s.  2,336a.  •  Ibid.,  s.  2,343. 


1  Ibid. 


1  Ibid. 
Ibid. 


s.  2,337.  10  Ibid.,  s.  2,344. 

s.  2,338.  "  Banking  Law,  Laws  of  1892,  c. 

s.  2,339.  689,   Consol.  Laws  of    1909,  c.  2,  a. 

s.  2,340-2,355.  186. 

s.  3,271.  "  Code  of  Civ.  Pro.,  s.  2,382. 


708  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

STATUTES  OF  LIMITATION. — Statutes  of  limitation  generally 
are  suspended  during  insanity.1 

SALE,  ETC.,  OF  EEAL  PROPERTY  OF  INCOMPETENTS. — An 
order  for  the  partition  of  real  property  held  in  joint  tenancy  or 
in  common  by  an  infant,  idiot,  lunatic,  or  habitual  drunkard, 
upon  the  agreement  of  the  general  guardian  or  committee  thereof, 
may  be  made  by  the  supreme  or  county  court  where  the  property 
is  situated.  Notice  shall  be  given  to  superintendent,  etc.,  of  a 
State  hospital  where  such  incompetent  is  confined.2 

An  action  may  be  maintained  to  compel  the  sale  of  an  incom- 
petent's real  property  in  certain  cases.3 

Certain  interests  of  incompetents  in  real  property  may  be  sold, 
upon  petition  of  the  committee,  notice  to  superintendent  as  above, 
and  an  order  of  the  court.4 

ANNULMENT  OF  MARRIAGE. — A  marriage  may  be  annulled 
for  the  cause,  existing  at  the  time  of  the  marriage,  that  one  of 
the  parties  was  an  idiot  or  a  lunatic.5 

Such  action  may  be  maintained  during  the  lifetime  of  the 
idiot  or  the  continuance  of  the  lunacy,  "by  any  relative  who  has 
an  interest  to  avoid  the  marriage. "  Such  an  action  may  also  be 
maintained  by  the  lunatic  after  restoration  if  there  has  been  no 
free  cohabitation  thereafter.  When  no  relative  brings  the  action 
a  next  friend  may  upon  order  of  the  court,  except  after  restora- 
tion of  the  lunatic.6 

MISCELLANEOUS  PRACTICE  PROVISIONS. — The  court  before 
swearing  an  apparently  weak-minded  witness  must  ascertain  his 
capacity  and  the  extent  of  his  knowledge.7 

No  person  interested  in  the  result  may  testify  to  personal 
transactions  with  one  since  become  insane  against  his  interest.8 

Testimony  of  a  witness  who  has  since  become  insane  given  on 
a  former  trial  may  be  read  on  a  new  trial  of  the  same  action.9 

If  a  justice  of  the  peace  becomes  insane  and  is  unable  to  make 
a  return  on  an  appeal,  the  proceedings  before  him  may  be  other- 
wise proved.10 

'Code  of  Civil  Pro.,  s.  375,   392,  lations  Law,  Laws  of  1896,   c.   272, 

396,  408,  1,291,  1,527.  Consol.  Laws  of  1909,  c.  14,  s.  7,  10. 

2  Ibid.,  s.  1,590-1,593.  *  Ibid.,  s.  1,746-1,748,  1,755. 

3  Ibid.,  s.  2,345-2,347.  7  Ibid.,  s.  850. 

4  Ibid.,  8.  2,348-2,351,  2,353-2,359,          8  Ibid.,  s.  829. 

2,360-2,364.  8  Ibid.,  a.  830,  2,651 ;  Code  of  Crimi- 

8  Ibid.,  8.  1,743.     c/.  Domestic  Re-      nal  Pro.,  s.  8. 

10  Ibid.,  s.  3,056. 


STATUTES   OF  NEW   YORK.  709 

If  a  notary  public  becomes  insane  his  original  protest  of  a 
demand  of  acceptance  or  of  payment  is  presumptive  evidence.1 

Personal  service  of  the  summons  in  an  action  or  of  a  citation 
against  a  person  judicially  declared  to  be  incompetent  to  manage 
his  affairs  for  whom  a  committee  has  been  appointed  must  be 
made  on  the  committee  and  also  on  the  incompetent.2 

If  the  defendant  is  believed  to  be  incompetent  though  not  de- 
clared so,  the  court  may  by  order  designate  a  person  on  whom 
service  shall  also  be  made.3 

The  same  may  be  done  when  a  committee  has  been  appointed 
but  the  court  believes  him  not  disinterested ;  and  the  court  may 
appoint  a  general  guardian  ad  litem  to  the  exclusion  of  the  com- 
mittee.4 

If  service  on  the  lunatic  will  be  dangerous  it  may  be  dis- 
pensed with.5 

A  lunatic  or  an  idiot  may  be  discharged  from  arrest  under 
civil  process  as  a  privileged  person  in  the  discretion  of  the  court.8 

PROCEDURE  IN  CRIMINAL  CASES. — In  criminal  cases  "when- 
ever a  person  in  confinement  under  indictment  desires  to  offer 
the  plea  of  insanity,  he  may  present  such  plea  at  the  time  of  his 
arraignment,  as  a  specification  under  the  plea  of  not  guilty."7 

"When  the  defense  is  insanity  of  the  defendant  the  jury  must 
be  instructed,  if  they  acquit  him  on  that  ground,  to  state  the  fact 
with  their  verdict.  The  court  must,  therefore,  if  the  defendant 
be  in  custody,  and  they  deem  his  discharge  dangerous  to  the 
public  peace  or  safety,  order  him  committed  to  the  State  lunatic 
asylum  until  he  becomes  sane."8 

After  conviction,  the  defendant  may  show  for  cause  why  he 
should  not  be  sentenced,  that  he  is  insane.  If  the  court  believes 
he  is  insane  the  question  must  be  tried,  and  if  the  prisoner  is 
found  insane  he  must  be  confined  in  the  asylum  until  he  recovers.9 

When  the  defendant  pleads  not  guilty  because  of  insanity, 
the  court  may,  instead  of  proceeding  with  the  trial,  appoint  a 
commission  of  not  more  than  three  persons  to  examine  him  and 
report  as  to  his  insanity  at  the  time  of  the  commission  of  the 
crime. 

1  Code  of  Civil  Pro.,  s.  924.  •  Ibid.,  s.  534. 

7  Ibid.,  B.  426,  2,526.  T  Code  of  Criminal  Pro.,  s.  336. 

3  Ibid.,  s.  427.  "  Ibui.,  s.  454. 

4  Ibid.,  s.  428;   cf.  B.  2,530-2,531.  •  Ibid.,  a.  481. 
6  Ibid.,  s.  429. 


710  INCOMPETENT   PERSONS — BROWN   AND  BECKER. 

If  a  defendant  in  confinement  under  indictment  appears  to 
be,  before  or  after  conviction,  insane,  the  court  may  appoint  a 
like  commission  (unless  he  is  under  sentence  of  death). 

The  commission  must  take  the  oath,  be  attended  by  the  district 
attorney,  and  call  witnesses.  Counsel  for  defendant  may  take 
part.1 

If  the  finding  is  that  he  is  insane,  the  trial  must  be  suspended, 
and  he  may  be  confined.2 

The  costs  and  expenses  are  a  charge  on  the  county.3 

CRIMINAL  EESPONSIBILITY. — "A  person  is  presumed  to  be 
responsible  for  his  acts.  The  burden  of  proving  that  he  is  irre- 
sponsible is  upon  the  accused  person,  except  as  otherwise  pre- 
scribed in  this  chapter. " 4 

"An  act  done  by  a  person  who  is  an  idiot,  imbecile,  lunatic, 
or  insane  is  not  a  crime.  A  person  cannot  be  tried,  sentenced 
to  any  punishment  or  punished  for  a  crime  when  he  is  in  a  state 
of  idiocy,  imbecility,  lunacy,  or  insanity  so  as  to  be  incapable  of 
understanding  the  proceeding  or  making  his  defense."5 

"A  person  is  not  excused  from  criminal  liability  as  an  idiot, 
imbecile,  lunatic,  or  insane  person,  except  upon  proof  that,  at 
the  time  of  committing  the  alleged  criminal  act,  he  was  laboring 
under  such  a  defect  of  reason  as : 

"  1.  Not  to  know  the  nature  and  quality  of  the  act  he  was 
doing;  or 

"2.  Not  to  know  that  the  act  was  wrong."8 

"No  act  committed  by  a  person  while  in  a  state  of  voluntary 
intoxication  shall  be  deemed  less  criminal  by  reason  of  his  hav- 
ing been  in  such  condition.  But  whenever  the  actual  existence 
of  any  particular  purpose,  motive,  or  intent  is  a  necessary  ele- 
ment to  constitute  a  particular  species  or  degree  of  crime,  the 
jury  may  take  into  consideration  the  fact  that  the  accused  was 
intoxicated  at  the  time,  in  determining  the  purpose,  motive,  or 
intent  with  which  he  committed  the  act."7 

"A  morbid  propensity  to  commit  certain  prohibited  acts,  ex- 
isting in  the  mind  of  a  person  who  is  not  shown  to  have  been  in- 
capable of  knowing  the  wrongfulness  of  such  acts,  forms  no  de- 
fense to  a  prosecution  therefor. " 8 

1  Code  of  Criminal  Pro.,  s.  658.  *  Ibid.,  s.  1,120. 

2  Ibid.,  8.  659,  661.  6  Ibid.,  s.  1,120. 

3  Ibid.,  8.  662,  662a.  7  Ibid.,  s.  1,120. 
*  Penal  Law,  s.  815.  8  Ibid.,  s.  34. 


STATUTES   OF   NEW   YORK.  711 

CRIMES  AGAINST  THE  INSANE. — One  person  may  use  violence 
upon  the  person  of  another  who  is  of  unsound  mind,  including 
persons  temporarily  or  partially  deprived  of  reason,  to  restrain 
him  from  committing  an  act  dangerous  to  himself  or  another,  or 
to  restrain  him  for  the  benefit  of  his  health  until  legal  authority 
therefor  can  be  obtained.1 

When  through  unsoundness  of  mind,  including  temporary 
unsoundness,  a  woman  is  incapable  of  giving  consent  or  does 
not  offer  resistance,  intercourse  is  rape.2 

A  minister  or  magistrate  who  knowingly  solemnizes  the  mar- 
riage of  an  idiot  or  insane  person  is  guilty  of  a  misdemeanor.3 

A  person  who  unlawfully  confines  or  who  maltreats  an  idiot, 
lunatic,  or  insane  person,  or  neglects  his  duty  to  such  person  under 
confinement,  is  guilty  of  a  misdemeanor.4 

Maintaining  a  private  insane  asylum  without  a  license  is  a 
misdemeanor.5 

The  exhibition  of  any  child  under  sixteen  who  is  insane  or 
idiotic  is  a  misdemeanor.6 

EXEMPTIONS  AND  DISABILITIES  OF  INSANE  PERSONS.  —The 
consent  of  an  insane  parent  to  the  adoption  of  his  child  is  un- 
necessary.7 

An  idiot  or  person  of  unsound  mind  is  not  one  of  those  who 
may  transfer  real  property,  make  a  will,  or  prosecute  an  action 
in  person  or  by  attorney.8 

Idiots,  lunatics,  and  habitual  drunkards  are  excepted  from 
liability  to  military  duty.9 

Idiots  and  lunatics  are  not  liable  to  the  village  poll  tax.10 

They  are  exempt  from  assessment  for  highway  labor  in 
towns.11 

INSANE  EMIGRANTS. — The  master  of  every  vessel  entering 
the  port  of  New  York  shall  make  a  report  in  writing,  which  shall 
show  whether  any  passengers  are  lunatics  or  idiots,  etc.12 

1  Penal  Law,  s.  246.  c.  50,  Laws  of  1867,  c.  782,  s.  3.  Code 

Ihid.  e.  2,010.  of  Civil  Pro.,  s.  55. 

s.  1,450.  •  Military  Law,  Laws  of    1898,  c. 

s.  1,121.  212. Consul.  Laws  of  1909.  c.  36,8.  110. 

8.  1 ,122.  •  lo  Village  Law,  Laws  of  1897,  c.  414, 
s.  485,  subd.  4.  Consol.  Laws  of  1909.  c.  64.  s.  103. 

7  Domestic  Relations  Law,  s.  Ill,  "  Highway  Law,  Laws  of  1890,  c. 
Laws  of  1896,  c.  272.     Consol.  Laws  568,  Consol.  Laws  of  1909.  c.  25,  s.  43. 
of  1909,  c.  14.  12  Laws  of  1847.  c.    195,   s.    1,   as 

8  Real  Property  Law,  s.  11,  Laws  of  amended  Laws  of  1849,  c.  350,  s.  1, 
!396,  c.  547;  Consol.  Laws  of  1909,  and  Laws  of  1851,  c.  523,  a.  3. 


Ibid. 

Ibid. 
'  Ibid. 
'Ibid. 


712  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

The  commissioners  of  emigration  shall  inspect  the  ship  and 
ascertain  whether  there  are  any  such  persons  on  board,  etc.1 

NORTH  CAROLINA. 

[The  references  are  to  Eevisals  of  1905  and  of  1907  of  North 
Carolina.] 

INQUISITION  OF  LUNACY. — On  verified  petition  to  the  Superior 
Court  of  the  county  where  the  alleged  idiot,  inebriate,  or  lunatic 
resides,  an  inquisition  may  be  had  on  notice  to  the  person  by  a 
jury  of  twelve  men.  If  such  person  be  found  an  idiot,  inebriate, 
or  lunatic,  a  guardian  may  be  appointed  as  in  cases  of  orphans.2 

WHO  DEEMED  AN  INEBRIATE.  — Any  person  who  habitually, 
whether  continuously  or  periodically  indulges  in  the  use  of  intoxi- 
cating liquors,  narcotics,  or  drugs  to  such  an  extent  as  to  stupefy 
his  mind,  and  to  render  him  incompetent  to  transact  ordinary 
business  with  safety  to  his  estate,  or  to  render  him  dangerous  to 
persons  or  property,  or  cruel  to  his  family,  shall  be  deemed  an 
inebriate.  At  the  time  of  inquisition  such  use  of  liquors  must 
be  of  at  least  one  year's  standing.3 

EESTORATION  OF  PROPERTY  OF  LUNATIC  OR  INEBRIATE. 
—Whenever  a  lunatic  or  inebriate  shall  recover  and  become 
capable  of  managing  his  own  affairs,  the  court  which  appointed 
such  guardian  is  authorized  to  remove  him  and  restore  all  the 
property  of  such  person  after  an  inquisition  by  a  jury  of  six.4 

APPOINTMENT  OF  GUARDIAN  FOR  LUNATIC  CONFINED  IN 
ASYLUM. — If  any  person  be  confined  in  any  asylum  for  lunatics 
and  insane  persons,  the  certificate  of  the  superintendent  declar- 
ing such  person  to  be  of  unsound  mind  and  memory,  sworn  to 
and  subscribed  before  the  clerk  of  the  superior  court  of  the  county 
in  which  such  asylum  is  situated,  shall  be  sufficient  evidence  to 
authorize  the  clerk  to  appoint  a  guardian  for  such  person.5 

SALE  OF  PROPERTY  OF  INSANE  PERSON. — Property  of  an 
insane  person  may  be  sold  on  the  order  of  the  clerk  of  the 
superior  court,  when  it  appears  to  him  that  the  personal  estate 
has  been  expended,  or  is  insufficient  for  the  support  of  the  luna- 
tic, and  that  he  is  likely  to  become  chargeable  on  the  county. 
The  order  shall  specify  the  property  to  be  disposed  of. 

»Laws    of     1847,     c.     195,   a.    3,          3  Ibid.,  s.  1,892. 

amended,  ut  supra.  4  Ibid.,  B.  1,893. 

2  Revisal,  s.  1,890.  •  Ibid.,  B.  1,891. 


STATUTES  OF  NORTH   CAROLINA.  713 

Such  order  shall  bo  made  upon  the  petition  of  tho  guardian 
setting  forth  that  such  sale  is  necessary  for  the  support  of  the 
insane  person,  or  for  the  discharge  of  debts  incurred  for  his 
maintenance.1 

SURPLUS  INCOME. — Whenever  tho  annual  income  of  tho  es- 
tate of  a  male  lunatic  is  more  than  suflicient  to  support  himself 
and  to  maintain  and  educate  the  members  of  his  family,  the  clerk 
of  the  court  may  direct  that  fit  and  proper  advancements  be  made 
out  of  the  surplus  of  such  income  to  children  and  grandchildren, 
not  being  memlx;rs  of  his  family  and  entitled  lobe  supported, 
educated,  and  maintained  out  of  such  estate.  In  the  case  of  a 
lunatic  widow,  the  mother  of  minor  children,  the  surplus  of  her 
income  may  be  disposed  of  in  like  manner. 

Such  advancements  shall  only  be  made  for  tho  bettor  pro- 
motion in  life  of  such  as  are  of  ago  or  married,  and  for  the  main- 
tenance, support,  and  education  of  such  as  are  under  the  ago  of 
twenty-one  years  and  unmarried. 

In  every  application  for  such  advancement,  tho  guardian  of 
the  insane  person  and  of  persons  entitled  to  a  distributive  share 
of  the  estate  shall  be  made  parties.  Huch  advancement  shall  bo 
made  in  the  same  equal  manner  as  if  made  by  the  insane  |>orson 
himself,  and  every  sum  advanced  to  a  child  or  grandchild  shall 
bo  an  advancement  and  shall  boar  interest  from  the  time  it  was 
received.  Tho  clerk  may  select  and  decree  advancement  to  such 
as  most  need  the  same. 

The  clerk  shall  withhold  advancements  from  such  persons  as 
will  probably  waste  them.2 

STATE  HOHIMTALH. — There  are  three  asylums  maintained  at 
the  expense  of  the  State — one  located  near  Raleigh,  another  near 
Morgaiiton,  and  another  nearCJoldsboro.     The  first  two  arc  chiefly 
for  the  accommodation  of  tho  white  insane,  and  the  Stato  llos 
pital  at  Goldsboro  is  used  exclusively  for  the  colon*!  insane  of 
the  State.     In  addition  there  is  a  State  Hospital  for  the  Danger 
ous  Insane,  located  in  the  State's  prison. 

Each  asylum  is  under  the  management  of  a  lioard  of  nine 
directors  holding  office  for  six  years.  Three  mcml>erM  of  the 
board  constitute  an  executive  committee. 

Each  board  directs  and  manages  the  afl'airs  of  the  m-l Million 
under  its  charge,  and  shall  appoint  a  superintendent  thereof  and 
1  Reviaal,  «.  1,890,  1,897.  »  Ibid.,  H.  1.89V- 1.900. 


714  INCOMPETENT    PERSONS — BROWN   AND    BECKER. 

prescribe  his  duties.  He  shall  be  a  skilful  physician,  educated 
to  his  profession,  of  good  moral  character,  of  prompt  business 
habits,  and  of  kindly  disposition.  His  term  is  six  years. 

The  superintendent  appoints  one  or  more  assistant  physicians, 
a  steward,  and,  if  advisable,  a  matron. 

Each  board  makes  such  by-laws  and  regulations  for  the  gov- 
ernment of  the  institution  under  its  charge  as  shall  be  necessary. 

Private  asylums  are  required  to  be  licensed.1 

ADMISSION  INTO  STATE  ASYLUMS. — Idiots  are  not  admitted. 
Priority  shall  be  given  to  the  indigent.  An  affidavit  shall  be 
filed  in  writing  with  the  clerk  of  the  superior  court  of  the  county, 
or,  in  an  emergency,  a  justice  of  the  peace  by  any  person  alleging 
the  examination  of  the  insane  person  and  the  belief  that  he  is  in- 
sane and  a  fit  subject  for  admission  into  the  insane  asylum. 
Thereupon  the  clerk  shall,  if  necessary,  cause  to  be  apprehended 
the  person  alleged  to  be  insane,  examine  him,  and  take  the  testi- 
mony of  the  county  physician,  or  some  other  licensed  resident 
physician,  and  others.  If  he  decides  that  such  person  is  insane, 
and  no  person  is  willing  to  give  security  to  restrain  the  lunatic 
from  committing  injuries  and  to  keep  and  support  him,  they 
shall  direct  such  lunatic  to  be  removed  to  the  proper  hospital  as 
a  patient,  and  to  that  end  direct  a  warrant  to  the  sheriff,  and  at 
the  same  time  transmit  to  the  proper  board  of  directors  the  ex- 
amination of  the  witnesses  and  a  statement  of  such  facts  as  the 
said  justice  shall  deem  pertinent  to  the  subject-matter. 

If  any  person  becomes  suddenly  violently  insane  in  another 
county  than  that  of  his  residence,  the  authorities  there  have  juris- 
diction to  commit.  Non-resident  insane  are  to  be  returned  to 
their  State.2 

CRIMINAL  INSANE.  —The  State  Hospital  for  the  Dangerous 
Insane  is  for  persons  accused  or  convicted  of  crime  and  insane, 
or  acquitted  because  of  insanity,  and  insane  convicts.  Such  are 
committed  after  an  inquest.  Discharges  may  be  obtained  by 
writ  of  habeas  corpus.3 

'Revisal,     s.     4,542-4,568,     4,600,          2  Ibid.,  8.  4,572-1,578,  4,582. 
4,612.  3  Ibid.,  8.  4,612-^,621. 


STATUTES   OF   NORTH   DAKOTA.  715 


NORTH  DAKOTA. 

[The  references  are  to  Revised  Codes  of  North  Dakota,  1905.] 

DEFINITION. — The  term  "insane"  includes  any  species  of  in- 
sanity or  mental  derangement.  The  term  "idiot  "is  restricted 
to  persons  supposed  to  be  actually  without  mind.  No  idiot  shall 
be  admitted  into  the  hospital  for  the  insane. 

GUARDIANS. — The  county  court,  on  the  verified  petition  of 
any  relative  or  friend  that  any  person  is  of  unsound  mind,  or 
from  any  cause  is  mentally  incompetent  to  manage  his  property, 
may  cause  notice  to  be  given  to  such  alleged  insane  person  of  the 
time  and  place  of  hearing. 

If,  after  a  full  hearing  and  examination,  it  appears  to  the 
court  that  the  person  in  question  is  incapable  of  taking  care  of 
himself  and  managing  his  property,  it  must  appoint  a  guardian 
of  his  person  and  estate. 

POWERS  OF  GUARDIAN. — Every  guardian  appointed  as  pro- 
vided in  the  preceding  section  has  the  care  and  custody  of  the 
person  of  his  ward  and  the  management  of  all  his  estate,  until  he 
is  legally  discharged.1 

The  powers  and  duties  of  guardians  of  insane  persons  are 
similar  in  all  respects  to  those  of  guardians  of  minors  as  pre- 
scribed in  the  Probate  Code,  chapter  7,  articles  1,  3-6. 

RESTORATION  OF  INSANE. — Any  person  who  has  been  de- 
clared of  unsound  mind,  or  the  guardian  or  relatives  or  friend  of 
such  person,  may  apply  by  petition  to  the  county  court  of  the 
county  in  which  he  was  so  declared  to  have  the  fact  of  his  restora- 
tion to  capacity  judicially  determined.  Notice  of  a  hearing  must 
be  given  to  the  guardian  of  the  petitioner,  to  the  husband  or 
wife  if  there  be  one,  and  to  the  father  or  mother  if  living  in  the 
county.  On  the  trial  the  guardian  or  relative,  and  in  the  dis- 
cretion of  the  judge,  any  other  person,  may  contest  the  right  of 
the  petitioner  to  the  relief  demanded.  Witnesses  may  be  required 
to  appear  and  testify.  If  it  be  found  that  the  petitioner  be  of 
sound  mind  and  capable  of  taking  care  of  himself  and  of  his 
property,  his  restoration  to  capacity  shall  be  adjudged  and  the 
guardianship  shall  cease.2 

1  North  DakotaCodes,  1905,s.  8,248-          2  Ibid.,  s.  8,251. 
8.250.     Probate  Code,  Art.  2. 


716       INCOMPETENT  PERSONS— BROWN  AND  BECKER. 

COMMISSIONERS  OF  INSANITY  AND  COMMITMENT  OF  THE 
INSANE.  — There  is  in  each,  county  a  board  of  commissioners,  con- 
sisting of  three  persons,  known  as  commissioners  of  insanity. 
The  county  judge  is  a  member  and  chairman  of  such  board,  and 
of  the  others,  one  is  a  lawyer  and  one  a  physician. 

Such  commissioners  have  cognizance  of  all  applications  for 
admission  to  the  hospital,  or  for  the  safe-keeping  of  insane 
persons  within  their  counties. 

Application  for  admission  to  the  hospital  must  be  made  in 
writing  in  the  nature  of  a  verified  information  alleging  that  the 
person  on  whose  behalf  the  application  is  made  is  believed  to  be 
insane  and  a  fit  subject  for  custody  and  treatment  in  the  hospital. 

The  grounds  of  the  information  shall  thereupon  be  investi- 
gated by  the  commissioners.  They  may  require  that  the  person 
be  brought  before  them  and  examined,  and  may  issue  their  war- 
rant therefor.  They  shall  hear  testimony  for  and  against  the 
application,  if  any.  Any  citizen  or  relative  of  the  alleged  in- 
sane person  may  appear  by  counsel.  The  commissioners  shall 
appoint  some  regularly  practising  physician  of  the  county,  who 
may  be  of  their  own  number,  to  make  a  personal  examination 
touching  the  truth  of  the  allegations  in  the  information,  and  the 
actual  condition  of  such  person,  and  report  to  them  thereon. 

On  the  return  of  the  physician's  certificate,  the  commissioners 
shall  conclude  their  investigation  and  find  whether  the  person  is 
insane  and  a  fit  subject  for  treatment  and  custody  in  the  hospital. 
If  he  is  found  not  insane,  they  shall  order  his  discharge.  If 
insane,  they  shall  issue  their  warrant  authorizing  the  superin- 
tendent of  the  hospital  to  receive  such  person  as  a  patient.  If 
such  person  cannot  be  admitted  into  the  hospital  at  once  and 
cannot  with  safety  be  allowed  to  go  at  liberty,  the  commissioners 
shall  require  him  to  be  suitably  provided  for  otherwise,  until 
such  admission  can  be  had.  Such  patients  may  be  cared  for 
either  as  public  or  private  patients.  Private  patients  are  those 
whose  relatives  or  friends  will  obligate  themselves  to  take  care 
of  and  provide  for  them  without  public  charge.  In  the  case  of 
private  patients  the  commissioners  appoint  a  special  custodian  to 
restrain  and  care  for  the  patient.  Public  patients  are  cared  for 
at  the  expense  of  their  county.1 

EESTORATION  TO  SANITY. — To  secure  the  release  of  persons 

1  N  orth  Dakota  Codes,  1905,  s.  1,889-1,896;   chapter  137,  Laws  of  1907. 


STATUTES   OP  OHIO.  717 

under  confinement  as  insane  a  special  commission  of  three  per- 
sons may  be  obtained  by  verified  petition  and  an  inquiry  had, 
but  not  oftener  than  once  in  six  months.1 

WRIT  OF  HABEAS  CORPUS.  — All  persons  confined  as  insane 
shall  be  entitled  to  the  benefit  of  habeas  corpus,  and  the  question 
of  insanity  shall  be  decided  at  the  hearing,  and  if  the  judge  or 
court  shall  decide  that  the  person  is  insane,  such  decision  shall 
be  no  bar  to  the  issuing  of  a  writ  the  second  time,  whenever  it 
shall  be  alleged  that  such  person  has  been  restored  to  reason.2 

STATE  ASYLUM. — The  North  Dakota  Hospital  for  the  Insane 
is  located  near  Jamestown  in  the  county  of  Stutsman.  It  is  gov- 
erned by  a  board  of  trustees  of  five  members  appointed  by  the 
governor. 

As  to  the  care  and  management  of  the  hospital,  see  sections 
1183-1208,  article  11  of  chapter  15  of  the  North  Dakota  Political 
Code,  as  amended  by  chapter  137  of  the  Laws  of  1907. 

CRIMINAL  INSANE.  — When  a  defendant  is  acquitted  by  reason 
of  insanity,  the  judge  may  commit  him  to  the  State  hospital, 
or  to  the  care  of  some  person.3 

The  insanity  of  criminals  condemned  to  death  may  be  tried 
by  a  jury  of  six.4 

A  special  jury  of  twelve  may  be  summoned  to  try  a  prisoner's 
sanity  before  or  during  his  trial,  or  after  conviction.5 

The  provisions  as  to  criminal  responsibility  are  similar  to 
those  of  the  New  York  Penal  Law.  The  test  is  whether  "  at  the 
time  of  committing  the  act  charged  they  were  incapable  of  know- 
ing its  wrongfuluess. " 8 

OHIO. 

[The  references  are  to  Bates'  Annotated  Ohio  Statutes,  1008.] 
DEFINITIONS. — The  terms  "insane"  and  "lunatic"  include 

every   species  of  insanity   or  mental   derangement;   the  term 

"idiot"  is  restricted  to  a  person  foolish  from  birth,  one  supposed 

to  be  actually  without  mind.7 

GUARDIANS  OF  LUNATICS,  IDIOTS,    AND   IMBECILES. —The 

probate  court,  upon  satisfactory  proof  that  any  person  is  a  luna- 

1  North    Dakota    Codes,  1905,    a.          *  Ibid.,  s.  10,028-10.130. 
1,904-1,905.  *  Ibid.,  s.  10.207-10,215. 

1  Ibid.,  s.  1 ,906.  •  Ibid.,  s.  8,544.  8,546. 

•  Ibid.,  B.  8,547,  10,064.  T  Ohio  Statutes,  s.  720. 


718  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

tic,  idiot,  or  imbecile,  shall  appoint  a  guardian  for  such  person. 
No  such  guardian  shall  be  appointed  except  upon  three  days' 
notice  to  the  person's  next  of  kin  residing  in  the  county. 

If  the  wife  of  such  person  is  competent,  the  probate  judge 
may  appoint  her  as  his  guardian. 

All  laws  relating  to  guardians  for  minors  and  their  wards  and 
pointing  out  the  duties,  rights,  and  liabilities  of  such  guardians 
and  their  sureties,  are  applicable  to  such  guardians. 

In  the  settlement  of  accounts  of  guardians  of  idiots,  imbeciles, 
or  lunatics,  no  voucher  shall  be  received  from  or  allowed  as  a 
credit  to  the  guardian  which  is  signed  by  such  idiot,  imbecile, 
or  lunatic.1 

MANAGEMENT  OF  EEAL  ESTATE  OF  WARD. — Whenever  the 
sale  of  the  real  estate  or  minerals  therein  of  a  ward  is  necessary 
for  his  support  or  the  support  of  his  family  or  the  payment  of 
his  debts,  or  when  such  sale  will  be  for  the  interest  of  such  ward 
or  his  children,  the  guardian  may  sell  the  same  under  like  pro- 
ceedings as  required  to  authorize  the  sale  of  real  estate  by  the 
guardian  of  a  minor.  But  if  it  be  more  for  the  interest  of  such 
ward  or  his  children,  the.  probate  court  upon  the  petition  of  the 
guardian  may  authorize  and  sell  all  such  real  estate  iu  private, 
but  only  at  full  value. 

The  guardian  may  in  the  same  manner  as  the  guardian  of  a 
minor  be  authorized  to  lease  and  improve  the  real  estate  of  his 
ward,  and  if  the  lease  extend  beyond  the  time  of  the  restoration 
of  such  ward  to  sound  mind  or  his  death,  such  lease  shall  termi- 
nate on  his  restoration  or  death,  unless  such  lease  be  confirmed 
by  such  ward  or  his  legal  representatives ;  but  in  case  of  such 
termination  of  the. lease,  the  tenant  shall  have  a  lieu  upon  the 
premises  for  any  sum  expended  by  him  in  making  improvements. 

The  probate  court  may  authorize  the  guardian  to  lease  the 
real  estate  for  a  term  of  years  or  by  perpetual  lease,  with  or  with- 
out the  privilege  of  purchase  if  it  is  necessary  for  the  support  of 
the  ward  or  his  family,  or  if  such  lease  will  be  for  the  best  inter- 
est of  him  or  them. 

The  application  for  authority  to  make  such  a  long  lease  is  by 
petition  setting  forth  the  necessary  facts. 

On  filing  the  petition  the  same  proceedings  shall  be  had  as  on 
petition  for  sale  of  the  real  estate  of  a  minor. 

1  Ohio  Statutes,  s.  6,302-6.304. 


STATUTES   OF   OHIO  719 

The  court  may  prescribe  the  terms,  covenants,  conditions,  and 
stipulations  of  the  lease. 

The  guardian  may  in  like  manner  obtain  authority  to  improve 
the  real  estate.1 

INSOLVENCY  OF  LUNATIC.— If  the  estate  of  an  idiot,  imbecile, 
or  lunatic  is  insolvent,  the  same  shall  be  settled  in  like  manner 
and  like  proceedings  may  be  had  as  is  required  by  law  for  the 
settlement  of  the  insolvent  estate  of  a  deceased  person.2 

GUARDIANS  OF  DRUNKARDS. — The  probate  court,  upon  sat- 
isfactory proof  that  any  person  is  incapable  of  taking  proper  care 
of  himself  or  his  property  by  reason  of  intemperance  or  habitual 
drunkenness,  shall  appoint  a  guardian  of  the  person  and  property 
of  such  person ;  and  all  laws  relating  to  guardians  for  lunatics, 
idiots,  or  imbeciles  and  their  wards  are  applicable  to  such 
guardians.3 

COMMITMENT  OF  THE  INSANE  TO  INSANE  ASYLUMS. — The 
State  of  Ohio  is  divided  into  six  districts,  in  each  of  which  is 
situated  a  State  hospital  for  the  insane.  There  is  also  a  hospital 
for  the  criminal  and  the  dangerous  insane,  a  hospital  for  epilep- 
tics, and  the  Longview  Asylum  at  Cincinnati  for  inhabitants  of 
Hamilton  County  only.  Also  an  Institution  for  Feeble-minded 
Youth,  to  which  adults  also  may  be  committed.4 

Each  county  is  entitled  to  send  patients  to  the  asylum  of  the 
district  in  which  such  county  is  situated  in  proportion  to  the  in- 
sane population  of  such  county,  said  number  being  ascertained 
by  the  board  of  State  charities  and  reported  to  the  superinten- 
dent of  each  of  the  asylums  and  the  probate  judge  of  the  counties. 

Patients  are  admitted  on  the  filing  of  an  affidavit  of  some 
resident  citizen  of  the  county  with  the  probate  judge,  alleging 
that  a  certain  person  is  insane  and  that  because  thereof  his  being 
at  large  is  dangerous  to  the  community. 

The  probate  judge  shall  apprehend  such  alleged  insane  person 
and  bring  him  before  him  upon  a  certain  day,  at  which  time,  if 
any  person  disputes  the  insanity,  the  probate  judge  shall  issue 
subp<enas  for  such  persons  as  are  required  to  be  examined  on 
l>ehalf  of  the  alleged  insane  person,  including  a  physician. 

The  judge  shall  proceed  to  examine  the  witnesses  and  attend- 
ants, and  if  he  is  satisfied  that  the  person  is  insane,  he  shall 

1  Ohio  Statutes,  s.  6,306-6,313  (4).  4  Ibui.,  s.  698,  699,  721  (1),  721  (2), 

1  Ibui.,  s.  6,314.  722,  736,  751  (1)  el  seq.,  671-674  f. 

3  Ibid.,  s.  6,317-6,319. 


720  INCOMPETENT   PERSONS— BROWN   AND   BECKER. 

cause  a  certificate  to  be  made  out  by  the  medical  witness  and  at- 
tendants setting  forth  such  facts  as  are  prescribed  by  statutes. 
Upon  receiving  such  certificate  he  shall  forthwith  apply  to  the 
superintendent  of  the  asylum  situated  in  the  district  in  which 
such  patient  resides  and  at  the  same  time  transmit  copies  of  the 
medical  witnesses'  certificate,  and  if  the  probate  judge  is  advised 
that  the  medical  superintendent  will  receive  the  patient,  he  shall 
cause  him  to  be  transmitted  to  the  asylum. 

When  the  patient  is  sent  to  the  asylum,  the  probate  judge 
shall  see  that  he  is  supplied  with  the  proper  clothing,  and  if  not 
otherwise  furnished,  he  shall  furnish  such  clothing,  which  shall 
be  a  county  charge.1 

CRIMINAL  INSANE. — Insane  convicts,  dangerously  insane  per- 
sons in  other  hospitals,  and  persons  accused  of  crime  but  not  tried 
because  of  insanity  or  acquitted  because  of  insanity  are  confined 
in  the  Lima  State  Hospital.  All  except  the  first  two  classes  must 
be  committed  after  an  inquisition.2 

OKLAHOMA. 

[The  references  are  to  Wilson's  Eevised  and  Annotated  Stat- 
utes of  Oklahoma,  1903.] 

DEFINITION  AND  EIGHTS  OF  PERSONS. 3 — "Persons  of  un- 
sound mind  within  the  meaning  of  this  chapter  are  idiots,  luna- 
tics, and  imbeciles. " 

"  A  person  entirely  without  understanding  has  no  power  to 
make  a  contract  of  any  kind,  but  he  is  liable  for  the  reasonable 
value  of  things  furnished  to  him  necessary  to  his  support  or  the 
support  of  his  family." 

"A  conveyance  or  other  contract  of  a  person  of  unsound 
mind  but  not  entirely  without  understanding,  made  before  his 
incapacity  has  been  judicially  determined,  is  subject  to  rescis- 
sion "  as  provided  in  the  chapter  relating  to  contracts  (chapter 
15,  article  5),  that  is,  diligently,  and  with  return  of  considera- 
tion. After  an  undisturbed  adjudication  as  insane,  a  person  can 
make  no  conveyance  or  other  contract,  nor  designate  any  power, 
nor  waive  any  right;  but  if  actually  restored  he  may  make  a 
will. 

1  Ohio  Statutes,  s.  698-706.  fornia    and    Georgia    Statutes,    after 

2  Ibid.,  s.  721  (1)-721  (25).  which  these  are  patterned. 

3  cf.  North  and  South  Dakota,  Cali- 


STATUTES   OF    OREGON.  721 

A  person  of  unsound  mind  is  civilly  liable  for  wrongs  done 
by  him,  but  cannot  be  subjected  to  exemplary  damages  unless 
he  was  capable  of  knowing  the  act  was  wrong. l 

GUARDIANS. — The  probate  court  has  power  to  appoint  a 
guardian  of  the  person  or  property  or  both  of  an  insane  resident 
or  non-resident.  Any  relative  or  friend  may  file  a  verified  peti- 
tion that  a  person  is  insane  or  from  any  cause  mentally  incom- 
petent to  manage  his  property.  There  shall  be  five  days'  notice 
to  the  person,  and  he  shall  if  able  attend.  The  probate  judge 
holds  the  hearing,  no  jury  being  provided  for. 

The  guardian  has  the  usual  powers.2 

COMMITMENT. — A  person  of  unsound  mind  may  be  placed  in 
an  asylum  for  such  persons  upon  the  order  of  the  probate  court 
of  his  county,  the  court  being  satisfied  by  the  oath  of  two  phy- 
sicians and  an  examination  of  his  insanity.  From  his  commit- 
ment the  person,  his  husband  or  wife,  or  relative  to  the  third 
degree,  may  appeal  to  the  district  court  and  demand  an  inquisi- 
tion before  a  jury.3 

The  governor  contracted  with  private  persons  for  the  care  of 
the  Oklahoma  insane,  according  to  the  requirements  of  the  Illi- 
nois and  Kansas  statutes,  prior  to  the  erection  of  an  asylum  in 
the  State.  The  provisions  for  the  appointment  of  commissioners 
of  the  insane  and  their  supervision  of  the  insane  were  copied 
from  those  of  the  Dakota  codes ;  see  South  Dakota  and  North 
Dakota.4 

CRIMINAL  INSANE. —  See  Dakota  codes,  from  which  these 
provisions  seem  to  have  been  taken. 

OREGON. 

[The  references  are  to  Bellinger  and  Cotton's  Annotated 
Codes  and  Statutes,  1902.] 

JURISDICTION. — The  county  court  has  exclusive  jurisdiction 
in  the  first  instance  to  take  the  care  and  custody  of  the  person 
and  estate  of  a  lunatic  or  habitual  drunkard,  and  to  appoint  and 
remove  guardians  therefor ;  to  direct  and  control  the  conduct  of 
such  guardians  and  to  settle  their  accounts.5 

1  Oklahoma  Statutes,  s.  3,910, 3,917-      tions  are  superseded  by  the  following 
3,921,  cf.  s.  732-733,  taken  from  the      synopsized  sections. 

Dakota  Code.  4  JUti.,  s.  3,960-3,985. 

2  Ibid.,  s.  3,815,  3,816,  1,827  el  seq.  B  Oregon  Codes  and  Statutes,  s.  911. 
1  Ibid.,  a.  3,831.    Query  if  these  sec- 
Ill.— 46 


722  INCOMPETENT    PERSONS — BROWN   AND    BECKER. 

GUARDIANS. — Guardians  of  insane  persons  are  appointed  by 
the  county  court  upon  application  of  relatives  or  friends  of  such 
insane  person,  or  of  any  other  person  residing  in  the  county  where 
such  insane  person  resides.  The  j  udge  shall  cause  a  notice  to  be 
given  to  the  person  alleged  to  be  insane  of  the  time  and  place 
appointed  for  the  hearing,  not  less  than  ten  days  before  such 
time.  If,  after  a  full  hearing,  it  shall  appear  to  the  judge  that 
the  person  in  question  is  incapable  of  taking  care  of  himself,  the 
judge  shall  appoint  a  guardian  of  his  person  and  estate.1 

POWERS  AND  DUTIES. — The  guardian  so  appointed  has  the 
care  and  custody  of  the  person  and  the  management  of  the  estate 
of  such  insane  person  until  he  shall  be  legally  discharged,  and 
he  shall  give  a  bond  to  the  State  of  Oregon  in  like  manner  as 
guardians  of  minors.2 

GUARDIANS  FOR  SPENDTHRIFTS. — When  any  person  by  ex- 
cessive drinking,  gaming,  idleness,  or  debauchery  of  any  kind 
so  spends,  wastes,  or  lessens  his  estate  as  to  expose  himself  or 
family  to  want  or  suffering,  or  the  county  to  expense  for  the  care 
of  himself  or  his  family,  the  county  court  shall  present  a  com- 
plaint to  the  county  judge  setting  forth  the  facts  and  circum- 
stances of  the  case  and  praying  to  have  a  guardian  appointed  for 
him. 

Notice  shall  be  given  to  such  supposed  spendthrift  of  the  time 
and  place  of  the  hearing  not  less  than  ten  days  before  such  hear- 
ing, and  if  after  a  full  hearing  it  shall  appear  that  the  person  com- 
plained of  comes  within  the  description  the  judge  shall  appoint 
a  guardian  of  his  person  and  estate. 

A  copy  of  the  complaint  shall  be  filed  in  the  office  of  the 
county  clerk  after  the  order  of  notice  has  been  issued. 

When  a  guardian  shall  be  appointed  for  the  insane  person  or 
spendthrift,  the  judge  shall  make  an  allowance  to  be  paid  to  the 
guardian  for  all  reasonable  expenses  incurred  by  the  ward  in 
defending  himself  against  the  complaint. 

The  guardian  so  appointed  has  the  care  and  custody  of  the 
person  and  management  of  the  estate  in  the  same  manner  as 
guardians  of  insane  persons.3 

MANAGEMENT  OF  ESTATE. — The  guardian  shall  apply  the 
income  and  profits  of  the  ward's  estate  for  the  comfortable  and 

'Oregon  Codes    and    Statutes,    s.          2  Ibid.,  s.  5,268. 
5,267-5,268.  3  Ibid.,  s.  5,270-5,274. 


STATUTES   OF  OREGON.  723 

suitable  maintenance  and  support  of  the  ward  and  his  family. 
If  they  be  insufficient  for  that  purpose,  the  guardian  may  sell  the 
real  estate  upon  obtaining  a  license  therefor  as  provided  by  law. 

The  estate  of  the  ward  shall  be  appraised  by  three  suitable 
persons  appointed  and  sworn  as  required  with  respect  to  the  in- 
ventory of  the  property  of  a  deceased  person. 

The  county  courts  upon  application  of  the  guardian  or  any 
person  interested  in  the  estate  of  the  ward  may  authorize  the 
transfer  and  reinvestment  of  the  property  of  the  ward.1 

DEFINITIONS. — The  words  "  insane  person  "  are  intended  to  in- 
clude every  idiot,  every  person  not  of  sound  mind,  every  lunatic 
and  distracted  person;  and  the  word  "spendthrift"  is  intended 
to  include  any  one  who  is  liable  to  be  put  in  guardianship  on 
account  of  excessive  drinking,  gaming,  idleness,  or  debauchery.2 

COMMITMENT  OF  INSANE. — The  county  judge  upon  applica- 
tion of  any  citizen  in  writing,  setting  forth  that  any  person  by 
reason  of  insanity  or  idiocy  is  suffering  from  neglect,  exposure, 
or  otherwise,  or  is  unsafe  to  be  at  large,  shall  cause  such  person 
to  be  brought  before  him  and  at  the  same  time  and  place  one  or 
more  competent  physicians,  who  shall  examine  the  person  alleged 
to  be  insane  or  idiotic.  If  such  physician  or  physicians,  after 
careful  examination,  shall  certify  upon  oath  that  such  person  is 
insane  or  idiotic,  then  the  judge,  if  in  his  opinion  such  person 
be  insane  or  idiotic,  shall  cause  such  person  to  be  placed  in  the 
insane  asylum  of  the  State  of  Oregon.  An  appeal  shall  lie  from 
the  county  court  in  such  case  in  the  same  manner  as  in  all  other 
cases.  But  no  insane  or  idiotic  person  shall  be  committed  to  the 
asylum  who  has  friends  desiring  to  provide  for  his  safe-keeping 
and  medical  treatment.  When  the  county  judge  cannot  act  the 
sheriff  shall  notify  a  justice  of  the  peace  to  act.3 

All  the  proceedings  upon  such  application  and  the  judgment 
of  the  court  shall  be  recorded  in  the  records  of  the  county  court. 
When  the  patient  is  adjudged  insane,  the  county  judge  shall 
make  a  warrant  reciting  his  findings,  the  cause  of  insanity,  when 
the  same  can  be  ascertained,  together  with  the  name,  age,  nativity, 
and  present  residence  of  the  patient.  The  expense  of  sending 
insane  and  idiotic  persons  committed  to  the  asylum  shall  be  paid 
by  the  State  treasurer  out  of  the  fund  appropriated  for  such  pur 

1  Ore-'on    Codes    and    Statutes,  s.          *  Un<l.,  s.  ">.2W. 
5,27o--.->,278.  3  Ibid.,  s.  3,019. 


724         INCOMPETENT  PERSONS— BROWN   AND   BECKER. 

pose.  The  cost  of  examination  and  committal  Hlmll  be  first  paid 
by  the  county  and  afterward  repaid  by  the  State  treasurer  upon 
the  certificate  of  the  county  judge  and  the  audit  of  the  secretary 
of  State  by  the  State  treasurer  out  of  funds  appropriated  for  that 
purpose.1 

OREGON  STATE  INSANE  ASYLUM. — The  State  insane  asylum 
is  governed  by  a  board  of  trustees  composed  of  the  governor, 
secretary  of  State,  and  the  State  treasurer.  They  appoint  all 
officers  and  employees  of  the  asylum,  prescribe  their  duties,  and 
remove  them  when  in  their  judgment  the  good  of  the  public  ser- 
vice requires  it.  They  are  required  to  visit  the  asylum  once  in 
three  months  and  keep  themselves  constantly  advised  of  all  items 
of  labor  and  expense,  and  the  condition  of  the  buildings  and 
property  of  the  asylum.  They  are  required  to  report  biennially 
to  the  legislative  assembly. 

They  appoint  a  medical  superintendent  who  shall  servo  four 
years  or  during  good  behavior,  and  on  his  nomination  two  or 
more  assistant  physicians  and  other  oflieers  according  to  the  re- 
quirements of  the  institution.  The  superintendent  and  all  the 
assistant  physicians  shall  reside  at  the  asylum  and  shall  be  regu- 
lar graduates  in  medicine.  Two  consulting  physicians  may  also 
be  appointed.  * 

The  superintendent  is  the  executi  ve  officer  of  the  asylum  u  nder 
the  regulations  and  by-laws  of  the  board  of  trustees.  He  has 
control  of  the  patients,  proscribes  and  directs  their  treatment, 
adopts  sanitary  measures  for  their  welfare,  and  discharges  such 
as  in  his  opinion  have  permanently  recovered  their  reason,  or 
such  other  patient  as  the  best  interests  of  the  State  and  the  insti- 
tution require.2 

CRIMINAL  INHANK.  --The  court  may  eonnnit  a  person  acquitted 
t>eeauso  of  insanity  to  the  asylum  if  he  deems  it  dangerous  for 
him  to  be-  at  large." 

Insanity  as  a  defence  must  bo  proved  beyond  a  reasonable- 
doubt.4 

The  provision  as  to  the  effect  of  intoxication  is  copied  from 
the  New  York  Penal  Law.4 

1  Oregon  Co<lenan<l  Statutes,*).  8,020.          '  Ibul.,  B.  1,424. 
3  Ibid.,  a.  3,010-3,616.  *  Ilnd.,  s.  1,393. 


STATUTES  OF  PENNSYLVANIA.  736 


PENNSYLVANIA. 

[The  references  arc  to  Steward's  Purdon's  Digest,  1003.] 
COMMISSION  TO  INQUIKK  INTO  LUNACY  on  H.UIITITAL 
DBXJNKKNNKtw.— Jurisdiction  to  issue  :i  commission  in  (ho  nature 
of  a  writ*?*?  lunatics  /m//wrw/*>,  to  inquire  into  lunacy  or  habitual 
drunkenness  of  any  person,  is  vested  in  any  court  of  common 
pleas. 

It  is  to  bo  issuod  by  tho  court  of  the  county  in  which  tho  per- 
son resides. 

The  form  of  tho  commission  in  proscribed  by  statute. 

No  commission  shall  bo  issued,  except  upon  application  in 
writing  of  a  relative  by  blood  or  marriage  of  tho  person  therein 
named,  nor  unless  such  application  be  accompanied  by  affidavit* 
of  the  truth  of  tho  r.n-is  therein  stated. 

If  tho  alleged  lunatic  or  habitual  drunkard  has  no  such  rela- 
tive, any  disinterested  person  of  tho  same  township,  ward,  or  bor- 
ough may  make  application  to  tho  court  for  such  a  commission. 

The  commission  may  bo  Mi  reeled  to  any  one  or  more  |>orsoiiH. 

Upon  granting  the  application  for  a  commission  the  court 
shall  give  such  notice  to  tho  alleged  lunatic  or  habitual  drunkard 
or  his  near  relatives  or  friends  as  it  shall  deem  advisable. 

Tho  commissioner  or  commissioners  shall  summon  such  num- 
ber of  persons,  not  less  than  six  nor  more  than  twelve,  to  attend 
upon  the  inquest  as  the  cinm instances  of  the  (tone  may  seem  to 
them  to  require.  Tho  testimony  taken  before  such  jury  shall  bo 
filed  with  the  CMiirt  by  the  commissioners  as  part  of  their  report 
whenever  exceptions  thereto  aro  filed,  and  if  such  exceptions  Are 
sustained  by  the  court  it  shall  dismiss  I  lie  proceedings. 

If  upon  such  inquisition  it  IN)  found  that  tho  party  is  not  a 
lunatic  or  habitual  drunkard  and  that  there  was  no  caimo  for  such 
application,  the  judge  shall  certify  tho  same  on  such  inquisition, 
and  thereupon  the  party  making  the  application  shall  IN)  liable 
for  the  costs. 

Whenever  any  person  shall  l>o  found  to  IN)  Insane,  tho  com- 
mittee of  the  person  or  of  the  estate  and  also  tho  dork  of  the 
court  shall  forthwith  send  to  tho  committee  on  lunacy,  at  their 
oilier,  the  statement  in  writing  of  the  name,  age,  sex,  and  resi- 
dence of  the  lunatic  and  tho  residence  of  the  committee.  The 


726  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

committee  oil  lunacy,  or  any  one  or  more  of  the  members,  may 
visit  and  examine  the  said  lunatic  or  authorize  such  visiting  and 
examination,  and  may  apply  to  any  court  having  jurisdiction 
over  the  committee,  or  to  the  judge  of  the  court  of  common  pleas, 
to  make  such  orders  for  the  maintenance,  custody,  or  care  of  the 
lunatic,  and  for  the  care  and  disposition  of  the  property  as  the 
case  may  require.  An  appeal  to  the  supreme  court  lies  from  any 
order  thus  made. 

TRAVERSE  OP  THE  INQUISITION. — Any  person  aggrieved  by 
such  inquisition  may  traverse  the  same  in  the  court  where  it  is 
found,  but  not  after  three  months  unless  the  traverse  is  specially 
allowed  by  the  court  at  a  later  day.1 

APPOINTMENT  OF  THE  COMMITTEE. — On  the  return  of  an 
inquisition  finding  the  person  a  lunatic  or  habitual  drunkard,  the 
court  may  commit  the  custody  and  care  of  the  person  or  estate 
or  of  both  to  such  person  or  persons  as  they  may  deem  most  suit- 
able. A  bond  shall  be  given  by  the  person  appointed  committee 
of  the  estate  in  such  sum  as  the  court  shall  direct,  with  condition 
for  the  faithful  performance  of  the  trust  and  for  a  due  account 
of  all  property  and  funds  coining  into  his  hands.2 

POWERS  AND  DUTIES  OF  THE  COMMITTEE.  — The  committee, 
within  forty  days  after  undertaking  the  trust,  shall  file  in  the 
office  of  the  prothonotary  of  the  court  a  just  and  true  inventory 
of  all  personal  estate  belonging  to  his  ward  together  with  a  state- 
ment of  the  real  estate. 

The  committee  of  the  estate  of  every  person  found  to  be  a 
lunatic  or  habitual  drunkard  shall  have  the  management  of  the 
real  and  personal  estate,  and  apply  so  much  of  the  income  as  is 
necessary  to  the  payment  of  the  debts  and  for  the  support  and 
maintenance  of  the  person  and  of  his  family,  and  for  the  educa- 
tion of  his  minor  children.  If  the  income  is  not  sufficient,  under 
the  direction  of  the  court  the  committee  may  apply  so  much  of 
the  principal  of  the  personal  estate  as  is  necessary. 

Under  the  direction  of  the  court,  the  committee  may  invest 
the  money  of  the  ward  in  such  stocks  or  securities  as  are  approved 
by  the  court.  Each  committee  shall  account  for  the  property 
committed  to  him  once  in  three  years.3 

1  Purdon's  Digest,  p.  2,386-2,392,  2  lUd.,  p.  2,393-2,394. 
Title : "  Lunatics  and  Habitual  Drunk-  3  Ibid.,  p.  2,395-2,397. 
ards." 


STATUTES   OF   PENNSYLVANIA.  72? 

SALE  OF  THE  REAL  ESTATE  OF  A  LUNATIC.— If  the  per- 
sonal estate  of  a  lunatic  is  not  sufficient  for  the  support  of  the 
lunatic,  the  court  may  authorize  the  sale  of  his  real  estate,  upon 
an  application  by  the  committee  setting  forth  a  statement  or  in- 
ventory of  the  real  and  personal  estate,  the  debts  due  by  the 
lunatic  or  habitual  drunkard,  and  an  estimate  of  the  amount 
properly  required  annually  for  his  support  and  maintenance  and 
that  of  his  family  and  the  education  of  his  children. 

No  order  shall  be  granted  except  upon  due  notice  to  the  next 
of  kin  of  the  lunatic  or  habitual  drunkard. 

Each  order  for  the  sale  of  real  estate  shall  specify  the  property 
to  be  sold,  the  notice  of  the  sale  to  be  given  by  the  committee, 
the  terms  of  sale,  the  amount  of  security  to  be  given  by  the  com- 
mittee, and  the  day  on  which  the  order  is  returnable.  Each 
order  for  the  mortgaging  of  real  estate  shall  specify  the  amount 
to  be  raised,  the  property  to  be  mortgaged,  the  rate  of  interest, 
the  amount  of  security  to  be  given  by  the  committee,  and  the  day 
on  which  the  order  is  returnable. 

No  sale  or  mortgage  shall  be  confirmed  by  the  court  until  the 
committee  have  given  security  for  the  faithful  application  of  the 
proceeds. 

If  the  sale  or  mortgage  be  confirmed  by  the  court,  the  com- 
mittee shall  execute  such  sale  or  mortgage  according  to  the  terms 
of  the  contract. 

On  the  application  of  the  committee  the  court  may  authorize  the 
sale  of  timber  standing  upon  the  lands  of  such  lunatic  or  drunkard.1 

LUNATIC  ASYLUMS. — The  board  of  public  charities  has  the 
supervision  of  all  houses  or  places  in  which  any  person  of  un- 
sound mind  is  detained,  whenever  the  person  having  charge  of 
the  lunatic  receives  any  compensation  for  the  custody,  control, 
or  attendance  of  such  lunatic. 

The  board  shall  appoint  a  committee  of  five  to  act  as  the  com- 
mittee on  lunacy.  The  two  professional  members,  one  a  physi- 
cian and  the  other  a  lawyer,  shall  be  members  of  that  committee. 
The  committee  on  lunacy  shall  examine  and  report  annually  to 
the  board  the  condition  of  the  insane  in  the  State  and  the  man- 
agement and  conduct  of  the  hospitals,  public  and  private  alms- 
houses,  and  all  other  places  in  which  the  insane  are  kept  for  care 
and  treatment  or  detention. 

1  Purdon's  Digest,  p.  2,:i97-2,399. 


728          INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

The  board  shall  have  power  to  ordain  rules  and  regulations 
relating  to  the  licensing  of  all  places  where  persons  are  detained 
as  lunatics  or  of  unsound  mind,  and  for  the  insuring  of  proper 
treatment  of  persons  so  detained,  and  as  to  the  forms  to  be  ob- 
served in  the  commitment,  transfer  of  custody,  and  discharge  of 
all  lunatics  other  than  those  committed  by  order  of  a  court  of 
record. l 

The  asylums  are,  the  Pennsylvania  State  Lunatic  Hospital, 
the  Western  Pennsylvania  Hospital,  the  Warren  State  Hospital, 
the  Asylum  for  Chronic  Insane,  and  the  Homeopathic  State 
Hospital  for  the  Insane.2 

ADMISSION  TO  INSANE  ASYLUMS.— No  person  shall  be  re- 
ceived as  a  patient  in  any  insane  asylum  without  a  certificate 
signed  by  at  least  two  physicians  that  they  have  examined  sepa- 
rately the  person  alleged  to  be  insane,  and  thoroughly  believe 
that  the  person  is  insane  and  that  the  disease  is  of  a  character 
requiring  that  the  person  should  be  placed  in  a  hospital  or  other 
establishment  where  the  insane  are  detained  for  care  and  treat- 
ment, and  that  they  are  not  related  by  blood  or  marriage  to  the 
person  alleged  to  be  insane,  nor  in  any  way  connected  with  the 
hospital  or  other  establishment. 

There  shall  be  delivered  at  the  time  of  the  admission  of  the 
patient  a  written  statement  signed  by  the  person  at  whose  instance 
the  insane  person  has  been  removed  and  detained,  containing  the 
name,  age,  residence,  occupation,  parents  if  living,  husband  or 
wife,  children,  brothers  and  sisters,  and  residence  of  each  of  these 
persons ;  if  not  more  than  one  of  these  classes  is  known  the  names 
and  residence  of  such  of  the  next  degree  of  relatives  as  are  known, 
a  statement  of  the  time  at  which  the  insanity  has  been  supposed 
to  exist,  and  the  circumstances  that  induced  the  belief  that  in- 
sanity exists,  and  the  name  and  address  of  all  medical  attend- 
ants of  the  patient  during  the  past  two  years.  A  certificate  of 
the  physician  and  a  statement  furnished  at  the  time  of  the  recep- 
tion of  the  patient  shall  be  forwarded  by  mail  to  the  committee 
on  lunacy  within  seven  days  from  such  reception. 

Any  physician  designated  by  the  lunatic  or  any  member  of 
his  family  or  near  friend  shall  be  permitted  at  all  reasonable 
hours  to  visit  and  examine  the  patient.  All  patients  shall  be 

1  Punion's  Digest,  p.   2,362-2,363,          2  Ibid.,  p.  2,370-2,385. 
Title:  "  Lunatic  Asylums." 


STATUTES  OF  RHODE   ISLAND.  729 

given  reasonable  opportunity  and  furnished  with  materials  for 
communicating  with  any  person  without  the  building.  They 
shall  have  the  unrestricted  privilege  of  addressing  communica- 
tions, not  oftener  than  once  a  month,  to  any  member  of  the  com- 
mittee on  lunacy.1 

COMMITMENT  OF  INSANE  PERSONS  BY  THE  COURT. — Insane 
persons  may  be  placed  in  hospitals  by  the  order  of  any  court, 
and  a  statement  in  writing  of  any  respectable  citizen  that  a  cer- 
tain person  is  insane  and  that  his  welfare  or  that  of  others  re- 
quires his  restraint.  The  judge  shall  thereupon  appoint  immedi- 
ately a  commission  to  inquire  into  the  report  upon  the  facts  of 
the  case.  The  commission  shall  be  composed  of  three  persons, 
one  a  physician  and  one  a  lawyer.  In  their  inquisition  they  shall 
hear  such  evidence  touching  the  merits  of  the  case  as  well  as  the 
statements  of  the  party  complained  of.  If  in  their  opinion  it  is 
a  suitable  case  for  confinement,  the  judge  shall  issue  his  warrant 
for  such  disposition  of  the  insane  person  as  will  promote  the  ob- 
ject desired. 

If  the  commission  report  that  it  is  not  a  suitable  case  for  con- 
finement, the  petitioner  shall  be  liable  for  all  costs.  If  the  com- 
mission report  the  case  a  suitable  one  for  confinement,  and  it 
shall  appear  that  the  lunatic  has  real  or  personal  property,  such 
property  shall  be  liable  to  all  costs.2 

VOLUNTARY  PATIENTS.  — Persons  voluntarily  placing  them- 
selves in  asylums,  who  may  be  suffering  from  nervous  diseases 
threatening  mental  disorder,  may  be  received  for  one  month  or 
less  by  agreement.3 

EHODE  ISLAND. 

[The  references  are  to  General  Laws  of  Rhode  Island,  1896.] 
DEFINITION. — "Insane  person"  includes  every  idiot,  person 
of  unsound  mind,  lunatic  and  distracted  person.4 

RESTRAINT  OF  INSANE  PERSONS. — Whenever  complaint  in 
writing  and  under  oath  shall  be  made  to  any  justice  or  clerk  of 
the  district  court  that  any  person  within  the  county  is  insane  so 
as  to  be  dangerous  to  the  peace  or  safety  of  the  people  of  the 
State,  or  so  as  to  render  his  restraint  and  treatment  necessary  for 

1  Purdon's  Digest,  p.  2,364-2,366.  4  Rhode  Island  General  Laws,  1896, 

3  Ibid.,  p.  2,358-2,361.  p.  125. 

1  Ibid.,  p.  2,367. 


730  INCOMPETENT    PERSONS — BROWN   AND   BECKER. 

his  own  welfare,  such  justice  or  clerk  shall  cause  such  person  to 
be  arrested  and  brought  before  some  district  court  for  examina- 
tion relative  to  such  complaint.  When  the  insane  person  can- 
not be  examined  in  open  court  such  examination  may  be  held  at 
such  times  and  places  as  shall  be  most  conducive  to  the  health 
and  comfort  of  the  person  to  be  examined. 

If  the  court  on  such  examination  adjudge  such  complaint  to 
be  true,  it  shall  commit  such  person  to  the  Butler  hospital  for 
the  insane,  or  to  the  State  asylum  for  the  insane,  to  be  detained 
until  upon  instruction  and  examination  he  shall  be  declared  to 
be  restored  to  soundness  of  mind. 

The  warrant  of  commitment  shall  state  the  town  in  which 
such  lunatic  or  mad  person  was  arrested. 

The  costs  shall  be  paid  out  of  the  property  of  the  lunatic  if 
he  have  any,  otherwise  in  the  first  instance  by  the  State  until  the 
liability  of  some  town  in  the  State  for  the  maintenance  of  such 
person  is  established. 

Commissioners  may  be  appointed  on  petition  under  oath  to 
inquire  into  the  condition  of  the  insane  person  and  to  report  all 
facts  connected  with  the  case,  together  with  their  opinion  whether 
such  person  if  insane  should  be  placed  in  such  hospital  or  State 
asylum.1 

EXAMINATION  OF  CONFINED  INSANE  PERSON. — On  petition 
of  any  person  confined  in  an  insane  asylum  or  of  any  person  on 
his  behalf  to  a  justice  of  the  supreme  court  setting  forth  that 
such  persons  confined  therein  is  not  insane  and  is  unjustly  de- 
prived of  his  liberty,  such  justice  shall  issue  a  like  commission 
as  provided  for  the  commitment  of  the  insane  person  for  the 
purpose  of  inquiring  into  the  condition  of  such  person. 

The  person  confined  as  insane  shall  have  the  right  to  confer 
with  counsel,  to  produce  evidence,  and  to  be  present  at  the  in- 
quisition. The  petitioner  or  his  counsel  may  examine  the  insane 
person  at  the  place  where  he  is  confined.  The  commissioners 
shall  make  a  personal  examination  of  such  insane  person  at  the 
place  where  confined  without  the  presence  of  the  superintendent 
or  any  other  person  connected  with  the  institution,  but  no  per- 
son detained  as  insane  shall  be  taken  from  the  institution  with- 
out an  order  of  the  supreme  court. 

Justices  of  the  supreme  court  may  either  confirm  or  disallow 
1  Rhode  Island  General  Laws,  1896,  p.  278  et  seq. 


STATUTES   OF   SOUTH   CAROLINA.  731 

the  report  of  the  commissioners  and  order  the  recommitment  or 
discharge  of  such  person,  or  dismiss  the  petition  altogether,  as 
the  facts  shall  seem  to  require.1 

APPOINTMENT  OF  GUARDIAN. — Whenever  any  idiot  or  luna- 
tic or  person  of  unsound  mind,  or  any  person  who  from  excessive 
drinking,  gaming,  idleness,  or  debauchery  of  any  kind,  or  from 
want  of  discretion  in  managing  his  estate,  shall  be  likely  to  bring 
himself  or  family  to  want  or  to  render  himself  or  family  charge- 
able, the  court  of  probate  shall  have  the  right  to  appoint  a  guard- 
ian of  the  person  and  estate  of  such  person. 

The  guardian  of  any  habitual  drunkard  shall  have  the  right 
to  commit  the  ward  to  any  curative  hospital  either  within  or 
without  this  State,  until  he  is  cured  of  his  drunkenness,  but  not 
exceeding  six  months  at  any  one  time.  The  estate  of  the  ward 
shall  be  chargeable  with  the  expenses  incident  to  such  committal 
and  custody.  The  provisions  in  regard  to  the  guardianship  of 
minors  are  also  applicable  to  the  guardianship  of  insane  persons 
and  habitual  drunkards.2 

SOUTH  CAROLINA. 

[The  references  are  to  the  South  Carolina  Codes,  1902.] 

GUARDIANS.  —The  judge  of  probate  has  jurisdiction  in  cases 
of  idiocy  and  lunacy,  and  of  the  appointment  of  guardians  of  in- 
sane and  idiotic  persons,  and  persons  non  compotes  mentis.3 

STATE  HOSPITAL  FOR  INSANE  AND  COMMITMENTS. — The 
governor  shall  appoint  five  regents  for  the  State  hospital  for  the 
insane,  at  Columbia,  who  hold  office  for  six  years.  The  regents 
have  general  control  of  the  hospital.4 

The  hospital  admits  only  insane  persons,  by  which  are  meant 
those  dangerously  insane,  whose  disease  is  of  a  more  or  less  per- 
manent character,  not  transient  like  delirium,  and  who  are  unable 
to  transact  their  ordinary  business.  Preference  is  given  to  re- 
cent, curable  cases  over  chronic  cases,  idiots,  epileptics,  dipso- 
maniacs, etc.  Persons  insane  from  the  use  of  alcohol  or  drugs 
are  received  as  paying  patients  only.5 

1  Rhode  Island  General  Laws,  1896,      C.,  82.    But  the  probate  court  cannot 
s.  15-18.  grant  leave  to  traverse  an  inquisition 

2  Ibid.,  p.  637;    c.  196.  in  lunacy;    that  can  only  be  done  in 
8  Code  of  Civil  Procedure,  s.  37-38.       the  court  of  common  pleas.     Walker  v. 

The  jurisdiction  is  not  exclusive,  but  is      Russel,  supra. 

concurrent  with  that  of  the  court  of          *  Civil  Code,  s.  2.247-2,248. 

common  pleas.    Walker  v.  Russel,  10  S.          8  Ibid. ,  s.  2,250,  2,268. 


73$          INCOMPETENT  PERSONS — BROWN  AND  BECKER. 

A  relative,  friend,  or  other  citizen  interested  may  apply  to 
the  judge  of  probate,  who  may  investigate,  and,  if  convinced  that 
the  application  is  a  just  one,  commit,  upon  the  certificate  of  two 
physicians  that  the  patient  is  an  epileptic,  idiot  or  lunatic,  in- 
curable at  home,  and  violent  or  dangerous.1 

At  the  same  time  the  judge  of  probate  must  ascertain  the 
patient's  financial  condition  to  determine  whether  he  shall  be  ad- 
mitted as  a  paying  patient,  or  as  a  beneficiary  patient.2 

The  superintendent  of  the  hospital  may  receive  violent  and 
dangerous  patients  temporarily,  on  the  certificate  of  two  physi- 
cians.3 

Upon  the  certificate  of  two  regents  and  the  physician  in  charge, 
the  judge  of  probate  may  appoint  a  committee  of  the  estate  of  a 
patient  committed  to  the  hospital.4 

Discharges  are  regulated  by  the  regents.5 

CRIMINAL  INSANE. — Any  judge  of  the  circuit  court  may  send 
to  the  State  hospital  any  person  charged  with  a  criminal  offence 
who  shall  upon  the  trial  prove  to  be  non  compos  mentis.  If  he 
has  an  estate  he  must  support  himself  therein.6 

SOUTH  DAKOTA. 

[The  references  are  to  Eevised  Codes  of  South  Dakota, 
1903.] 

DEFINITION. — The  term  "insane  "  includes  any  species  of  in- 
sanity or  mental  derangement.  The  term  "  idiot "  is  restricted 
to  persons  supposed  to  be  naturally  without  mind.  No  idiot  shall 
be  admitted  into  the  hospital  for  the  insane.7 

GUARDIANS. — The  county  court,  on  the  verified  petition  of 
any  relative  or  friend  that  any  person  is  insane,  or  from  any 
cause  is  incompetent  to  manage  his  property,  may  cause  notice 
to  be  given  to  such  alleged  insane  person  of  the  time  and  place 
of  the  hearing,  ano\if  such  person  is  able  to  attend,  he  must  be 
produced  before  him  on  the  hearing.8 

If,  after  a  full  hearing  and  examination,  it  appears  to  the 
judge  of  the  court  that  the  person  in  question  is  incapable  of 

'Civil  Code,  s.  2,251-2,253,  2,263.  5  Ibid.,  s.  2,267. 

See  also  Code  of  Civ.  Proc.,  s.  70.  6  Ibid.,  s.  2,264. 

2  Ibid.,  s.  2255.  7  South   Dakota   Political  Code,    s. 

3  Ibid.,  s.  2,253.  2,829. 

4  Ibid.,  a.  2262.  •  Probate  Code,  s.  379. 


STATUTES   OF  SOUTH   DAKOTA.  733 

taking  care  of  himself  and  managing  his  property,  he  must  ap- 
point a  guardian  of  his  person  and  estate.1 

POWERS  OF  GUARDIAN. — Every  guardian  appointed  as  pro- 
vided in  the  preceding  section  has  the  care  and  custody  of  the 
person  of  his  ward  and  the  management  of  all  his  estate,  until  he 
is  legally  discharged.2 

The  powers  and  duties  of  guardians  of  insane  persons  are 
similar  in  all  respects  to  those  of  guardians  of  minors,  as  pre- 
scribed in  the  Probate  Code,  chapter  13,  articles  1,  3-7. 

EESTORATION  OF  INSANE. — Any  person  who  has  been  de- 
clared insane,  or  the  guardian,  or  any  relative  within  the  third 
degree,  or  any  friend,  may  apply  by  verified  petition  to  the 
county  court  of  the  county  within  which  he  was  declared  insane, 
to  have  the  fact  of  his  restoration  to  capacity  judicially  deter- 
mined. Notice  of  the  trial  must  be  given  to  the  guardian  of  the 
petitioner,  to  the  husband  or  wife  if  there  be  one,  and  to  the 
father  or  mother,  if  living  in  the  county.  On  the  trial  the 
guardian  or  relative,  and,  in  the  discretion  of  the  judge,  any  other 
person,  may  contest  the  right  of  the  petitioner  to  the  relief  de- 
manded. Witnesses  may  be  required  to  appear  and  testify.  If 
it  be  found  that  the  petitioner  be  of  sound  mind  and  capable  of 
taking  care  of  himself  and  his  property,  his  restoration  to  capacity 
shall  be  adjudged  and  the  guardianship  shall  cease.3 

COMMISSIONERS  OF  INSANITY  AND  COMMITMENT  OF  THE 
INSANE. — There  is  in  each  county  aboard  of  commissioners,  con- 
sisting of  three  persons,  known  as  commissioners  of  insanity. 

The  county  judge  is  a  member  and  chairman  of  such  board; 
and  of  the  others,  one  is  a  lawyer  and  one  a  physician. 

Such  commissioners  have  cognizance  of  all  applications  for 
admission  to  the  hospital,  or  for  the  safe-keeping  of  insane  per- 
sons within  their  counties. 

Application  for  admission  to  the  hospital  must  be  made  in 
writing  in  the  nature  of  a  verified  information  alleging  that  the 
person  on  whose  behalf  the  application  is  made  is  believed  to  be 
insane  and  a  fit  subject  for  custody  and  treatment  in  the  hospital. 
The  grounds  of  the  information  shall  thereupon  be  investigated 
by  the  commissioners.  They  may  require  that  the  person  be 
brought  before  them  and  examined,  and  may  issue  their  warrant 

1  Probate  Code,  s.  380.  8  Ibid.,  s.  382. 

2  Ibid.,  B.  381. 


734  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

therefor.  They  shall  hear  testimony  for  and  against  the  appli- 
cation, if  any.  Any  citizen  or  relative  of  the  alleged  insane  per- 
son may  appear  by  counsel.  The  commissioners  shall  appoint 
some  regularly  practising  physician  of  the  county,  who  may  be 
of  their  own  number,  to  make  a  personal  examination  touching 
the  truth  of  the  allegations  in  the  information,  and  the  actual 
condition  of  such  person,  and  report  to  them  thereon. 

On  the  return  of  the  physician's  certificate  the  commissioners 
shall  conclude  their  investigation  and  find  whether  the  person  is 
insane  and  a  fit  subject  for  treatment  and  custody  in  the  hos- 
pital. If  he  is  found  not  insane,  they  shall  order  his  discharge. 
If  insane,  they  shall  issue  their  warrant  authorizing  the  superin- 
tendent of  the  hospital  to  receive  such  person  as  a  patient. 

If  such  person  cannot  be  admitted  into  the  hospital  at  once, 
and  cannot  with  safety  be  allowed  to  go  at  liberty,  the  commis- 
sioners shall  require  him  to  be  suitably  provided  for  otherwise, 
until  such  admission  can  be  had.  Such  patients  may  be  cared 
for  either  as  public  or  private  patients.  Private  patients  are 
those  whose  relatives  or  friends  will  obligate  themselves  to  take 
care  of  and  provide  for  them  without  public  charge.  In  the  case 
of  private  patients  the  commissioners  appoint  a  special  custodian 
to  restrain  and  care  for  the  patient.  Public  patients  are  cared 
for  at  the  expense  of  their  county.1 

RESTORATION  TO  SANITY. — To  secure  the  release  of  persons 
under  confinement  as  insane,  a  special  commission  of  three  per- 
sons may  be  obtained  by  verified  petition  and  an  inquiry  had, 
but  not  oftener  than  once  in  six  months.2 

WRIT  OF  HABEAS  CORPUS.— All  persons  confined  as  insane 
shall  be  entitled  to  the  benefit  of  habeas  corpus,  and  the  question 
of  insanity  shall  be  decided  at  the  hearing,  and  if  the  judge  or 
court  shall  decide  that  the  person  is  insane,  such  decision  shall 
be  no  bar  to  the  issuing  of  a  writ  the  second  time,  whenever  it 
shall  be  alleged  that  such  person  has  been  restored  to  reason.3 

STATE  ASYLUM.— The  South  Dakota  State  hospital  for  the 
insane  is  located  near  the  city  of  Yauktou.  It  is  governed  by 
the  State  board  of  charities  and  corrections.  As  to  the  care  and 
management  of  the  hospital,  see  article  1  of  chapter  9  of  the 
South  Dakota  Political  Code. 

1  Political  Code,  s.  2,806-2,817.  3  Ibid.,  s.  2  826 

2  Ibid.,  3.  2^24,  2.825. 


STATUTES   OF  TENNESSEE.  735 

CRIMINAL  INSANE. — When  a  defendant  is  acquitted  by  reason 
of  insanity,  and  the  court  deems  his  discharge  dangerous,  it  may 
order  him  committed  to  the  State  hospital,  or  to  the  care  of  some 
person  (or  to  the  care  of  the  sheriff),  until  he  becomes  sane.1 

The  insanity  of  a  criminal  condemned  to  death  may  be  tried 
by  a  jury  of  twelve.2 

A  special  jury  of  twelve  may  be  summoned  to  try  a  prisoner's 
sanity,  when  his  trial  is  called  or  after  conviction.3 

The  provisions  as  to  criminal  responsibility  are  similar  to 
those  of  the  New  York  Penal  Law.  The  test  is  whether  "at  the 
time  of  committing  the  act  charged  they  were  incapable  of  know- 
ing its  wrongf uluess. "  4 

TENNESSEE. 

[The  references  are  to  Shannon's  Code  of  Tennessee,  189G, 
and  Supplement,  1903.] 

DEFINITION. — The  terms  "lunatic,"  "insane,"  "non  compos 
mentis,"  include  all  persons  of  unsound  mind.5 

JURISDICTION. — Jurisdiction  over  the  persons  and  estates  of 
idiots,  lunatics,  and  other  persons  of  unsound  mind  is  vested  in 
the  county  and  chancery  courts.6 

INQUISITION. — Upon  information  made  to  the  county  court 
that  any  idiot  or  lunatic  resides  within  the  jurisdiction  thereof, 
the  court  shall  order  the  sheriff  to  summon  a  jury  of  twelve  free- 
holders to  ascertain  by  inquisition  the  idiocy  or  lunacy  and  -the 
property  and  estate  of  the  idiot  or  lunatic  and  make  return  there- 
of to  the  court.7 

Witnesses  may  be  subpoenaed  and  are  subject  to  the  penalties 
and  entitled  to  the  privileges  of  other  witnesses.8  If  the  person 
is  not  declared  a  lunatic,  the  person  on  whose  application  the  in- 
quisition is  issued  is  liable  for  costs.  Otherwise  they  are  paid 
from  the  lunatic's  estate.9 

Upon  the  return  of  the  jury  that  the  person  is  an  idiot  or 
lunatic  and  that  he  has  property,  the  court  shall  appoint  a 
guardian  for  the  person  and  property  of  such  idiot.  If  the  idiot 
or  lunatic  has  no  property  or  not  sufficient  for  his  maintenance, 

1  Penal  Code,    s.    19;     c/.     Code   of  8  Code  of  Tennessee,  s.  62. 

Criminal  Procedure,  s.  418.  6  Ibid.,  s.  5,451. 

a  Code  of  Crim.  Proc.,  s.  464-468.  '  Ibid.,  s.  5,452. 

3  Ibid.,  s.  543-552.  «  Ibid.,  s.  5,455. 

•  Penal  Code,  s.  16,  17.  •  Ibid.,  s.  5,456. 


736  INCOMPETENT  PERSONS — BROWN  AND   BECKER. 

he  may  be  let  out  for  the  term  of  one  year  to  the  lowest  bidder 
as  other  poor  persons,  or  be  otherwise  provided  for  as  the  court 
may  direct. 

If  let  out  to  the  lowest  bidder,  bond  and  sufficient  security  as 
prescribed  by  the  court  shall  be  taken  for  the  safe-keeping,  pro- 
viding sufficient  diet,  washing  and  apparel,  and  proper  treatment 
for  the  term  of  letting.1 

INQUISITION  IN  THE  CHANCERY  COURT. — The  application 
to  the  chancery  court  shall  be  by  petition  verified  by  affidavit 
setting  forth  the  facts  in  regard  to  the  person  and  property  of 
the  supposed  idiot  or  lunatic. 

No  application  shall  be  made  unless  the  value  of  the  property 
exceeds  five  hundred  dollars. 

The  chancellor  shall  direct  the  issuance  of  a  writ  of  inquisition 
upon  the  giving  of  a  bond  by  the  petitioner  conditioned  to  pay 
costs  and  all  such  damages  as  the  defendant  may  sustain  in  con- 
sequence of  the  petitioner  having  wantonly  and  maliciously  in- 
stituted proceedings.  He  may  make  such  order  for  the  presence 
and  examination  of  the  person  as  he  may  think  proper. 

The  jury  consists  of  twelve  freeholders,  and  are  required  to 
ascertain  by  their  verdict  whether  the  defendant  be  an  idiot  or 
lunatic  or  person  of  unsound  mind. 

Notice  of  the  time  and  place  of  the  inquest  shall  be  given  to 
the  alleged  lunatic  at  least  five  days  previous  to  the  time  of  hear- 
ing; if  the  jury  find  the  person  to  be  a  lunatic,  the  verdict  shall 
ascertain  the  value  of  the  estate  and  of  what  it  consists  and  who 
are  the  next  of  kin  of  the  insane  person. 

Upon  such  finding  the  clerk  shall  appoint  a  guardian  to  take 
care  of  the  estate  and  person  of  the  insane  person.  Upon  motion 
after  the  return  of  the  inquisition  the  verdict  of  the  jury  may  be 
set  aside  and  the  chancellor  may  thereupon  order  another  inquest 
to  be  held. 

If  the  jury  disagree,  the  chancellor  may  in  his  discretion 
order  another  inquest  or  decide  the  case  himself  upon  the  testi- 
mony returned  and  such  other  testimony  as  may  be  offered.2 

POWERS  OF  GUARDIAN. —The  guardian  may  upon  the  coming 
of  age  or  marriage  of  the  child  of  the  confirmed  lunatic  make 

1  Code  of  Tennessee,  s.  5,457-5,459.  sons.     They  were  enacted  by  chapter 

These  provisions  as  to  letting  out  are  41  of  the  Laws  of  1797. 
survivals  of  an  obsolete  conception  of          2  Ibid.,  s.  5,461-5,497. 
the  duty  of  the  state  to  insane  per- 


STATUTES   OF   TENNESSEE.  737 

such  settlement  upon  such  child  as  the  situation  of  the  estate,  the 
condition  of  the  lunatic  and  his  wife,  and  other  circumstances 
may  render  reasonable  and  just.  The  guardian  may  apply  in 
such  case  to  the  chancellor  for  direction. 

The  real  and  personal  property  of  a  person  laboring  under 
confirmed  mental  unsoundness  may  be  portioned  by  the  court 
among  his  children  or  descendants  as  in  case  of  death  and  intest- 
acy, such  portion  to  be  charged  as  an  advancement. 

The  property  of  a  person  of  unsound  mind  may  be  sold  upon 
the  petition  of  the  guardian  if  it  appear  manifestly  for  the  inter- 
est of  such  person,  and  the  proceeds  shall  be  disposed  of  by  the 
court  in  such  manner  as  best  to  promote  the  interests  of  the  owner. 
Guardians  of  lunatics,  idiots,  and  other  persons  of  unsound  mind 
shall  be  punishable  for  the  same  abuses,  mismanagements,  ne- 
glects, failures,  and  other  offences  as  guardians  of  minors  and 
in  the  same  manner.1 

EESTORATION  TO  SANITY. — Bestoratiou  to  sanity  may  be 
similarly  inquired  into,  on  petition  accompanied  by  the  certifi- 
cate of  two  physicians,  presented  to  the  county  court,  through 
a  jury  of  twelve,  but  not  oftener  than  once  a  year;2  or  by 
habeas  corpus.3 

HOSPITALS  FOR  THE  INSANE. — The  Tennessee  hospitals  for 
the  insane  at  Nashville,  Knoxville,  and  Bolivar,  are  governed  by 
boards  of  five  trustees  each. 

Each  board  shall  appoint  a  superintendent  of  the  hospital 
who  shall  be  a  skilful  physician  of  unblemished  moral  character, 
of  enlightened  and  thorough  professional  education,  of  prompt 
business  habits,  and  of  humane  and  kind  disposition.  He  shall 
be  a  married  man,  and  with  his  family  shall  reside  constantly  in 
the  institution. 

It  shall  be  his  duty  to  exercise  a  general  superintendence  over 
all  matters  relating  to  the  hospital,  to  visit  the  patients  therein 
at  least  twice  a  week,  to  call  extraordinary  meetings  of  the  board 
whenever  it  may  be  deemed  necessary,  to  report  to  the  trustees 
annually  the  number  of  patients  admitted  in  the  hospital,  the 
date  of  admission  of  each  patient,  the  degree  and  kind  of  insanity 
with  which  each  patient  is  afflicted,  the  length  of  time  supposed 
to  have  been  afflicted  before  admission,  the  previous  occupation, 

1  Code  of  Tennessee,  s.  5,478-5,490.          3  Ibid.,  B.  5,500  et  seq. 

2  Ibi<i.,s.  5,491-5,499. 

III.— 47 


738  INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

age,  aiid  habits  of  each  patient,  the  names  and  addresses  of  those 
discharged,  and  the  situation  of  each  when  discharged,  and  such 
other  particulars  as  he  may  deem  necessary.1 

ADMISSION  OF  PATIENTS.— Insane  persons  may  be  placed  in 
the  hospitals  by  their  legal  guardians  or  by  their  relatives  or 
friends  in  case  they  have  no  guardian,  or  by  the  justice  of  the 
peace  if  the  person  be  proved  to  be  insane. 

Non-paying  patients  may  be  admitted  to  the  number  of  one 
to  every  eighteen  hundred  of  the  population  of  each  county, 
upon  a  statement  in  writing  of  some  respectable  citizen  of  the 
county,  filed  with  a  justice  of  the  peace,  to  the  effect  that  the  per- 
son is  insane  and  that  his  insanity  is  of  less  than  two  years'  dura- 
tion, that  he  is  in  needy  circumstances,  and  is  a  citizen  of  the 
State  of  Tennessee. 

The  justice  shall  issue  subprenas  for  persons  named  as  wit- 
nesses and  such  other  persons  as  he  may  think  proper.  If  after 
such  inquest  the  justice  is  satisfied  of  the  truth  of  the  allegations 
contained  in  the  statement,  he  shall  require  the  medical  witnesses 
to  certify  that  they  have  examined  the  person  alleged  to  be  in- 
sane and  as  to  his  condition.  If  satisfied  that  the  person  alleged 
to  be  insane  is  insane,  the  justice  shall  certify  to  such  fact  and 
transmit  to  the  clerk  of  the  county  court  a  certificate  of  the  pro- 
ceedings had.  The  clerk  shall  file  such  certificate  in  his  office  and 
transmit  a  copy  of  the  same  to  the  superintendent  of  the  hospital, 
accompanied  with  an  application  for  the  admission  of  the  patient 
therein  named.  Upon  the  receipt  of  the  application  the  superin- 
tendent shall  notify  the  clerk  as  to  when  the  patient  can  be 
received. 

Paying  patients  are  also  admitted.2 

CRIMINAL  INSANE. — The  court  may  commit  persons  arraigned, 
who  are  found  by  the  jury  to  be  presently  insane,  except  those 
accused  of  misdemeanor  or  felonious  assaults,  or  those  who  are 
admissible  to  the  hospitals  under  the  general  laws  of  commitment.3 

'Code  of  Tennessee,  s.  2,578-2,599.          'Ibid.,  a.  2,631-2,633. 
7  Ibid.,  s.  2,613-2,618,  2,622. 


STATUTES  OP  TEXAS.  739 

TEXAS. 

[The  references  are  to  Sayles'  Texas  Civil  Statutes,  1897 
(1900),  and  Supplement,  1906;  and  Willson's  Texas  Criminal 
Statutes,  1902.] 

DEFINITIONS. — Persons  of  unsound  mind  are  idiots,  lunatics, 
or  insane  persons. 

An  habitual  drunkard  is  one  whose  mind  has  become  so  im- 
paired by  the  use  of  intoxicating  liquors  or  drugs  that  he  is  in- 
capable of  taking  care  of  himself  or  his  property.1 

JURISDICTION. — The  county  court  has  power  to  appoint 
guardians  of  persons  of  unsound  mind  and  habitual  drunkards, 
settle  the  accounts  of  such  guardians,  and  transact  all  business 
pertaining  to  the  estates  of  such  persons. 

The  district  court  has  appellate  jurisdiction  over  the  county 
court  in  all  matters  of  guardianship,  and  original  jurisdiction 
under  such  regulations  as  may  be  prescribed  by  law.2 

APPOINTMENT  OF  GUARDIANS. — Proceedings  for  the  appoint- 
ment of  guardians  of  the  persons,  or  estate,  or  of  either,  of  persons 
of  unsound  mind  or  habitual  drunkards  shall  be  commenced  in 
the  county  where  such  person  of  unsound  mind  or  habitual 
drunkard  resides. 

The  nearest  of  kin  of  such  person  who  is  not  disqualified  shall 
be  entitled  to  the  guardianship,  and  where  two  or  more  are 
equally  entitled  the  guardianship  shall  be  given  to  the  one  or  the 
other  according  to  circumstances,  taking  into  consideration  the 
interests  of  the  ward  alone.  If  such  ward  have  a  husband  or 
wife  who  is  not  disqualified,  such  husband  or  wife  shall  be  en- 
titled to  the  guardianship  in  preference  to  any  other  person. 

Notice  of  the  application  of  the  appointment  of  a  guardian 
must  be  given  to  the  alleged  person  of  unsound  mind  or  habitual 
drunkard.  Before  appointing  a  guardian  the  court  must  be  satis- 
fied that  the  person  for  whom  the  guardian  is  to  be  appointed  is 
a  person  of  unsound  mind  or  a  habitual  drunkard,  that  the 
court  has  jurisdiction  in  the  case,  and  that  the  person  to  be  ap- 
pointed guardian  if  entitled  to  guardianship  is  not  disqualified, 
or  in  other  cases  that  he  is  a  proper  person  to  act.3 

Guardians  of  persons  of  unsound  mind  and  habitual  drunk- 

1  Texas  Civ.  Stat.,  a.  2,553,  2,554.  *  Ibid.,  a.  2,566,  2,583,  2,587,  2.588, 

*  Ibid.,  a.  2,550-2,551.  2,594. 


740          INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

ards  are  required  to  take  the  oath  aud  give  a  bond,  and  their 
powers  and  duties  with  regard  to  the  estate  of  their  wards  are 
the  same  as  guardians  of  minors.1 

PROCEEDINGS  FOR  THE  APPOINTMENT  OF  GUARDIANS. — 
Upon  information  given  to  the  judge  of  the  county  court  that 
any  person  is  of  unsound  mind  or  is  an  habitual  drunkard  and 
is  without  a  guardian  the  judge,  if  satisfied  that  there  is  good 
cause,  shall  issue  a  warrant  to  the  proper  officer  commanding 
such  person  to  be  brought  before  him  at  a  time  and  place  to  be 
named  in  such  warrant. 

The  information  shall  be  in  writing  stating  the  name  of  the 
person  charged,  and  that  such  person  is  of  unsound  mind  or  is 
an  habitual  drunkard ;  such  information  shall  be  subscribed  and 
sworn  to  by  the  informant. 

A  jury  shall  be  empanelled  to  try  the  case  and  decide  whether 
such  person  is  of  unsound  mind  or  is  an  habitual  drunkard. 

The  case  shall  be  conducted  in  the  name  of  the  county  as 
plaintiff  and  the  person  against  whom  the  information  is  filed 
as  defendant,  and  the  proceedings  aud  trial  therein  shall  be  gov- 
erned in  the  same  way  as  in  ordinary  suits  in  the  county  court, 
unless  otherwise  provided. 

If  it  be  found  that  the  defendant  is  of  unsound  mind  or  an 
habitual  drunkard,  the  court  shall  immediately  appoint  a  guard- 
ian of  the  person  and  estate  of  such  defendant.2 

WHEN  WARD  is  FURIOUSLY  MAD. — If  any  person  shall  be 
furiously  mad,  or  so  far  disordered  in  his  mind  as  to  endanger 
his  own  person  or  the  person  or  property  of  others,  it  shall  be 
the  duty  of  the  guardian  to  confine  him  in  some  suitable  place 
until  the  first  regular  term  of  the  county  court,  when  the  court 
shall  make  such  order  for  the  restraint,  support,  and  safe-keep- 
ing of  such  ward  as  circumstances  may  require.  If  any  such 
person  is  not  so  confined,  any  magistrate  may  cause  him  to  be 
apprehended  and  employ  any  person  to  confine  him  in  some  suit- 
able place  until  the  county  court  shall  make  further  order  thereon.3 

MAINTENANCE  OF  INSANE  PERSONS.— Where  the  person  of 
unsound  mind  or  habitual  drunkard  has  no  estate  of  his  own,  he 
shall  be  maintained:  1.  By  the  husband  or  wife,  if  any,  if  able 
to  do  so.  2.  By  the  father  or  mother,  if  able  to  do  so.  3.  By 

1  See  Texas  Civ.  Stat.,  chap.  8,  Title          2  IbuL,  a.  2,735-2,740. 

3  Ibid.,  a.  2,745,  2,746. 


STATUTES   OF   TEXAS.  741 

the  children  and  grandchildren,  if  able  to  do  so.  4.  By  the 
county  in  which  such  person  has  his  residence. 

The  expense  attending  the  confinement  shall  be  paid  by  the 
guardian  out  of  the  estate  of  the  ward,  if  he  has  any,  and  if  not, 
by  the  person  bound  to  provide  for  him ;  if  not  so  paid,  the 
county  shall  be  chargeable  with  such  expense.1 

LUNATIC  ASYLUMS. — The  general  control,  management,  and 
direction  of  Texas  asylums  for  the  insane  are  vested  in  the  boards 
of  managers,  consisting  of  five  members  appointed  by  the  gov- 
ernor. There  is  also  a  colony  for  epileptics,  and  an  asylum  for 
the  treatment  of  hydrophobia. 

They  shall  have  original  jurisdiction  and  control  of  all  the 
property  and  business  of  the  asylums.  They  may  make  by-laws 
and  regulations  for  the  government  of  the  institutions,  determine 
the  salary  and  wages  of  officers,  discharge  officers,  employees,  or 
patients,  appoint  assistant  physicians,  suitable  matrons  and 
apothecary,  examine  the  accounts  and  vouchers  of  the  superin- 
tendent, exercise  a  careful  supervision  over  the  general  opera- 
tions of  the  expenditures  of  the  asylums,  and  direct  the  manner 
in  whi«h  their  revenue  shall  be  disbursed. 

A  committee  of  the  board  shall  visit  each  asylum  once  every 
iiioiiik,  a  majority  quarterly,  and  the  whole  number  once  a  year.2 

POWERS  OF  THE  SUPERINTENDENT. — The  superintendent  shall 
be  elected  by  the  board  of  managers  of  the  asylum.  He  shall  be 
a  married  man,  a  skilful  physician,  and  experienced  in  the  treat- 
ment of  insanity.  He  shall  reside  at  the  asylum,  and  devote  his 

whole  time  to  the  duties  of  his  office. 

» 

He  shall  lie  the  chief  executive  and  medical  disbursing  officer 
of  the  institution,  and,  subject  to  the  by-laws,  shall  have  general 
care  and  control  over  everything  connected  therewith.  With 
the  consent  of  the  board  of  managers  he  shall  employ  such  officers 
and  other  persons  as  may  be  required.  He  shall  keep  a  register  of 
all  patients  received  into  the  asylum  and  discharged  therefrom.3 

ADMISSION  OF  PATIENTS  INTO  ASYLUM. — All  persons  ad- 
judged insane  and  ordered  confined  by  a  court  of  competent 
jurisdiction  may  be  admitted  into  an  asylum.  This  class  shall 
be  known  as  public  patients. 

All  persons  certified  to  be  insane  by  some  respectable  physi- 

1  Texas  Civ.  Stat.,  a.  2,747,  2,748.  *  Ibid.,  a.  97-105. 

2  Ibid.,  a.  88-90. 


742  INCOMPETENT  PERSONS  —  BROWN  AND  BECKER. 

cian  under  the  regulations  prescribed  by  statute  shall  be  received 
and  shall  be  known  as  private  patients. 

Before  any  person  can  be  received  as  a  private  patient,  the 
guardian,  or  parent,  or  some  near  relative  or  other  person  inter- 
ested in  him,  must  present  a  written  request  to  the  superinten- 
dent for  his  admission,  setting  forth  such  facts  as  may  be  re- 
quired by  the  superintendent,  which  written  request  must  be 
under  oath  of  the  party  presenting  it,  and  be  accompanied  with 
the  affidavit  of  the  physician  certifying  to  the  insanity. 

Such  application  must  also  be  accompanied  by  a  certificate 
of  the  county  j  udge  that  the  physician  certifying  to  the  insanity 
of  the  person  is  a  reputable  physician  in  regular  practice.  All 
private  patients  shall  be  kept  and  maintained  at  the  asylum  at 
their  own  expense,  or  the  expense  of  their  relatives  or  others. 
All  indigent  public  patients  shall  be  kept  and  maintained  at  the 
expense  of  the  State.1 

JUDICIAL  PROCEEDINGS  IN  THE  CASE  OF  LUNACY.  —  Upon 
information  in  writing  and  under  oath  to  the  county  judge  that 
any  person  in  his  county  is  a  lunatic,  and  that  the  welfare  of 
himself  or  of  others  requires  that  he  be  placed  under  restraint, 
or  that  such  lunatic  is  a  convict  confined  in  the  State  penitentiary, 
and  if  such  county  judge  shall  believe  such  information  to  be 
true,  he  shall  issue  his  warrant  for  the  apprehension  of  such  per- 
son and  fix  a  day  for  a  hearing.  A  jury  of  six  competent  jurors 
shall  be  summoned  and  duly  examined  and  sworn. 

Evidence  shall  be  produced  and  heard,  and  the  county  judge 
shall  submit  to  the  jury  the  question  as  to  whether  the  defendant 
is  of  unsound  mind  and  if  he  should  be  placed  under  restraint. 

If  this  question  be  decided  in  the  affirmative,  the  verdict  of 
the  jury  shall  state  the  age  and  nativity  of  the  defendant,  the 
number  of  attacks  of  insanity  he  has  had,  and  if  insanity  is 
hereditary  in  the  family  of  defendant  or  not. 

Judgment  shall  thereupon  be  entered  adjudging  the  defendant 
to  be  a  lunatic  and  ordering  him  to  be  committed  to  the  lunatic 
asylum  for  restraint  and  treatment.2 

CRIMINAL  INSANE.—  Insanity  after  conviction  for  crime  is 
tried  by  a  special  jury.  If  found  insane,  the  person  may  be  sent 
to  an  asylum  upon  proceedings  as  in  other  cases.3 


Texas  Crim-  stats-  a-  982-"5- 


STATUTES  OF  UTAH.  743 

UTAH. 

[The  references  are  to  Revised  Statutes  of  Utah,  1907.] 

DEFINITIONS. — The  words  "insane  person"  include  idiots, 
lunatics,  distracted  persons,  and  persons  of  unsound  mind.1 

In  the  statutes  relating  to  the  appointment  of  guardians,  the 
phrases  "incompetent,"  "mentally  incompetent,"  and  "incapa- 
ble "  include  any  person  who  though  not  insane  is  from  any  other 
cause,  unable,  unassisted,  to  properly  care  for  himself  and  his 
property,  etc.2 

GUARDIANS  OF  INSANE  AND  INCOMPETENT  PERSONS. — The 
district  court  of  each  county  may  when  it  appears  necessary  ap- 
point guardians  for  the  persons  and  estates  of  the  insane  or  in- 
competent, on  the  petition  of  a  relative  or  friend,  after  such 
notice  of  the  time  and  place  of  hearing  as  the  court  may  direct 
to  the  person  supposed  to  be  insane  or  incompetent  and  to  such 
other  person  as  the  court  may  direct.3 

Such  guardian  has  the  usual  powers  and  duties.4 

RESTORATION  TO  SANITY. — The  guardian  may  be  discharged 
upon  the  petition  of  the  person  or  any  relative  within  the  third  de- 
gree or  any  friend.  Notice  shall  be  given  to  the  guardian,  the  hus- 
band or  wife,  if  any,  and  the  father  or  mother,  if  living  within  the 
county.  There  must  be  a  hearing,  and  testimony  may  be  taken.5 

INSANE  ASYLUM  AND  COMMITMENTS. — The  board  of  State 
Insane  Asylum  Commissioners  consists  of  the  governor,  State 
treasurer,  and  State  auditor.  This  board  has  supervision  and 
control  of  all  insane  persons  in  the  State,  wherever  confined.  It 
appoints  the  medical  superintendent.6 

The  judges  of  the  district  courts  have  cognizance  of  all  ap- 
plications for  admission  to  the  State  asylum,  or  for  safe-keeping 
within  their  respective  districts.  There  must  be  a  verified  in- 
formation showing  that  it  is  believed  by  the  informant  that  the 
person  is  insane  and  a  fit  subject  for  custody  and  treatment  in 
the  asylum,  and  his  residence.  The  judge  then  holds  an  inqui- 
sition, summoning  witnesses,  including  two  physicians.  The  in- 
quisition and  proceedings  before  the  judge  are  substantially  as 
in  North  and  South  Dakota,  q.  v.1 

1  Utah  Rev.  Stats.,  s.  2,498,  subd.  16.  •  Ibid.,  8.  4,002;  cf.  8.  2,190. 

3  Ibid.,  s.  4,001.  •  Ibid.,  s.  2,153-2,170. 

3  Ibid.,  s.  4,000;  cf.  s.  2,181.  7  Ibid.,  s.  2,171-2,187. 

4  Ibid.,s.  4,003-4,019. 


744  INCOMPETENT   PERSONS — BROWN   AND    BECKER. 

When  room  is  lacking  at  the  asylum,  patients  shall  have  pre- 
cedence in  the  following  order:  1.  Cases  of  less  than  one  year's 
duration;  2,  chronic  cases  of  more  than  one  year's  duration, 
presenting  the  most  favorable  prospects  for  recovery ;  3,  those 
for  whom  application  has  been  longest  on  file.  When  cases  are 
equally  meritorious  the  indigent  are  to  be  preferred.1 

CRIMINAL  INSANE. — The  insanity  of  criminals  condemned  to 
death  is  tried  by  a  special  jury  of  twelve.2 

Any  person  not  indicted  or  acquitted  because  of  insanity,  or 
who  becomes  insane  during  his  trial  or  when  brought  up  for  sen- 
tence, shall  be  sent  to  the  State  insane  asylum,  if  the  judge 
deems  his  freedom  a  menace  to  public  quietude,  upon  being 
found  insane  by  a  special  jury.3 

VERMONT. 

[The  references  are  to  Public  Statutes  of  Vermont,  1906.] 

DEFINITIONS. — The  words  "insane  person"  shall  include 
every  idiot,  non  compos,  lunatic,  and  distracted  person.4 

The  word  "spendthrift"  includes  every  person  who  is  liable 
to  be  put  under  guardianship  on  account  of  excessive  drinking, 
gaming,  idleness,  or  debauchery.5 

APPOINTMENT  OF  GUARDIAN. — The  probate  court  may  ap- 
point guardians  of  insane  persons  or  spendthrifts,  including  an 
insane  married  woman  abandoned  by  her  husband  without  means, 
or  any  insane  married  woman  having  real  or  personal  estate,  or 
any  person  mentally  incapable  of  taking  care  of  himself  or  his 
property,  on  the  application  of  a  relative  or  friend,  or  of  the 
overseer  of  the  poor  of  the  town  in  which  the  person  resides  or 
is  chargeable,  representing  to  the  court  that  such  person  is  insane 
and  incapable  of  taking  care  of  himself,  and  praying  that  a  guard- 
ian be  appointed. 

The  court  shall  fix  a  time  for  considering  the  application, 
notice  of  which  shall  be  given  to  the  alleged  insane  person  or 
spendthrift  at  least  twelve  days  before  the  time  set. 

The  court  shall  investigate  the  case  and  make  such  decree  in 
the  premises  as  appears  just.  If  a  guardian  is  appointed,  the 

1  Utah  Rev.  Stats.,  s.  2,191.  «  Pub.  Stats.,  s.  91,  sub.  7. 

3  Ibid.,  s.  4,932-4,935.  •  Ibid.,  s.  3,138. 

3  Ibid.,  B.  5,052-5,061. 


STATUTES  OF  VERMONT.  745 

cost  of  the  ward  in  defending  against  the  application  shall  be  paid 
out  of  the  ward's  estate.1 

POWERS  OF  GUARDIANS. — Guardians  shall,  until  they  are 
legally  discharged,  have  the  possession  and  management  of  the 
estates  of  their  wards  and  the  care  and  custody  of  the  persons  of 
their  wards,  unless  otherwise  ordered  by  the  court,  and  of  such 
members  of  the  families  of  their  wards  as  are  dependent  upon 
them  for  support,  education,  or  employment,  unless  they  have 
other  guardians.2 

A  married  woman  may  be  appointed  guardian  of  her  hus- 
band, or  of  any  other  person,  and  when  so  appointed,  shall  have 
the  same  rights,  powers  and  privileges,  and  be  subject  to  the 
same  liabilities,  as  if  she  were  unmarried.3 

The  general  provisions  applicable  to  the  care  and  manage- 
ment of  the  estates  of  minors  are  also  made  applicable  to  the 
guardians  of  insane  persons  and  spendthrifts. 

The  estates  of  such  wards  are  controlled  subject  to  the  direc- 
tion of  the  probate  court,  and  no  disposition  thereof  can  be  made 
except  upon,  the  order  of  such  court.4 

INSANE  POOR. — Insane  persons  in  any  town  destitute  of  the 
means  to  support  themselves,  and  having  no  relatives  bound  by 
law  to  support  them,  and  having  no  legal  settlement  in  any  town, 
shall  be  supported  by  the  State  at  the  insane  asylum.5 

The  facts  shall  be  determined  by  the  probate  court,  which 
may  order  the  person  removed  to  an  insane  hospital.8 

SUPERVISION  OF  THE  INSANE. — The  governor  shall  appoint 
biennially  one  of  three  supervisors  of  the  insane  who  shall  hold 
their  offices  for  six  years.  Two  of  such  supervisors  shall  be 
physicians,  and  none  of  them  shall  be  a  trustee,  superintendent, 
employee,  or  other  officer  of  an  insane  asylum  in  the  State. 

The  supervisors  shall  visit  the  Vermont  hospital  for  the  in- 
sane and  the  Brattleboro  Retreat  as  often  as  occasion  requires, 
and  one  member  as  often  as  once  a  month,  and  also  any  other 
place  where  insane  persons  are  confined  in  the  State,  at  their  dis- 
cretion. They  shall  examine  into  the  condition  of  the  asylums 
in  such  other  places,  the  management  and  treatment  of  the 
patients  therein,  their  physical  and  mental  conditions  and  medi- 
cal treatment ;  form  a  careful  opinion  of  the  patients,  apart  from 

1  Pub.  Stats.,  s.  3.159-3,163.  4  Ibid.,  s.  3,171-3,223. 

2  Ibid.,  8.  3,1(59-3,170.  •  7W.,  s.  3.715. 

3  Ibid.,  s.  3,070.  'Ibid.,  s.  3,716-3,718. 


746          INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

the  officers  and  keepers,  and  investigate  the  cases  that  in  fheir 
judgment  require  special  investigation,  and  particularly  ascer- 
tain whether  persons  are  confined  in  such  asylums  or  other  places 
who  ought  to  be  discharged.1 

ADMISSION  TO  INSANE  ASYLUM. — No  person  shall  be  ad- 
mitted to  or  detained  in  the  insane  asylum  as  a  patient  or  inmate 
(unless  as  a  voluntary  patient)  except  upon  the  sworn  certificate 
of  such  person's  insanity,  made  by  two  physicians  of  unques- 
tioned integrity  and  skill  residing  in  the  State. 

Such  certificate  shall  be  made  not  more  than  ten  days  previous 
to  the  admission  of  such  insane  person.  Such  certificate,  with 
the  certificate  of  the  judge  of  the  probate  district  in  which  the 
physicians  reside,  stating  that  such  physicians  are  of  unquestioned 
integrity  and  skill  in  their  profession,  shall  be  presented  to  the 
proper  officer  of  the  asylum  at  the  time  such  insane  person  is 
presented  for  admission. 

The  certificate  of  the  physicians  shall  only  be  given  after  a 
careful  examination  of  the  patient,  made  not  more  than  five  days 
previous  to  making  the  certificate. 

An  appeal  may  be  taken  by  a  relation  or  friend  of  the  person 
committed,  to  the  State  board  of  supervisors,  and  pending  such 
appeal  the  person  shall  not  be  confined. 

A  person  may  be  received  into  an  asylum  without  a  certificate 
upon  the  order  of  the  supreme  or  county  court  upon  the  presen- 
tation of  a  certified  copy  of  the  order  or  sentence.2 

Voluntary  patients  may  be  received  on  their  written  appli- 
cation. Such  persons  shall  not  be  detained  after  they  give  notice 
of  desire  to  leave.3 

INSANE  HOSPITALS. — The  Vermont  State  Hospital  is  the  hos- 
pital for  the  care  and  custody  of  the  criminal  insane  of  the  State, 
and  such  of  the  insane  poor  as  can  be  accommodated  therein. 

It  is  governed  by  a  board  of  three  persons,  appointed  by  the 
governor,  which  may  also  contract  with  the  Brattleboro  Eetreat 
for  the  care  of  part  of  the  insane  poor. 

The  said  board  appoints  the  superintendent.4 

Private  hospitals  must  be  licensed  by  the  Board  of  Supervis- 
ors of  the  Insane.5 

When  insane  persons  are  not  in  hospitals,  they  must  be  kept 

1  Pub.  Stats.,  s.  3,741-3,752.  « Ibid.,  s.  3,767-3.780. 

1  Jbui.,  s.  3,753-3,763.  •  Ibid.,  s.  3,794-3,799. 

1  Ibid.,  s.  3,764-3,766. 


STATUTES  OF  VIRGINIA.  747 

in  restraint  by  their  guardians,  or,  if  poor,  by  the  overseers  of 
the  poor.1 

CRIMINAL  INSANE. — Persons  acquitted  or  not  indicted  be- 
cause of  insanity  may  be  committed  to  the  State  hospital  or  to 
the  State  prison.2 

VIRGINIA. 

[The  references  are  to  Pollard's  Virginia  Code,  1904.] 

DEFINITIONS. — In  the  statutes  generally  the  words  "insane 
person  "  shall  be  construed  to  include  every  one  who  is  an  idiot, 
lunatic,  non  compos,  or  deranged.3 

But  in  reference  to  commitments  to  the  State  hospitals  the 
words  "insane  person  "  do  not  include  idiots.4 

CARE  AND  CUSTODY. — Adjudications  of  insanity  are  made 
on  the  complaint  of  any  citizen  or  on  the  court's  own  motion,  by 
any  county  or  corporation  judge,  or  justice  of  the  peace.  A 
warrant  is  issued ;  two  physicians,  one  of  whom  if  practicable  is 
the  person's  physician,  are  summoned,  who  with  the  judge  form 
a  commission.  The  commission  reports  on  a  prescribed  form, 
giving  full  history  and  diagnosis.5 

If  the  person  be  found  insane  and  one  who  ought  to  be  con- 
fined in  a  hospital,  the  judge  may  so  order,  or  commit  him  to  a 
private  sanitarium,  or  the  care  of  friends.6 

The  writ  of  habeas  corpus  may  be  obtained  to  test  the  legality 
of  detention  in  a  hospital.7 

The  same  proceedings  apply  to  the  adjudication  of  non-resi- 
dent insane  persons,  but  they  shall  be  returned  to  their  homes.8 

When  any  person  is  found  insane  as  above,  the  court  of  the 
county  or  corporation  of  which  he  is  an  inhabitant  shall  appoint 
a  committee  for  him.  The  circuit  courts  have  concurrent  juris- 
diction.9 

On  application  of  any  party  a  committee  may  l>e  appointed 
for  an  insane  person  not  so  adjudicated,  or  for  a  non-resident.10 

The  committee  has  the  usual  powers." 

1  Pub.  Stats.,  s.  3,800-3,806.  5  Ibid.  s.  1,669. 

1  Ibid.,  s.  3,329,  2,330,  2,331,  6,063-  •  Ibid.  s.  1 ,670. 

6,066.     This  is  the  only  State  which  7  Ibid.  s.  1,675. 

authorises  the  confinement  in  a  State  8  Ibid.  s.  1,676. 

prisoft  of   persons  acquitted    on  the  '  Ibid.  s.  1 ,697 ,  1 ,700. 

ground  of  insanity.  10  Ibid.  s.  1,698.  1,699. 

»  Virginia  Code,  s.  5,  sub.  5.  "  Ibid.  s.  1,702-1,706. 

4  Ibid.,  s.  1,712. 


748          INCOMPETENT   PERSONS — BROWN  AND   BECKER. 

Upon  complaint  of  any  relative,  or  if  none,  any  two  friends, 
an  habitual  drunkard,  opium-eater,  or  person  addicted  to  other 
drug  habits  and  lost  to  self-control,  who  would  be  benefited  by 
treatment  in  a  private  hospital  or  sanitarium,  may  be  committed, 
by  three  justices  so  determining,  to  such  an  institution,  for  not 
exceeding  four  months.  On  appeal  such  person  has  the  right 
to  trial  by  jury.  A  committee  may  be  appointed  for  such 
person  by  the  circuit  court.1 

STATE  HOSPITALS. — The  State  hospitals  are  the  Eastern,  at 
Williamsburg,  the  Western,  at  Staunton,  the  Southwestern,  at 
Marion,  and  the  Central  (for  colored  persons  of  unsound  mind), 
at  Petersburg.2 

Each  is  managed  by  a  board  of  directors  of  three  persons 
appointed  by  the  governor,  who  constitute  a  general  board  of 
directors.3 

The  general  board  of  directors  appoints  the  superintendents, 
and  other  resident  officers.  The  salaries  of  superintendents  vary 
from  $1,800  to  $2,500,  with  board,  etc.  The  superintendents 
appoint  employees.4 

In  addition  there  is  a  commissioner  of  State  hospitals,  ap- 
pointed by  the  governor,  who  is  ex-officio  chairman  of  the  general 
and  each  of  the  special  boards.  He  is  the  financial  officer,  and 
makes  reports  of  the  condition  and  needs  of  the  hospitals.5 

The  superintendent  may  allow  furloughs,  and  deliver  the  in- 
sane to  their  friends,  who  give  bonds,  or  if  harmless  and  incur- 
able, without  bond.6 

Voluntary  patients  may  be  received  in  the  hospitals,  and 
non-residents  when  there  are  vacancies.7 

All  persons  committed  to  the  State  hospitals  are  removed 
there  and  maintained  at  the  expense  of  the  State.8 

CRIMINAL  INSANE. — Any  person  charged  with  crime,  found, 
in  the  court  before  which  he  is  so  charged,  to  be  insane,  may  be 
confined  in  a  State  hospital.  But  any  convict  becoming  insane 
shall  be  confined  in  a  special  ward  in  the  State  penitentiary.9 

Trial  may  be  suspended  until  a  jury  inquires  into  the  fact  as 
to  the  present  sanity  of  a  person  accused  of  crime.  If  the  jury 

1  Virginia  Code,  s.  l,713a.  6  Ibid.,  s.  1,688,  1,683. 

1  Ibid.,  s.  1,660-1,661.  7  Ibid.,  s.  1,677-1,678. 

1  Ibid.,  s.  1,662.  8  Acts  of  Assembly,  1908,  c.  401. 

4  Ibid.,  s.  1,663.  9  Virginia  Code,  s.  1,682.     But  cf. 

*lbid.,  s.  1,664.  s.  4,123. 


STATUTES   OF   WASHINGTON.  74 U 

find  him  insane,  they  shall  also  inquire  as  to  his  sanity  at  the  time 
of  the  offence.  If  they  find  he  was  then  insane,  he  may  be  dis- 
charged or  committed  for  treatment.  If  they  find  he  was  not  then 
insane,  he  shall  be  confined  until  he  is  restored  and  can  be  tried.1 

After  conviction  and  before  sentence  a  jury  may  be  impan- 
elled to  inquire  into  sanity.2 

When  a  person  tried  for  an  offence  is  acquitted  by  reason  of 
insanity,  the  verdict  shall  so  state,  and  he  shall  be  sent  to  one  of 
the  asylums.3 

WASHINGTON. 

[The  references  are  to  Balliuger's  Annotated  Codes  and  Stat 
utes  of  Washington,  1897,  Supplement,  1903.] 

CARE  AND  CUSTODY. — The  superior  court  of  any  county  has 
jurisdiction  of  commitments  to  the  hospital  for  the  insane,  and 
also  the  appointment  of  guardians  of  insane  persons  and  idiots.4 

Any  person  may  apply  for  the  restraint  of  an  insane  person 
unsafe  to  be  at  large.  The  person  shall  be  brought  before  the 
court,  and  he,  or  any  one  in  his  behalf,  may  demand  a  jury  trial. 
Physicians  shall  be  summoned.  If  the  disease  is  recent  or  cur- 
able, or  of  a  dangerous  tendency,  the  court  shall  commit  him  to 
the  State  hospital  for  the  insane  or  to  the  care  of  friends  giving 
bond.5 

No  cases  of  idiocy,  imbecility,  harmless  chronic  mental  un- 
soundness,  acute  mania  a  potu,  or  contagious  or  infectious  dis- 
ease shall  be  admitted  to  the  State  hospital.6 

On  the  petition  of  a  relative  or  friend  and  notice  to  an  insane 
person  or  idiot,  a  guardian  may  be  appointed.7 

The  guardian  has  the  usual  powers.  He  shall  care  for  the 
maintenance  of  the  incompetent  and  his  family,  and  the  educa- 
tion of  his  children.8 

A  foreign  guardian  may  qualify  in  the  State,  on  filing  a  copy 
of  his  letters  and  a  bond.9  If  there  is  no  foreign  guardian,  any 
person  interested  may  apply  for  letters.10  The  powers  and  duties 
of  such  guardians  are  similar." 

1  Virginia    Code,     s.    4,030-4,031,  7  Ibid.,  s.  6,424a  (Supp.)-6,426. 

4,033-4,034-  *  Ibid.,  s.  0.424,  6,427-6,433.  6,439, 

3  Ibid.,  s.  4,032-4,034.  6,4f>2-6,4f>f>,  6.444  (Supp.);    rf.  foot- 

3  Ibid.,  s.  4,035.  note  to  vol.  2.  p.  1,790. 

4  Washington  Code,  s.  2,60)0,  6,424.  *  Ibid.,  s.  6,447. 

5  Ibid.,  s.  2,660-2,664,  2,677-2,678.  10  Ibid.,  s.  6.449. 

•  Ibid.,  s.  2,666-2,6C8.  "  IbuL,  s.  6,450-6,451. 


750  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

The  real  property  of  idiots  and  insane  persons  may  be  sold 
at  private  sale  through  a  court  proceeding.1 

Upon  complaint  by  a  person  interested  of  any  person  addicted 
to  the  excessive  use  of  intoxicating  liquors,  that  he  is  an  habit- 
ual drunkard,  and  squandering  his  property  or  abusing  his  fam- 
ily, he  may  be  adjudged  an  habitual  drunkard.  Selling  liquor 
to  such  a  person  is  a  crime ;  and  any  one  whose  person  or  prop- 
erty is  injured  by  such  adjudged  drunkard  when  intoxicated 
may  recover  his  damages  from  the  one  who  gave  him  the  liquor.2 

Lists  of  adjudged  habitual  drunkards  are  posted  in  places  of 
business  of  liquor-sellers.3 

STATE  HOSPITALS. — The  State  hospitals  for  the  insane  are 
"The  Western  Washington  Hospital  for  the  Insane,"  at  Fort 
Steilacoom,  and  "The  Eastern  Washington  Asylum  for  the  In- 
sane," at  Medical  Lake.4 

The  State  Board  of  Audit  and  Control  have  the  general  man- 
agement. The  board  consists  of  five  members,  appointed  by  the 
governor,  one  of  whom  is  known  as  the  commissioner  of  public 
institutions.  The  governor  is  chairman  ex  officio.5 

The  board  shall  appoint  a  superintendent,  who  shall  have 
entire  control  of  the  medical,  moral,  and  dietetic  treatment  of 
patients,  of  the  discharge  of  patients,  and  hire  officers  and  em- 
ployees.6 

Preference  shall  be  given  in  admissions  as  follows:  1,  cases 
of  less  than  one  year's  duration ;  2,  cases  of  more  than  one  year's 
duration  according  to  prospects  of  recovery ;  3,  seniority  of  ap- 
plication, other  things  being  equal;  4,  the  indigent  shall  have 
the  preference  generally.7 

The  superintendent's  salary  is  $2,200 ;  ward  attendants',  $600. 
They  are  furnished  with  quarters.8 

CRIMINAL  INSANE. — The  commitment  of  insane  convicts  or 
persons  accused  of  crime  is  by  the  governor  and  by  the  court 
wherein  the  jury  finds  him  insane,  respectively.9 

But  the  warden  of  the  State  penitentiary  apparently  has 
power  to  send  insane  convicts  to  a  State  hospital. 10 

1  Washington  Code,  s.  6,460-6,469.          •  Ibid.,  s.  2,655,  2,657-2,659,  2,673, 

2  Ibid.,  s.  6,487-6,492.  2,675. 

8  Ibid.,  8.  6,493.  7  Ibid.,  s.  2,672. 

4  Ibid.,  s.  2,651-2,654.  8  Ibid.,  s.  2,700,  2,701. 

5  Ibid.,  s.  2,621-2,629,  2,655,  2,690-  •  Ibid.,  s.  2,665,  2,664. 
2,696.  "Ibid.,  s.  2,748,  sub.  5. 


STATUTES  OF  WEST  VIRGINIA.  751 

When  auy  person  tried  for  an  offence  is  acquitted  by  reason 
of  insanity,  the  jury  shall  so  certify,  and  if  his  condition  be  such 
that  it  is  dangerous  for  him  to  be  at  large,  the  court  may  commit 
him  to  prison,  or  to  the  custody  of  friends  giving  bond.1 

WEST  VIRGINIA. 

[The  references  are  to  West  Virginia  Code,  1906  (West  Pub- 
lishing Company).] 

DEFINITIONS. — "Persons  under  disability"  includes  insane 
persons.  "Insane  person"  includes  every  one  who  is  an  idiot, 
lunatic,  non  compos,  or  deranged.2 

In  the  chapter  relating  to  care  and  custody  in  State  hospitals, 
etc.  (Acts,  1899,  chap,  xix.,  Acts,  1901,  chap.  liii. ),  "lunatic" 
includes  every  insane  person  who  is  not  an  idiot.3 

CAEE  AND  CUSTODY. — Inquiry  into  insanity  is  a  summary 
proceeding  conducted  by  a  justice  of  the  county.  Questions  to 
be  propounded  are  prescribed.  If  he  decides  that  the  person  is 
a  lunatic,  he  may  either  commit  him  to  a  hospital  (the  examin- 
ing board  of  the  hospital  concurring),  or  to  the  care  of  a  proper 
person  giving  bond.  Non-residents  are  to  be  sent  to  their  States.4 

A  committee  is  appointed  by  the  circuit  court  for  any  person 
found  to  be  insane,  or  in  a  criminal  proceeding ;  and  for  any 
person  found  to  be  insane  after  an  inquisition  held  by  the  circuit 
court  upon  application  of  any  person  interested,  notice  being 
given  the  lunatic.5 

A  like  appointment  may  be  made  for  any  non-resident  insane 
person  having  property  in  the  State.6 

The  committee  has  the  usual  powers  over  the  person  and 
estate.7 

STATE  HOSPITALS. — The  West  Virginia  Hospital  for  the  In- 
sane, at  Westou,  and  the  Second  Hospital  for  the  Insane,  at 
Spencer,  are  under  the  management  of  boards  of  directors  of 
nine  persons  each,  appointed  by  the  governor.8 

The  boards  appoint  the  superintendents  and  assistants.9 

Any  one  or  more  of  the  directors,  with  the  superintendent, 


1  Washington  Code,  s.   6,959;   but  *  Ibid, 
cf.  s.  2,664.  « Ibid. 

2  West  Virginia  Code,  s.  293,  sub.  T  Ibid. 
13-14.  etc. 

3IbuL,  s.  2.679.  8/6tV/. 

4  Ibid.,  a.  2,644-2,652.  » Ibid. 


s.  2,655.  2,668-2,669. 

s.  2,670. 

s.  2,672-2,675,  3,228-3,254, 

s.  2,637-2,639. 
s.  2,641. 


752  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

constitute  au  examining  board,  to  examine  persons  brought  to 
the  hospital  as  lunatics.1 

The  board  shall  order  any  idiot  received  in  the  hospital  re- 
moved to  the  county  whence  he  came.2 

The  examining  board  may  discharge  those  recovered.3 

The  West  Virginia  Asylum  for  Incurables,  at  Huutiugtou,  is 
under  the  control  of  a  board  of  directors  of  five  persons,  ap- 
pointed by  the  governor.  They  appoint  the  superintendent  and 
assistants.4 

The  class  of  persons  who  shall  be  admitted  shall  consist  of 
epileptics,  idiots,  and  such  other  incurable  defectives  and  insane 
as  the  board  of  directors  may  deem  eligible,  but  not  tubercular, 
cancerous,  or  leprous  patients.  Paying  patients  are  admitted, 
but  charity  patients  have  the  preference.5 

The  governor  may  transfer  patients  from  the  other  hospitals 
to  this.6 

Admission  is  obtained  for  a  person  incapable  of  deciding  for 
himself,  by  application  of  the  father,  guardian,  etc.,  to  the 
county  court;  otherwise,  by  petition  of  the  person  himself.7 

CRIMINAL  INSANE. — When  a  person  charged  with  crime  is 
not  indicted  because  of  insanity  the  grand  jury  shall  so  certify, 
and  the  court  may  commit  him,  etc. 8 

No  person  shall,  while  he  is  insane,  be  tried  for  a  criminal 
offense.  If  a  person  so  charged  be  suspected  of  being  insane,  a 
jury  shall  be  convened.  If  they  find  him  presently  sane,  they 
shall  inquire  no  further,  but  if  they  find  him  insane,  they  shall 
inquire  whether  he  was  at  the  time  of  the  offense ;  and  if  they  so 
find  he  may  be  discharged  or  committed  to  a  hospital.  If  they 
find  he  was  then  sane  but  now  insane  he  may  be  committed  until 
restored.9 

After  conviction  the  court  may  by  jury  inquire  whether  he 
has  become  insane  and  if  so' found  commit  him  to  a  hospital.10 

When  a  prisoner  is  convicted  on  account  of  insanity,  the  ver- 
dict shall  state  the  fact,  and  the  court  may,  if  it  deem  him  dan- 
gerous, send  him  to  a  hospital.11 


'West    Virginia    Code,    s.    2,641,  6  Ibid 

2.649-2,650.  '  Ibid 

2  Ibid.,  s.  2,654.  8  Ibid. 

3  Ibid.,  s.  2,660.  9 Ibid. 

4  Ibid.,  s.  2,683-2,689.  10  Ibid. 
8  Ibid.,  s.  2,690-2,691,  2,698.  »  Ibid. 


s.  2,690. 

s.  2,692-2,693. 

s.  4,551. 

s.  4,575,  4,577,  4,578. 

s.  4,576. 

s.  4,579. 


STATUTES   OP  WISCONSIN.  753 

CONTRACTS,  ETC. — A  marriage  between  insane  persons  may 
be  annulled.1 

No  person  of  unsound  mind  shall  be  capable  of  making  a  will.2 
Persons  of  unsound  mind  are  incompetent  to  testify  as  wit- 
nesses.3 

WISCONSIN. 

[The  References  are  to  Wisconsin  Statutes  of  1898,  Sauborn 
and  Berry  man ;  Supplement,  1906.] 

DEFINITION. — In  the  statutes,  the  words  "insane  persons" 
shall  be  construed  to  include  every  idiot,  non  compos,  lunatic, 
and  distracted  person.4 

CARE  AND  CUSTODY. — A  relative  or  friend  of  insane  person 
or  any  person  "  who,  by  reason  of  extreme  old  age  or  other  cause, 
is  mentally  incompetent  to  have  the  charge  of  his  property  "  may 
petition  county  court  for  appointment  of  a  guardian  of  his  per- 
son and  estate.  Notice  must  be  ordered  by  the  court  to  be  given 
the  person,  or  the  superintendent  of  an  asylum  where  he  is  con- 
fined. When  he  has  been  already  adjudged  insane  and  committed 
to  a  hospital  (see  below)  a  special  guardian  may  be  appointed.5 

Guardians  may  likewise  be  appointed  for  drunkards,  spend- 
thrifts, etc.8 

After  the  order  of  notice  (if  a  guardian  is  appointed)  all 
contracts,  except  for  necessaries,  gifts,  sales,  and  transfers  of 
property  shall  be  void.7 

The  superintendent  of  a  hospital  for  the  insane  may  apply 
for  a  guardian  for  any  inmate  having  property.8 

A  county  court  may  appoint  a  guardian  for  the  whole  State 
of  the  property  of  a  non-resident  incompetent.9 

A  guardian  or  friend  of  a  lewd,  insane,  incompetent,  or  im- 
becile person  may  petition  for  an  order  of  confinement.10 

Guardians  have  the  usual  powers.11 

Guardians  ad  litem  may  be  appointed  for  the  insane,  with  the 
usual  powers.12 

STATE  HOSPITALS. — The  "Wisconsin  State  Hospital  for  the 

1  West  Virginia  Code,  s.  2,917.                  7  Ibid.,  s.  3,979. 

-  IbitL,  s.  3,i:J4.  •  Ibid.,  s.  3,979a. 

1 1bitL,  s.  2,059.  •  IbiiL,  s.  3,980. 

4  Wisconsin     Statutes,  s.     4,971,         10  Ibid.,  s.  3,981a-3,981b. 

sub.  7.  "  IbitL,  s.  3,982-3.993. 

8  Ibi,L.  s.  3,970-3,977.  "  IbitL,  s.  2,015-2,018,  3,994. 
8  Ibid.,  s.  3,978. 
III.— 48 


754  INCOMPETENT   PERSONS — BROWN   AND   BECKER. 

Iusaiie,"at  Madison,  aud  the  "Northern  Hospital  for  the  In- 
sane," at  Oshkosh,  are  maintained  and  governed  by  the  State 
Board  of  Control  of  five  persons  appointed  by  the  governor. 
This  board  acts  as  commissioners  of  lunacy,  and  as  such  may  in- 
quire into  the  sanity  of  any  person  confined  in  any  public  or 
private  asylum,  and  into  the  conduct  of  such  asylums.1 

The  board  appoints  superintendents,  who  have  the  immediate 
supervision  of  the  State  hospitals,  and  entire  control  over  subor- 
dinate officers  and  employees.2 

Admissions  to  the  State  hospitals  are  apportioned  among  the 
counties  according  to  population.  No  person  idiotic  from  birth, 
or  who  may  safely  be  allowed  liberty  notwithstanding  imbe- 
cility, shall  be  admitted ;»  and  no  person  incurably  insane  shall 
be  retained  to  the  exclusion  of  curable  cases.  Persons  under 
charge  or  convicted  of  crime  shall  not  be  discharged  without  an 
order  of  the  court.3 

Any  three  citizens  may  apply  to  the  county  court  for  a  judi- 
cial inquiry  and  an  order  committing  a  person  to  a  State  hospital. 
Two  physicians  are  appointed  as  examiners  in  lunacy.  The 
form  of  their  report  is  prescribed.  Notice  to  the  insane  person 
must  be  given,  if  not  injurious  to  him,  and  he  or  a  relative  may 
demand  a  jury  trial.  In  proper  cases  the  person  may  be  com- 
mitted to  a  county  hospital  for  the  chronic  insane.  Upon  peti- 
tion alleging  recovery,  a  similar  proceeding  may  be  had,  or  the 
State  board  of  control  may  decide. 4 

Insane  persons  may  be  admitted  as  voluntary  patients,  upon 
two  physicians'  certificates.5 

Paroles  are  permitted,  by  the  superintendents,  and  after  a 
parole  of  two  years  the  presumption  of  insanity  arising  from  the 
original  adjudication  that  the  person  was  insane  ceases.8 

All  insane  persons  residents  of  the  State  admitted  to  the  hos- 
pitals shall  be  maintained  at  the  expense  of  the  State  and  the 
county  of  residence;  but  relatives,  friends,  or  guardians  may 
contribute  and  may  provide  special  attendance.7  The  financial 
ability  of  the  person  shall  be  examined  into  by  the  county  judge 
on  the  inquisition,  notice  being  given  to  the  district  attorney.8 

1  Wisconsin  Statutes,  s.  561-561q,          5  Ibid.,  s.  587a. 

564,  580.  •  Ibid.,  s.  587 c.  (Supp.) 

2  Ibid.,  s.  561q.,  582.  '  Ibid.,  s.  588. 

*  Ibid.,  s.  583-584.  8  Ibid.,  Supp.,  s.  584a. 

•  Ibid.,  a.  585-587. 


STATUTES   OF  WISCONSIN.  755 

-residents  may  be  sent  to  their  State,  etc.1 
Belease  of  inmates  may  be  obtained  by  the  writ  of  habeas 
corpus.2 

A  rehearing  of  the  inquisition  may  also  be  had  at  any  time  on 
application  of  the  person  adjudged  insane  before  any  court  of 
record  of  the  county.  A  jury  trial  may  be  demanded,  or  the 
condition  of  the  person  reported  on  by  two  physicians.3 

Any  county  board  may,  with  the  consent  of  the  State  board 
of  control,  maintain  an  asylum  for  the  chronic  insane.4 

County  asylums  are  governed  by  a  board  of  three  trustees. 
The  judge  of  the  district  court  of  Milwaukee  County  has  power 
to  commit  to  the  county  hospital.5 

Corporations  may  be  formed  to  conduct  asylums.6 
CRIMINAL  INSANE. — Insanity  is  pleaded  as  a  defence  by 
special  plea  filed  with  the  plea  of  not  guilty,  and  is  first  tried  by 
the  jury.  The  finding  is  conclusive.  If  the  jury  find  that  there 
is  a  reasonable  doubt  of  the  defendant's  insanity  at  the  time  of 
the  offence,  they  must  acquit,  and  they  shall  specify  that  ground 
and  also  whether  he  has  recovered.  If  the  jury  cannot  agree  on 
this  plea,  the  trial  proceeds,  and  the  issue  is  then  determined. 
The  presumption  of  sanity  shall  prevail  unless  the  evidence  raises 
a  reasonable  doubt  of  his  sanity.  If  the  defendant  is  found  still 
insane  he  shall  be  confined  in  a  State  hospital.7 

When  the  court  learns  that  a  person  accused  is  probably  in- 
sane at  the  time,  it  shall  in  a  summary  manner  make  inquiry 
thereof  by  a  jury  or  otherwise,  and  if  he  is  found  insane  he  shall 
be  confined  in  a  hospital  or  elsewhere  as  provided.8 

Insane  convicts  may  be  ordered  confined  in  a  hospital,  etc.9 
Abuse  of  any  inmate  by  an  officer  or  employee  is  a  crime. 10 
CONTRACTS,  ETC. — Conveyances  may  be  made  by  insane  per- 
sons under  order  of  the  court;  and  contracts  of  persons  after- 
ward becoming  insane  may  be  enforced  by  decree  of  specific  per- 
formance when  proper." 

Marriages  may  be  annulled  for  want  of  understanding,  unless 
the  plaintiff  knew  of  the  defendant's  insanity.12 

'Wisconsin  Statutes,  s.  594.  r  Ibid.  s.  4,697-4,699. 

3  Ibid.,  s.  595.  *Ibid.  s.  4.700. 

» Ibul.,  Supp.,  s.  587.  •  Ibid.  s.  4,944. 

'  Ibid.,  s.  603-6048.  10  Ibid.  s.  4,389. 

6  Ibid.,  Supp..  s.  604a-604x.  "  Ibid.  s.  3,49S-3.519a. 

"  Ibid.,  a.  l,786a.  »  Ibid.  s.  2,350,  2,354. 


756        INCOMPETENT  PERSONS — BROWN  AND  BECKER. 

WYOMING. 

[The  references  are  to  Eevised  Statutes  of  Wyoming,  Eevi- 
sion  of  1899.] 

CARE  AND  CUSTODY. — Any  person  may  petition  the  district 
court  for  the  appointment  of  a  guardian  of  a  person  insane  "or 
from  any  cause  mentally  incompetent  to  manage  his  property, " 
or  an  habitual  drunkard.  Notice  must  be  given  to  the  supposed 
incompetent  and  a  trial  by  jury  held.  The  jury  finds  also  the 
value  of  the  incompetent's  property,  if  any,  or  whether  he  is  a 
pauper.  If  there  is  any  estate  the  judge,  court  commissioner, 
or  clerk  shall  appoint  a  guardian  of  the  person  and  estate.1 

The  estate  is  entitled  to  exemptions  from  creditors'  claims 
for  the  care  of  the  incompetent  and  his  family.2 

When  the  jury  finds  the  person  incompetent  the  county 
physician  shall  prepare  a  " lunacy  statement,"  in  a  statutory 
form,  showing  diagnosis,  history,  and  prognosis.  This  statement 
is  filed  and  accompanies  the  warrant.3 

Restoration  to  sanity  is  also  to  be  determined  by  a  jury.4 

Guardians  have  the  usual  powers.5 

Guardians  to  hold  the  property  of  non-resident  incompetents 
may  be  appointed.6 

In  actions  when  the  present  insanity  of  a  party  is  alleged  but 
not  apparent,  the  court  may  try  the  issue,  or  summon  a  jury.7 

INSANE  HOSPITALS. — "The  Wyoming  State  Hospital  for  the 
Insane  "  at  Evanston  is  under  the  jurisdiction  of  the  State  board 
of  charities  and  reform,  composed  of  the  governor,  secretary  of 
state,  State  treasurer,  State  auditor,  and  State  superintendent  of 
public  works.8 

The  board  appoints  the  superintendent,  a  physician,  who 
manages  the  asylum.9 

Paying  patients  may  be  admitted,  and  if  the  incompetent  has 
an  estate,  the  guardian  must  pay  for  his  support  from  the  estate.10 

The  superintendent's  salary  is  $1,800;  attendants',  $35  per 
mouth.11 

1  Wyoming  Statutes,  s.  4,879-4,881,          7  Ibid.,  s.  3,476 

4,88.V4,889,  4,890,  4,896,  4,897.  » Ibid.,    s.    632,    633,    647,    1832 

2  Ibid.,  s.  4,882.  1,848-1,852. 

1  Ibid.,  s.  4,884-4,886.  9  Ibid.,  s.  648 

1  Ibid.,  s.  4.894-4,895.  >° Ibid.,   s.   649,  4.891,  4,892;   cf.  s. 

5  Ibid.,  s.  3,472,  3,474,  4,890,  4,898-  4.887,4,888,651,652 

4,922.  "  Ibid.,  s.  659. 
•  Ibid.,  s.  4,923-4,929. 


STATUTES   OF  WYOMING.  T~>; 

CRIMINAL  INSANE. — "Drunkenness  shall  not  be  an  excuse 
for  any  crime  or  misdemeanor,  unless  such  drunkenness  be 
occasioned  by  the  fraud,  contrivance,  or  force  of  some  other  per- 
son or  persons,  for  the  purpose  of  causing  the  perpetration  of  an 
offence,  in  which  case  the  person  or  persons  so  causing  said  drunk- 
enness for  such  malignant  purpose  shall  be  considered  principal 
or  principals,  and  suifer  the  same  punishment  as  would  have 
been  inflicted  on  the  person  or  persons  committing  the  offence, 
if  he.^or  she,  or  they  had  been  possessed  of  sound  reason  and  dis- 
cretion. Where  a  crime  rests  in  intention,  the  inebriated  con- 
dition of  the  defendant  at  the  time  of  committing  the  offence 
may  be  proven  to  the  jury,  as  bearing  upon  the  question  of  in- 
tention."1 

Persons  accused  or  convicted  of  crime  are  to  be  kept  at  the 
State  asylum  or  elsewhere  after  being  declared  insane  by  the  in- 
quiry provided  for  as  above.2 

When  a  person  condemned  to  death  appears  to  be  insane,  a 
jury  of  twelve  men  determines  the  question,  and  execution  is 
suspended  until  the  governor,  upon  being  convinced  of  restora- 
tion, issues  a  wrarrant  appointing  a  time  for  the  execution.3 

1  Wyoming  Statutes,  s.  5,369.  3  Ibid.,  s.  5,408-5,410. 

a  Ibid.,  s.  654-658. 


THE    MEDICO-LEGAL    ASPECTS 


OF 


MARRIAGE  AND  DIVORCE 


BY 

ALFRED  L.  BECKER, 

of  the  Buffalo,  N.  Y.,  Bar. 


THE  MEDICO-LEGAL  ASPECTS  OF  MAR- 
RIAGE  AND  DIVORCE 

SCOPE   OF  THE   ARTICLE 

TN  some  aspects  the  whole  subject  of  the  sex  relation  is  a 
medico-legal  one.  The  purpose  of  this  article,  however,  is  not 
to  treat  of  it  in  its  broad  aspects,  but  only  to  consider  some  of  its 
legal  problems  with  which  the  medical  profession  may  have  to 
deal. 

CAPACITY   FOB   MARRIAGE. 

All  unmarried  persons  are  legally  capable  of  intermarriage 
provided  they  are  of  competent  age,  and  possess  the  mental 
capacity  at  the  time  of  the  marriage  requisite  to  give  the  neces- 
sary consent  to  the  marriage  contract,1 

Impotency  does  not  render  a  person  legally  incapable  of 
marriage,  but  does  render  the  marriage  voidable. 

Mental  Capacity. — The  effects  of  mental  unsoundness  on 
marriage  have  been  fully  treated  above.2  The  tests  are  substan- 
tially the  same  as  of  capacity  to  enter  into  any  civil  contract : 
mental  capacity  sufficient  so  that  the  party  is  able  to  understand 
the  nature  and  consequences  of  his  act,  and  hence  able  to  give  an 
intelligent  consent  to  the  contract  of  marriage  as  such.3 

1  Meister  v.  Moore,  96  U.   S.,  76;  Prine,  36  Fla.,  676,  18  So.  R.,  781. 
O'Gara  v.   Eisenlohr,  38  N.  Y.,  296;  The  earlier  view  seems  to  have  been 
Little  v.  Little.  13  Gray  (Mass.),  264;  that  the  marriage  contract  stood  on 
Deitzman  v.   Mullin,   108  Ky.,  610,  precisely    the    same    basis    as    any 
67  S.  W.  R.,  210;  Schoulers  Dom.  ordinary  business  contract,  and  if  a 
Rel.,  sec.  12;  1  Bishop  Marr.  Div.  and  party  could  enter  into  the  latter,  he 
Sep.,  sec.  3;  Cyclopedia  of  Law  and  was  certainly  capable  of  the  former. 
Proc.,  vol.  26,  pp.  825-826.    Cf.  N.  Y.  Middleborough     v.     Rochester,     12 
Dom.  Rel.  Law,  sec.   10;  California  Mass.,  363;  Atkinson  r.  Medford,  46 
Civil  Code    (1906),  sec.  55;    Turner  Me.,  510;  ex  jmrte  Glen,  4  Desauss. 
v.    Meyers    orse    Turner,     1     Hagg.  Eq.  (S.  C.),  546;  and  in  Nebraska  in 
Cons.  (Eng.),  414  (1808).  1904,  Aldrich  r.  Steen.  98  N.  W.  R. 

2  See  vol.  iii..  p.  376.  445,    100   N.   W.    R.,  311,  71  Neb., 

3  Kern  v.  Kern,  51  N.  J.  Eq.,  514,  33,  57.     But  later  cases  have  tended 
26    Atl.,    831;     Doe    v.    Roe,    Edm.  toward  the  view  that  there  must  be 
Sel.  Cas.  (N.  Y.),  344;  Nonnemacher  capacity  to  comprehend  the  particu- 
v.  Nonnemacher,   159  Pa.  St.,    634,  lar  obligations  and   duties  of  mar- 
28   Atl.    R..  439;    Elzey  v.   Elzey,  1  riage.     Smith  r.  Smith,  47  Miss.,  211; 
Houst.    (Del.),    308,    319;    Prine   v.  St.  George  v.  Biddeford,  76  Me.,  593; 

761 


762  MARRIAGE  AND   DIVORCE — A.  L,.  BECKER. 

Any  mental  unsoundness  causing  the  degree  of  incapacity 
specified  will  render  the  marriage  void,  whether  lunacy,1  imbe- 
cility,2 senile  dementia,3  delirium  of  fever,4  or  the  temporary 
incapacity  caused  by  drugs  or  alcohol.5  The  matter  is  usually 
subject  to  statutory  regulation ;  the  form  of  the  statute  may  ex- 
clude intoxication  as  a  disablement ;  and  it  may  provide  that  a 
divorce  instead  of  an  annulment  decree  shall  be  the  remedy.6 

The  effect  of  the  mental  incapacity  is  usually  held  to  be  that 
the  marriage  is  absolutely  void,  and  may  be  so  declared  in  a  suit 
for  a  decree  of  nullity  brought  by  either  party,  pr  in  any  suit 
between  other  parties  involving  the  validity  of  the  marriage.7 
Nevertheless,  the  marriage  may  be  confirmed  by  cohabitation 
during  a  lucid  interval  or  after  recovery  ;8  at  least,  in  jurisdic- 
tions where  no  ceremonial  marriage  is  required.9  And  by 
statute  in  a  number  of  States,  the  marriage  is  valid  until  judi- 
cially annulled,  and  the  children  of  the  marriage  are  legitimate.10 

Physical  Incapacity. — The  effects  of  sexual  incapacity 
have  been  treated  in  Dr.  Eosse's  article,  Vol.  II.,  page  625,  of 
this  work ;  but  more  particularly  in  their  medical  aspect. 

The  marriage  relation  presupposes  the  power  of  copulation. 
Incurable  inability  to  perform  substantially  normal  sexual  in- 
tercourse,11 with  the  possible  proviso  that  in  the  case  of  a  woman 

Durham  v.  Durham,  10  P.  D.  (Eng).,  v.   Rawdon,   28   Ala.,   565;   True  v. 

80  (adding  that  the  contract  of  mar-  Ranney,   21    N.    H.,   52;   Turner  v. 

riage  is  a  very  simple  one,  and  does  Meyers  orse   Turner,  1    Hagg.  Cons, 

not  require  a  high  degree  of  intelli-  (Eng.), 414;  Powell  v.  Powell,  18Kan., 

gence    to    comprehend);    Hunter    v.  371;  Wiser  v.  Lockwood,  42  Vt.,  720. 

Edney  orse  H.,  10  P.  D.,  93.  Otherwise  by   statute.     Stickney  v. 

1  Wightman  v.  Wightman,  4  Johns.  Mathes,  24  Hun  (N.  Y.),  461. 

Ch.  (N.  Y.),  343;  Chapline  v.  Stone,  8  Cole  v.  Cole,  5  Sneed  (Term.),  57; 

77  Mo.  App.,  523.  Sabalot  v.  Populus,  31  La.  Ann.,  854; 

2  Johnson  v.  Kincade,  37  N.  C.,  470;  Johnson    v.  Johnson,    45    Mo.,    595; 
Waymire  v.Jetmore,22  Ohio  St.,  271.  Ash's  Case  (Eng.),  I  Eq.  Cas.  Abr., 

3  Pyott  v.  Pyott,  191  111.,  280;  61  278. 

N.  E.  R.,  88.  9  As  in  Sims  v.  Sims,  121  N.  C., 

4Jaques  v.   Pub.  Adm.,   1  Bradf.  297,  28  S.  E.  R.,  407. 

Surr.  (N.  Y.),  499.  10  See  Synopsis  of  Statutes  relating 

5  Prine  v.  Prine,  36  Fla.,  676,  18  to  mental  unsoundness,  swpro,  passim; 

So.  R.,  781.  also  p.  376  of  this  volume. 

'  See  Synopsis  of  Statutes  relating  »  G.  v.  G.,  67  N.  J.  Eq.,  30;  56  Atl. 

to  mental  unsoundness,  supra;  Elzey  R.,  736;  Smith  v.  Morehead,  59  N.  C., 

v.  Elzey,  1  Houst.  (Del.),  308.  360;    Devanbagh    v.    Devanbagh,    5 

7  Bishop  on  Marr.  Div.  and  Sep.,  Paige  (N.  Y.),  554;  Newell  v.  Newell, 

sees.  627-645;  Wightman  v.  Wight-  9    Paige    (N.     Y.),    25;     Powell  v. 

man,    4    Johns.    Ch.    (N.    Y.),    343;  Powell,   18  Kan.,  371;   Anonymous, 

Window  v.  Troy,  97  Me.,  130, 133,  53  35  Ala.,  226;  Anonymous,  89  Ala., 

Atl.,   1,008;    Jaques   v.  Pub.    Adm.,  291,  7  So.  R.,  100;  Ferris  v.  Ferris, 

1  Bradf.  Surr.  (N.  Y.),  499;  Rawdon  8  Conn.,  166;  Lorenz  v.  Lorenz,  93 


CAPACITY  FOR  MARRIAGE.  763 

she  must  also  be  sterile,1  is  a  ground  for  annulment.2  The  mar- 
riage may  be  decreed  void  upon  the  suit  of  the  capable  party, 
provided  the  impotency  was  unknown  to  him  at  the  time  of  the 
marriage,  and  that  he  has  not  waived  his  right  to  relief  by  too 
long  delay.3  And  in  spite  of  English  decisions  intimating  the 
contrary,  we  think  the  marriage  may  be  annulled  at  the  suit  of 
the  impotent  person  himself  provided  he  was  honestly  ignorant 
of  his  condition;  though  otherwise  not.4 

But  sterility  alone,  whether  caused  by  an  operation,  such  as 
ovariotomy,  or  otherwise,  is  not  a  ground  for  annulment.8 

While  sterility  without  incapacity  for  copulation  is  no  ground 
for  annulment,  fecundity  proved  by  the  birth  of  children  seems 
to  be  considered  a  complete  defence  to  an  action  for  annulment 
against  the  wife.6 

The  courts  have  not  made  absolute  impossibility  of  copulation 
the  test  of  incapacity  sufficient  for  annulment.  Thus,  in  a  case 
where  the  woman  was  so  excessively  sensitive  and  nervous  that 
it  was  not  possible  unless  she  were  to  submit  to  the  influence  of 
morphine,  a  decree  was  granted.7  These  hysteria  cases  seem 
to  be  not  rare,  among  both  males  and  females.8 

In  another  English  case9  it  was  found  that  the  woman's  ex- 
ternal genitals  were  perfect ;  but  the  vagina  was  contracted  in 

111.,  376;  J.  G.  v.  H.  G.,  33  Md.,  401;  7  G.  v.  G.,  L.  R.  2  P.  and  D.,  287, 

Bascomb  r.  Bascomb,  25  N.  H.,  267;  40  L.  J.  P.  and  M.,  83,  25  L.  T. 

Merrill  v.  Merrill,  126  Mass.,  228.  Rep.  N.  S.,  510,  20  Wkly.  Rep.,  103; 

1  Riley  v.  Riley,  73  Hun  (N.  Y.),  cf.  P.  v.  P.,  11  Brit.  Col.,  369;  P.  v. 

575.  L.  orse  P.,  3  P.  D.,  73;  H.  v.  P.orse 

1  Or  divorce,  if  the  local  statute  H.,3  P.  and  D.,  126;  S.  v.  A.,  3  P.  D., 

so  provides.  72;  L.  v.  L.,  7  P.  D.,  16;  Merrill  v. 

3  Smith  v.  Morehead,  59  N.  C.,  360;  Merrill,  126  Mass.,  228. 

G.  v.  G.,  67  N.  J.  Eq.,  30,  56  All.  R.,  8  Forel,  The  Sexual  Question,  New 

736;  Peipho  v.  Peipho,  88  111.,  438.  York,  1908,  pp.  85,  219.     The  author 

4  Bishop's  Marriage,  Div.  and  Sep.,  of  this  interesting  treatise  describes 
sees.  792-793;  contra,  Norton  v.  Seton,  several    cases    of     "psychic    impo- 
3  Phill.  Eccl.,  147;  A.  v.  A.,  19  L.  R.  tence,"  and  remarks  (p.  219):  "This 
(Ireland),  403.  condition,  which  depends  on   auto- 

8  Payne  v.  Payne,  46  Minn.,  467;  suggestion,  is  best  treated  by  hypno- 

Wendel  v.  Wemfel,  30  App.  Div.  (N.  tic  suggestion."     In  any  case  where 

Y.),  447;  Schroterv.  Schroter,  56Misc.  such  conditions  are  alleged  as  ground 

(N.  Y.),    69;    Anonymous,  89    Ala.,  for  annulment,  the  curability  of  the 

291,  7  So.  R.,  100;  Griffeth  v.  Grif-  abnormal  state  by  hypnotic  treatment 

feth,  162  111.,  368,  44  N.  E.  R.,  820;  will  present  an  important  question 

J.  G.  v.  H.  G.,  33  Md.,  401;  Deane  v.  for  the  medical  expert,  inasmuch  as 

Aveling,   1   Rob.   Eccl.   (Eng.),  279;  curable  impotcncy  is  not  a  sufficient 

Devanbagh  v.   Devanbagh,  5  Paige  ground.  (Infra.) 

(N.  Y.),  554.  •  Deane  v.  Aveling,  1  Rob.  Eccl., 

*  Riley  v.  Riley,  73  Hun  (N.  Y.),  279,  298. 
575. 


764  MARRIAGE   AND    DIVORCE — A.  L.  BECKER. 

depth,  admitting  of  penetration  to  perhaps  less  than  half  the 
usual  extent,  and  becoming  impervious  at  that  depth,  where  it 
formed  a  cul  de  sac  with  no  communication  to  any  of  the  internal 
organs.  The  uterus  was  absent.  Upon  these  facts,  and  solely 
because  no  complete  copula  could  take  place,  the  marriage  was 
declared  void.  The  learned  judge,  Dr.  Lushingtou,  said:  "Sex- 
ual intercourse,  in  the  proper  meaning  of  the  term,  is  ordinary 
and  complete  intercourse ;  it  does  not  mean  partial  or  imperfect 
intercourse ;  yet  I  cannot  go  to  the  length  of  saying  that  every 
degree  of  imperfection  would  deprive  it  of  its  essential  character. 
There  must  be  degrees  difficult  to  deal  with ;  but  if  so  imperfect 
as  scarcely  to  be  natural,  I  should  not  hesitate  to  say  that,  legally 
speaking,  it  is  no  intercourse  at  all." 

In  a  Maryland  case,  the  development  of  the  woman's  sexual 
organs  had  been  arrested  before  puberty ;  they  were  those  of  a 
child.  Annulment  was  allowed.1 

It  has  been  noted  that  it  is  in  general  only  incurable  incapacity 
which  is  a  ground  for  annulment.  The  rule  was  thus  stated  by 
Chancellor  Walworth  of  New  York  in  the  early  case  of  Devan- 
bagh  v.  Devanbagh : 2 

"By  the  English  law,  as  it  existed  at  the  first  settlement  of 
this  country,  and  as  it  now  exists,  to  authorize  a  sentence  of 
nullity  on  the  ground  of  impotence,  it  is  necessary  for  the  com- 
plainant to  establish  the  fact  of  the  alleged  incapacity  at  the 
time  of  the  marriage,  and  that  such  incapacity  still  continues, 
and  is  incurable."3  "This  also  appears  to  be  the  law  of  France, 
and  of  Spain  and  Holland.  And  it  is  probably  the  law  of  the 
continent  of  Europe  generally."4 

The  Chancellor  then  quotes  from  Dr.  Beck's  "Medical  Juris- 
prudence "  to  show  that  cases  of  impotence  on  the  part  of  the 
female  which  will  not  yield  to  proper  medical  treatment  or  a 
surgical  operation  are  of  rare  occurrence.5 

More  recent  cases,  especially  in  England,  have  limited  the 

1  G.  v.  G.,  33  Md.,  401;    c/.  S.  v.  A.,  mous,  35  Ala.,  226;  Ferris  v.  Ferris, 

3  P.  I).,  72.  8  Conn.,   166;  Lorenz  v.  Lorenz,93 

-  5  Paige  Ch.,554,  at  page  556;  see  111.,  376;  J.  G.  v.  H.  G.,  33  Md.,  401; 

also  Serell  v.  Serell,  31  L.  J.  P.  and  Bascomb  v.  Bascomb,  25  N.  H.,  267; 

M.  55;  2  Swab,  and  T.,  422.  Bordolt  v.  Berdolt,  56  Neb.,  792,  77 

3 Citing    1    Chitty's   Med.    Jurisp.,  N.  W.  R.,  399. 

375;  Chitty's  Law  of  Husb.  and  Wife,  4  Citing     1     Beck's    Med.    Jurisp. 

16;  Brown  v.  Brown,  1   Hagg.  Eccl.  5th  ed.,  68;  4  Partida,  tit.  8,  Law  2; 

Rep.,  523;  Welde  v.  Welde,  2  Lee's  Van  Leeuw.  Com.,  87. 

Eccl.    Ca.,    580.     See    also    Anony-  s  1  Beck's  Med.  Jurisp.,  89. 


CAPACITY   FOB   MARRIAGE.  765 

supposed  rule  that  if  the  impotency  can  be  cured,  a  decree  of  an- 
nulment will  not  be  granted.  It  may,  we  think,  safely  be  stated 
as  law  that  if  the  defendant  could  obtain  a  cure  but  refuses  abso- 
lutely to  undergo  treatment,  or  in  any  event  if  the  treatment 
would  be  dangerous,  a  decree  will  be  granted.1 

And  it  may  further  be  stated  that  if  the  impotency  is  due  to 
the  fault  of  the  defendant,  as,  for  example,  to  habits  of  self- 
abuse  which  he  refuses  or  fails  to  restrain,  the  fact  that  such  con- 
dition is  curable  will  be  no  defence  to  him.2 

Refusal  to  allow  intercourse  has  been  held  to  be  no  proof  of 
impotency.3 

In  England  some  of  the  early  canon  law  decisions  where  the 
wife  was  plaintiff  attempted  to  establish  a  rule  that  there  must 
have  been  three  jrears  of  cohabitation,  at  the  end  of  which  the 
wife  was  found  to  be  virgo  intacta  before  the  marriage  could  be 
annulled.4 

No  such  rule  lias  ever  gained  a  foothold  in  America;5  but  in 
all  countries  one  of  the  problems  for  the  medical  expert  to  de- 
termine in  many  cases  will  be  whether  a  wife,  whose  first  mar- 
riage it  is  sought  to  annul,  is  still  a  virgin.  This  purely  medical 
question  will  be  found  treated  in  the  article  on  Rape  in  this 
work.8 

The  physical  examination  of  one  or  both  parties  is  frequently 
ordered  by  the  court  in  cases  of  this  character.  The  subject  is 
treated  in  this  work  under  that  heading.7 

Owing  to  the  local  statute,  in  many  States  a  divorce  instead 
of  a  decree  of  annulment  is  granted.  This  makes  no  difference 
in  the  substantive  law  applicable. 

1  L.  v.  L.,  7  P.  D.,  16;  cf.  G.  v.  G.,          5  Griffeth  v.  Griffeth,  162  111.,  368, 

2  P.  and  M.,  287  (supra);  P.  v.  L.,      372;  44  N.  E.  R.,  820. 

3  P.  D.,  73;  W.  v.  H.,  2  Swab,  and          "Vol.  ii.,  p.  662  el  seq. 

T.,  240.  7  Vol.  ii.,  p.  496.     See  Anonymous, 

2F.  v.  D.,  4  Swab,  and  T.,  86;  S.  v.  89  Ala.,  291;  Anonymous,  35  Ala., 

E.,  3  Swab,  and  T.,  240;  Griffeth  v.  226;  Anonymous,  34  Misc.  (N.  Y.), 

Griffeth,  162  111.,  368,  44  N.  E.  R.,  109,  69  Supp.   547;  Cahn  v.  Cahn, 

820,  55  111.  App.,  474.  21  Misc.  (N.  Y.),  506,  48  Supp.,  173; 

'Merrill  v.  Merrill,  126  Mass.,  228;  Newell  v.  Newell,  9  Paige  (N.  Y.), 

contra,  F.  v.  P.  orse  F.,  75  L.  T.,  192;  25;    Devanbagh    v.    Devanbagh,    5 

B.  orse  H.  v.  E.,  [1901]  P.  39.  Paige   (N.    Y.),   554;    Le   Barren   v. 

4  See  M.  v.   H.,  3  Swab,  and  T.,  Le  Barren,  35  Vt.,  365;  Chicago  &  N. 

517;  M.  v.  B.,  3  Swab,  and  T.,  550;  W.  Ry.  Co.  v.  Kendall,  167  Fed.,  62: 

Pollard  v.  Wyborn,   1    Hagg.   Eccl.,  Union  Pac.  R.  Co.  r.  Botsford,  141 

725;    Anonymous,    11    W.    N.   Cas.,  U.  S..  250;  Geisr.  Geis,  116  App.  Div. 

479;  Lewis  v.  Ilayward,  35  L.  J.  P.  (N.  Y.),362,  101  Supp.,  845. 

and  M.,  105. 


766  MARRIAGE   AND   DIVORCE— A.  L.  BECKER. 

It  is  fully  settled  that  the  marriage  of  an  impotent  person  is 
voidable,  not  void.1  Unless  such  marriage  had  been  annulled, 
therefore,  the  remarriage  of  either  party  would  be  bigamous. 

THE  LEGAL   EFFECTS  OF   DISEASE  ON   MARRIAGE. 

Annulment  for  Fraud. — The  particular  marital  fraud 
which  is  of  medico-legal  interest  is  the  concealment  or  fraudulent 
denial  of  the  presence  of  disease,  especially  venereal  disease. 
The  law  is  now  settled  that  before  marriage  it  is  the  duty  of  a 
person  having  a  venereal  disease  to  disclose  the  fact  to  his  or  her 
intended  husband  or  wife,  at  least,  if  he  has  knowledge  thereof. 

In  general,  a  marriage  can  be  annulled,  as  the  New  York 
Revised  Statutes  state  (declaring  the  common  law),  "when  the 
consent  of  either  party  shall  have  been  obtained  by  force  or 
fraud."2 

Whether  the  marriage  has  been  consummated  is  of  prime  im- 
portance, though  perhaps  not  necessarily  of  controlling  import- 
ance, when  it  is  sought  to  annul  a  marriage  for  fraud.  For, 
after  consummation,  the  marriage  ripens  into  a  "  public  status, " 
which  society  has  an  interest  in  perpetuating.  Then  the  marriage 
will  not  be  annulled  except  for  the  most  serious  cause.3 

But,  according  to  the  authority  of  some  of  the  later,  and,  as 
we  think,  more  sensible  decisions,  before  the  marriage  is  consum- 
mated the  marriage  will  be  annulled  for  practically  any  cause 
that  would  justify  the  avoidance  of  an  ordinary  contract. 
"When,  however,  the  fraud  is  discovered  before  the  marriage 
is  consummated,  and  the  innocent  party  refuses  to  cohabit,  the 
marriage  is  so  inchoate  and  incomplete  that  the  status  of  the  par- 
ties is  similar  to  that  of  parties  to  an  executory  contract,  and 
may  be  annulled  without  violating  any  considerations  of  public 
policy."4 

At  least  before  the  marriage  is  consummated,  it  is  the  estab- 
lished law  in  America  that  the  concealed  existence  of  venereal 

1  A.  v.  B.  and  ano.,  1  P.  and  D.  concealed  that  he  had  syphilis.     De- 
(Eng.),    559;    Nelson    on    Div.    and  cision  of  Truax,  J.,  July,   1897,  re- 
Sep.,  vol.   2,   §    705;  G.    v.    G.,  67  ferred  to  in  Anonymous,  21  Misc.  (N. 
N.  J.  Eq.,  30;  56  Atl.  R.,  736.  Y.),  765.     See  also  Gould  v.  Gould,  78 

2  ronsol.  Laws  of  1909,  ch.  14,  s.  7  Conn.,  242,  61  Atl.,  604;  cf.,  however, 
(Domestic  Relations  Law).  Vondal  v.  Vondal,  175  Mass.,  383. 

s  But  even  after  consummation  a  *  Di  Lorenzo  v.  di  Lorenzo,  71 
marriage  has  occasionally  been  an-  App.  Div.  (N.  Y.),  509,  519.  174  N. 
nulled  because  of  the  husband  having  Y.,  467;  Smith  v.  Smith,  171  Mass., 


.  THE    LEGAL   EFFECTS   OF   DISEASE   ON   MARRIAGE.        767 

disease  in  one  of  the  parties  to  a  marriage  is  ground  for  the  an- 
nulment thereof.1 

The  reasons  for  the  rule  are  obvious.  They  have  never  been 
more  succinctly  stated  than  by  the  Supreme  Court  of  Michigan.2 
"While  it  is  the  policy  of  the  law  to  encourage  marriage,  it  is 
not  the  policy  of  the  law  to  encourage  unhappy  marriages." 

The  danger  to  the  healthy  party  to  the  marriage,  the  likeli- 
hood of  the  offspring  being  infected  with  the  disease,  the  plain 
breach  of  duty  in  failing  to  disclose  the  condition,  all  lead  to 
the  conclusion  that  the  innocent  party  ought  to  have  relief  from 
such  a  marriage.3 

In  one  State  the  same  ruling  has  been  made  when  a  less  loath- 
some disease  was  concealed.  Thus,  in  a  State  where  a  statute 
forbids  an  epileptic  to  marry,  under  penalty  of  imprisonment,  it 
has  been  held  that  concealment  of  epilepsy,  or  the  failure  to  dis- 
close it,  is  such  a  fraud  as  will  justify  the  annulment  of  the  mar- 
riage.4 But  the  courts  are  not  likely  to  allow  annulment  for 
the  concealment  or  non -disclosure  of  other  diseases  than  venereal 
ones,  or  diseases  equally  dangerous,  except  in  extreme  cases  ;5  at 
least,  not  after  the  marriage  has  been  consummated.  When 
there  has  been  active  fraud,  an  untruthful  denial  of  the  presence 
of  disease,  a  stronger  case  for  annulment  is  presented. 

Disease  Rendering  Cohabitation  Dangerous  as  a 
Defence  to  an  Action  for  Breach  of  Promise  of  Mar- 
riage.— In  1858  an  English  court  held6  that  the  defendant's 
plea  that  after  promise  of  marriage  he  became  affected  with  a 

404,  408;  Bishop  on  Marr.,  Div.  and  Crane  v.  Crane,  62  N.  J.  Eq.,  21,  49 

Sep.,    §    166;   Nelson  on  Marr.   and  Atl.,  734. 

Div.,     §§     600,     601;     Svenson     v.  2  Goddard  v.  Westcott,  32  Mich., 

Svenson,  178  N.  Y.,  54,  58.     But  see  180,  46  N.  W.  R.,  242. 

Lyon    v.    Lyon,    230    111.,    366,    82  'Smith  v.  Smith,  171  Mass.,  404, 

N.  E.  R.,  850,  holding  that  in  all  408;  50  N.  E.  R.,  933. 

cases  the  misrepresentation  must  be  *  Gould  v.  Gould,  78  Conn..  242, 

such   as   affects    the    marital    state  61  Atl.,  604;  otherwise  where  there 

directly.  is  no  such  statute,  Lyon   v.   Lyon, 

1  Smith  v.  Smith,  171  Mass.,  404,  230  111.,  366,  82  N.  E.  R..  850. 

408;    50   N.  E.  R.,    933;   Vondal    v.  6  Kraus  v.  Kraus,  9  Ohio  S.  and 

Vondal,    175    Mass.,  383;    Ryder   v.  C.  P.  Dec.,  515,  6  Ohio  N.  P.,  248, 

Ryder,  66  Vt.,  158,  28   Atl.,  1,029;  where    the    husband    was   denied    a 

Svenson  v.  Svenson,  178  ¥.  Y.,  54;  decree  of  annullmont  sought  on  the 

Meyer  v.  Meyer,  49  How.  Pr.,    311;  ground  that  his  wife  concealed  the 

Anonymous,  21   Misc.  (N.  Y.),  765;  fact  that  she  hud  a  glass  eye;  Lyon  r. 

McMahen  v.  McMahen,  186  Pa.  St.,  Lyon,  230  111.,   366.   82  N.   E.   R., 

485,  40  Atl.,  795;  Martin  v.  Martin,  850. 

54  W.  Va.,  301,   46  S.    E.    R.,  120;  "Hall  v.  Wright,  1858,  E.  B.  and 

E.,  746. 


7G8  MARRIAGE   AND   DIVORCE— A.  L.  BECKER. 

pulmonary  disease  and  incapable  of  marriage  without  danger  to 
life,  is  no  defence  to  an  action  for  breach  of  promise.  But  this 
decision  was  not  followed  in  a  case  decided  in  1906. 1  In  the 
later  case,  the  defendant  in  a  suit  for  breach  of  promise  wrote  to 
the  father  of  the  lady  to  whom  he  was  engaged  that  the  marriage 
could  not  take  place  because  he  felt  his  mind  giving  way.  Sub- 
sequently he  was  certified  as  a  lunatic  and  committed  to  an  asy- 
lum. The  court  held  that  the  action  for  breach  of  promise  could 
not  be  maintained.  And  such  is  the  accepted  rule  in  the  United 
States. 

This  is  an  exception  to  the  ordinary  rule  of  contract  that  im- 
possibility of  performance  is  no  defence  to  an  action  for  breach 
of  contract.  The  reason  is  that  public  policy  forbids  marriage 
when  a  disease  of  such  character  as  would  make  the  fulfilment 
of  the  promise  of  marriage  dangerous,  has  supervened.  Thus, 
in  a  case  where  both  parties  probably  knew  at  the  time  of  the 
engagement  that  the  man  had  tuberculosis,  and  he  afterward  re- 
fused marriage,  it  was  held  that  the  woman  could  not  recover  for 
the  breach  of  promise.2 

The  existence  of  some  natural  impediment  to  marriage  will 
likewise  be  a  defence.3  But  it  is  believed  that  if  the  diseased 
party  fraudulently  concealed  his  condition  at  the  time  he  induced 
the  other  party  to  make  a  mutual  promise  of  marriage,  he  would 
not  be  allowed  to  avail  himself  of  his  own  fraud  to  avoid  liability 
for  breach  of  his  promise.4 

In  any  event,  the  contracting  of  a  temporary  curable  disease 
is  legal  ground  for  a  postponement  of  the  marriage  ceremony.5 

Disease  as  a  Ground  for  Divorce.6 — Where  a  partial  or 
absolute  divorce  is  allowed  for  cruelty,  it  has  been  held  that  for 
the  husband  to  compel  sexual  intercourse  when  he  has  a  venereal 
disease,  is  legal  cruelty ; 7  at  least  some  cases  say  when  the  inter - 

1  Liddell     v.     Eastern's     Trustees,  3Gring  v.  Lerch,  112  Pa.  St.,  244, 

9  F.,  154.  3  Atl.,  841. 

"Grover  v.  Zook,  44  Wash.,  489,  4  Cf.    Shackleford  v.  Hamilton,  93 

87    Pac.,    638.     See    also    Allen    v.  Ky.,  80,  19  S.  W.  R.,  5. 

Baker,    86    N.    C.,    91;    Sanders    v.  5Trammell   v.    Vaughn,    158   Mo., 

Coleman,  97  Va.,  690,  39  S.  E.  R.,  214,  59  S.  W.  R.,  79. 

621    (urinary    trouble);    Shackleford  6  Insanity  as  a  ground  for  divorce, 

r.  Hamilton,  93  Ky.,  80,  19  S.  W.  R.,  see  vol.  iii.,  p.  377. 

5  (syphilis,  of  which  the  defendant  7  Collett  v.  Collett,   1  Curt.   Eccl. 

honestly    believed    himself    cured);  (Eng.),  678,   reversed   in  Jud.  Com. 

Gardner  v.  Arnett,  21  Ky.  L.  R.,  1,  Privy  Coun.,  1840,  Wadd.  Dig.,  138; 

50  S.  W.  R.,  840;  Goddard  v.  West-  Long  v.  Long,  2  Hawkes,  189;  Brown 

cott,  32  Mich.,  180,  46  N.  W.  R.,  242.  r.  Brown,  L.  R.   1  P.  and  M.,  46; 


THE   LEGAL   EFFECTS   OF   DISEASE   ON   MARRIAGE.        769 

course  results  in  the  wife  becoming  infected,1 — a  distinction  of 
doubtful  propriety ! 

Contracting  Venereal  Disease  as  Proof  of  Adultery. 
—In  several  cases  it  has  been  held  that  the  fact  that  the  husband 
Jong  after  marriage  contracts  a  venereal  disease  is  prima  facie 
proof  that  he  has  committed  adultery,  provided  his  wife  either 
has  not  the  disease,  or  became  infected  with  it  from  him.2  But 
we  think  that,  in  view  of  modern  medical  opinion,  such  evidence, 
though  it  may  furnish  prima  facie  proof  of  adulterous  inter- 
course, is  essentially  weak.  For  there  are  to  be  considered  the 
well-established  possibility  of  infection  by  other  causes,  espe- 
cially in  the  case  of  syphilis ;  and  also  the  phenomena  of  latent 
gonorrhosa,  with  the  suppression  of  ordinary  symptoms  during  a 
considerable  period  of  time. 

Pregnancy  at  the  Time  of  Marriage  as  a  Ground 
for  Annulment  or  Divorce. — The  courts  have  been  disposed 
to  grant  relief  to  a  husband  who  marries  a  woman  supposing  her 
to  be  chaste,  but  finds  that  she  is  not  only  unchaste,  but  pregnant 
by  another  man.  Non-disclosure  of  the  pregnancy  is  such  a 
fraud  as  will  allow  him  a  decree  of  annulment.3 

But  if  he  knew  her  to  be  unchaste,4  or  had  had  intercourse 
with  her  himself,5  even  her  assurances  that  she  was  not  pregnant 
will  not  avail  him. 

Since  the  action  is  for  fraud,  it  would  seem  that  the  woman 
must  have  known  of  her  pregnancy  as  well  as  of  her  previous 

Bt-irdman  v.  Boardman,  L.  R.  1  P.  Nor  is   the   fact   that   the   husband 

and  M.,  233;  C.  v.  C.,  28  Eng.  L.  and  possesses   mixtures   commonly    used 

Eq.,  603,  609,  s.  c.  sub  nom.     Ches-  as  remedies  for  such  diseases.     Mack 

nutt    v.    Chesnutt,    1    Spinks,    196;  v.  Handy,  39  La.  Ann.,  491,2  So.,  181. 

Boughner  v.  Boughner,  19  Ky.  L.  R.,  Nor  that  he  has  stains  on  his  linen 

507,  41  S.  W.  R.,  26;  Glenn  v.  Glenn,  of    uncertain    character.     James    v. 

87  Mo.  App.,  377.  James,  29  Neb.,  533,  45  N.  W.  R., 

1  Ciocci  v.  Ciocci,  26  Eng.  L.  and  777;  Ferguson  v.  Ferguson,  1  Barb. 
Eq.,    604;    Canfield    v.   Canfield,    34  Ch.  (N.  Y.),  604. 

Mich.,  519.  s  Donovan    v.    Donovan,    9    Allen 

2  Bishftp  on  Marr.  Div.  and  Sep.,  (Mass.),  140;  Allen's  Appeal,  99  Pa. 
§     632;     Johnson    v.    Johnson,     14  St.,  196;  Sinclair  v.  Sinclair,  57  N.  J. 
Wend.  (N.  Y.),  637;  Popkinv.  Popkin,  Eq.,  222,  40  Atl.,  679;   Harrison  r. 
1   Hagg.  Eccl.,  765,  note  3;    Mount  Harrison,  94  Mich.,  559,  54  N.  W.  R., 
v.  Mount,  15    N.  J.  Eq.,  162.     But  275;  Baker  v.  Baker,  13  Cal.,  87. 
the  wife's  having  the  disease  is  not  4  Crehore  v.  Crehore,  97  Mass.,  330. 
sufficient    alone    to    prove    her   hus-  8  Seilheimer  r.  Seilheimer,  40  N.  J. 
band's  adultery.     Holthoefer  t>.  Holt-  Eq.,  412,  2  Atl.,  376;  Long  r.  Long, 
hoefer,  47   Mich.,    260,    643,    UN.  77  N.  ('.,  304;  Hoffman  ?-.  Hoffman, 
W.    R.,     150;     Homburger   r.  Horn-  30    Pa.    St.,   417;   but   see   Scott   v. 
burger,  46  How.   Pr.   (N.  Y.).  3-: 3.  Shufeldt,  5  Paige  (N.  Y.),  43. 

III.— 49 


770  MARRIAGE   AND    DIVORCE — A.    L.    BECKER. 

unchaste  conduct,  if  she  is  to  be  charged  with  fraudulent  non- 
disclosure. But  this  question  apparently  has  not  been  raised  in 
the  cases.  If  it  were  raised,  it  would  present  an  occasion  for 
medical  expert  testimony  to  show  the  probability  of  knowledge. 
In  the  decided  cases,  the  short  duration  of  the  pregnancy  prior  to 
marriage  seems  to  negative  any  certain  knowledge  on  the  part  of 
the  woman  that  she  was  not  only  unchaste  but  pregnant. l  In  fact, 
a  woman's  means  of  discovering  that  condition  in  herself  are  not 
much  superior  to  those  of  a  stranger.  Perhaps  the  rule  of  law 
must  be  taken  to  be  somewhat  anomalous:  that  concealed  un- 
chastity,  in  itself  no  ground  for  annulment,  if  it  happens  even 
without  the  woman's  knowledge  to  be  accompanied  by  preg- 
nancy, may  be  such  ground. 

1  In  Allen's  Appeal,  99  Pa.  St.,  196,  40  Atl.,  679,  and  Harrison  v.  Harri- 

parturition  took  place   about  seven  son,  94  Mich.,  559,  54  N.  W.  R.,  275 

months  after  the  marriage;  in  Sin-  about  six  months  after, 
clair  v.  Sinclair,  57  N.  J.  Eq.,  222, 


THE    MEDICO-LEGAL    KELATIOJS'S 

OP 

X-RAYS  AND  SKIAGRAPHS. 


BY 

ALBERT  G.  GEYSER,  M.D., 

JtculioyraphM  to  Cornell  University  Medical  College. 


X-RAYS   AND   SKIAGRAPHS. 

THE   X-RAY   IN  FORENSIC   MEDICINE. 

FOR  a  great  many  years  experimenters  had  been  watch- 
ing the  peculiar  effect  produced  in  glass  tubes  when,  after  ex- 
hausting the  air,  currents  of  high  tension  were  forced  though 
them. 

Geissler  tubes  were  the  forerunners  of  Crookes  tubes.  Crookes 
tubes  differed  from  Geissler  tubes  in  degree  of  vacuum.  It  was 
noticed  by  Crookes  that  the  higher  the  degree  of  vacuum  attain- 
able the  more  uniform  the  luminosity  in  the  tube  appeared. 

Lenard  discovered,  through  the  assistance  of  Hertz,  that 
when  a  current  of  sufficiently  high  tension  passed  through  a 
vacuum  tube  possessing  a  certain  degree  of  rarefaction,  a 
stream  of  luminosity  proceeded  from  the  cathode  or  negative 
side  of  the  tube  toward  the  positive. 

Through  further  experimentation  it  was  found  that  this 
cathode  stream,  as  it  was  called,  could  be  bent  from  its  path 
whenever  a  strong  magnet  was  brought  into  close  enough  prox- 
imity. This  bent  cathode  ray,  however,  refused  to  pass  through 
the  glass  of  the  tube,  but  impinging  Upon  it,  was  changed  into 
one  of  some  other  kind,  or  at  least  a  ray  having  different 
qualities. 

The  cathode  ray  was  later  studied  by  Lenard,  after  he  had 
succeeded  in  passing  it  out  of  the  tube  through  an  aluminum 
window. 

Lenard  then  describes  in  detail  the  effects  of  a  cathode  ray 
upon  photographic  plates  as  well  as  upon  other  chemicals.  Be- 
sides the  cathode  rays,  he  says,  there  are  other  rays  in  a  tube 
when  excited  into  activity  by  a  high-tension  current. 

It  was  this  statement  of  "other  rays"  that  interested  Profes- 
sor Roentgen,  and  in  December,  1895,  he  presented  his  paper  on 
the  effects  of  the  newly  discovered  ray. 

This  ray  possessed  a  wave-length  far  shorter  than  any  yet 

773 


774  X-RAYS   AND    SKIAGRAPHS— GEYSER. 

measured,  which  in  number  or  vibratory  rate  far  exceeded  all 
huinaii  calculations. 

This  ray  would  uot  obey  the  ordinary  laws  for  light.  It  could 
not  be  seen  or  heard,  and  various  articles,  otherwise  opaque  to 
light,  became  transparent,  while  such  media  as  glass  offered  more 
or  less  resistance  to  the  ray.  Neither  could  this  ray  be  bent  from 
its  path,  nor  could  it  be  refracted  or  diffracted ;  it  passed  in 
straight  lines  through  substances  according  to  their  specific 
gravity.  That  is  to  say,  the  metal  aluminum  having  a  lower 
specific  gravity  than  glass,  these  rays  will  pass  through  an  alu- 
minum plate  more  easily  than  through  glass.  Because  these  rays 
affected  photographic  plates  in  the  same  manner  as  light  rays  do, 
yet  would  not  obey  the  ordinary  laws  of  light,  Professor  Eoentgen 
described  them  as  the  a;- rays. 

A  Crookes  tube  became  an  #-ray  tube  when  the  proper  size 
and  shape  were  selected ;  later  an  anode  having  a  facing  of  plati- 
num was  placed  within  it.  The  metal  platinum  possessing  a  very 
high  specific  gravity,  the  cathode  rays  would  not  pass  through 
it ;  but,  when  f ocussed  upon  such  a  target,  were  converted  into 
oj-rays. 

This  theory  is  not  quite  clear,  for  it  is  a  fact  that  as  long  as 
we  have  within  the  #-ray  tube  a  rather  low  degree  of  vacuum 
just  so  long  do  we  have  the  cathode  rays.  On  the  other  hand, 
when  the  vacuum  is  raised  beyond  a  certain  point  the  cathode 
ray  is  no  longer  present,  at  least  cannot  be  seen ;  but  the  #-rays 
are  just  so  much  more  abundant  and  possess  so  much  more  power 
of  penetration. 

It  remains  for  the  present  a  disputed  point  whether  the 
cathode  rays  are  converted  into  ar-rays  or  whether  #-rays  begin 
to  exist  where  the  cathode  rays  cease.  A  suitable  #-ray  tube 
has  its  vacuum  reduced  to  about  one-millionth  of  an  atmosphere. 
The  x-ray  possesses  the  power  of  causing  various  substances  to 
become  fluorescent.  The  walls  of  the  tube,  if  they  are  made  of 
sodium  glass,  will  fluoresce  with  pale  yellow,  while  if  the  tube  is 
made  from  lead  glass  it  will  appear  a  light  blue.  Lead  glass  is 
also  much  the  more  impervious  to  the  passage  of  the  #-ray,  and  is 
therefore  frequently  used  in  the  construction  of  tubes.  These 
tubes  constructed  of  lead  glass  must  have  a  window  made  of 
sodium  glass  iu  order  that  the  rays  may  properly  pass  from 
t  hem. 


THE  X-RAY  IN  FORENSIC   MEDICINE.  775 

Certain  chemicals,  such  as  barium  platino-cyanide,  tungstate 
of  calcium,  quinine,  etc.,  also  fluoresce  under  the  or-ray.  Of 
these,  barium  platiuo-cyanide  fluoresces  the  most  brilliantly,  and 
with  a  green-yellow  color.  When  any  object,  whose  different 
parts  offer  varying  resistances  to  the  passage  of  the  ray,  is  placed 
between  the  tube  and  a  screen  covered  with  this  salt,  a  shadow, 
whose  parts  vary  in  intensity  with  the  different  resistances  of  the 
parts  of  the  object,  is  cast  upon  the  screen.  When  the  human 
body  is  thus  placed  between  tube  and  screen,  a  shadow,  whose 
diiferent  parts  vary  in  intensity  proportionately  to  the  different 
densities  of  the  body  structures,  appears  upon  the  screen. 

Such  a  procedure  is  termed  a  fluoroscopic  examination  from 
the  fact  that  the  prepared  barium  platiuo-cyanide  screen  and 
suitable  shadow-box  is  termed  a  "fluoroscope."  When  examin- 
ations of  patients  are  continued  too  long,  or  the  patient  is  placed 
too  close  to  the  tube,  a  reaction  or  dermatitis  results. 

All  tubes  do  not  act  alike ;  the  rays  seem  to  cause  the  great- 
est amount  of  effect  where  their  progress  appears  to  be  arrested. 

Tubes  are  classified  as  soft,  medium,  and  hard,  meaning 
thereby  that  a  soft  tube  is  one  giving  only  a  few  soft  tf-rays,  so 
weak  that  they  do  not  possess  very  much  power  of  penetration. 
When  the  hand  is  held  between  such  a  tube  and  the  screen,  the 
bones  appear  very  black.  All  the  rays  having  such  feeble 
power  of  penetration  are  arrested  upon  the  surface,  or  rather  just 
beneath  the  horny  layer  of  the  cutis.  Such  rays  when  used  too 
long  are  very  apt  to  be  followed  by  deleterious  results. 

A  tube  with  a  medium  ray  is  one  which,  when  the  hand  is  held 
between  it  and  the  fluoroscope,  sends  its  ray  through  the  soft 
parts  with  ease,  the  bones  appearing  gray  because  the  ray 
passes  through  them.  Such  a  tube  is  much  safer  for  examinations 
because  the  rays  are  not  all  arrested  just  beneath  the  skin,  but 
pass  on  to  the  deeper  structures ;  in  other  words,  their  destructive 
effect  is  spread  through  a  greater  volume  in  depth.  Such  a  tube 
can  be  used  with  greater  freedom  than  one  giving  soft  rays. 

A  hard  tube  produces  the  powerful  rays  that  will  pass  through 
the  body,  showing  outlines  of  ribs,  heart,  lungs,  liver,  and  also 
stomach  when  it  is  filled  with  bismuth  solutions.  It  will,  when  the 
hand  is  held  in  front  of  the  screen,  cause  the  outline  of  the  bones 
almost  to  disappear;  the  soft  parts  are  only  slightly  or  not  at  all 
discernible.  This  tube  is  really  the  safest;  patients  may  be 


776  X-RAYS   AND   SKIAGRAPHS — GEYSER. 

exposed,  especially  if  kept  thirty  or  more  inches  from  the  tube, 
for  fifteen  to  twenty  minutes  without  harmful  result. 

All  tubes  have  a  tendency  to  work  up  with  age ;  the  more 
they  are  used  the  harder  do  they  become.  New  tubes,  how- 
ever, in  the  beginning  are  very  apt  to  work  lower;  and  for 
that  reason  a  new  tube  should  never  be  used  to  make  ftuoro- 
scopic  examinations.  In  the  first  place,  the  tube  is  liable  to 
work  lower;  and  the  patient,  having  been  made  more  or  less  sus- 
ceptible by  the  original  hard  rays  from  such  a  tube,  is  now 
gradually  subjected  to  the  less  penetrating  rays,  which  are 
under  such  circumstances  very  liable  to  set  up  an  irritation  in 
the  tissues,  which  will  develop  into  a  radio-dermatitis.  In  the 
second  place,  when  a  new  tube  is  thus  overworked,  it  takes  very 
much  longer  to  bring  it  back  to  a  state  of  usefulness  and  safety. 
Again,  tubes  which  have  been  used  have  a  deposit  of  the  oxides 
of  platinum  and  iron  deposited  upon  the  inner  surface  of  the 
glass,  causing  them  to  appear  blackened.  This  fine  metallic 
covering  assists  in  holding  back  or  interfering  with  the  outward 
passage  of  the  soft  rays ;  therefore,  the  older  or  seasoned  tubes 
are  much  safer  than  the  new  tubes  just  from  the  factory. 

Tubes  made  partially  of  lead  glass  are  termed  "safety 
tubes";  this  refers,  not,  as  might  be  thought,  to  the  safety  of  the 
patient,  but  rather  to  the  safety  of  the  operator  or  other  per- 
sons in  the  room  during  the  time  of  treatment  or  examination. 

These  tubes  are  so  constructed  that  the  rays  will  pass  out  of 
a  certain  crown-glass  window,  and  can  therefore  be  focussed  or 
pointed  in  any  direction  desired,  and  as  very  few  or  no  rays 
leave  the  tube  through  the  rest  of  the  wall  of  the  tube,  it  must 
be  apparent  that  it  is  reasonably  safe  for  the  operator  to  remain 
within  close  proximity  to  such  a  tube  when  in  operation. 

All  tubes,  whether  old  or  new,  soft  or  hard,  can  under  favor- 
able conditions  cause  a  radio-dermatitis,  even  with  very  short  or 
few  exposures ;  in  fact,  it  is  not  impossible,  though  improbable, 
that  with  a  highly  susceptible  person  a  single  exposure  of  three 
minutes  may  cause  such  a  reaction  as  to  be  termed  a  dermatitis. 

There  are  reasonably  safe  measures  for  exposing  a  patient  to 
the  action  of  the  ray,  but  there  are  no  tubes  that  under  all  cir- 
cumstances are  absolutely  safe,  because  the  patient's  idiosyn- 
crasy cannot  be  known  until  after  a  reaction  has  taken  place. 

A  few  years  ago  there  existed  a  wide  range  of  differing  opin- 


EXPLANATION   OF   PLATE   V. 

FIGURE  1. — Lateral  view  of  fractured  femur,  showing  the  upper  frag- 
ment displaced  forward. 

FIGURE  2. — Antero-posterior  view  of  the  same  fracture,  but  giving  the 
appearance  of  perfect  apposition  and  reduction. 

FIGURE  3. — Lateral  view  when  perfectly  reduced. 

FIGURE  4. — Antero-posterior  view  after  perfect  reduction. 

NOTE. — Figures  2  and  4  do  not  differ  materially  from  each  other,  al- 
though in  the  latter  the  fracture  is  reduced,  while  in  the  former  it  is  not.  It 
is  therefore  necessary  to  show  two  views,  taken  at  right  angles  to  each  other. 


EXPLANATION   OF   PLATE   VI. 

FIGURE  1. — Antero-posterior  view  of  a  fracture  of  the  forearm,  showing 
apparent  reduction. 

FIGURE  2.— Lateral  view  of  the  same  fracture,  showing  its  unreduced 
condition. 


MEDICAL    JURISPRUDENCE-PLATE   V. 


MEDICAL   JURISPRUDENCE— PLATE   VI. 


1 


2. 


THB  X-RAY   IN  FORENSIC  MEDICINE.  779 

ions  as  to  the  legal  value  and  admissibility  of  a  Roentgen-ray 
photograph.  According  to  circumstances,  attorneys  argued  for 
or  against  the  introduction  of  negatives  as  well  as  prints  in 
courts  and  before  juries.  There  is  no  doubt  that  both  sides 
had  much  that  was  right  and  just  in  their  favor.  Fortunately, 
the  condition  of  things  has  changed  much  for  the  better.  In 
the  early  days  only  a  very  few  men  were  sufficiently  well  ac- 
quainted with  the  proper  technique  for  the  production  of  a  suit- 
able a?- ray ;  after  the  same  had  been  produced,  there  was  still 
lacking  the  experience  that  only  time  can  supply,  correctly  to 
interpret  a  negative.  It  was  easy  to  produce  enough  evidence  to 
place  in  doubt  the  introduced  reading  of  a  negative.  Not  un- 
commonly it  happened  that  one  #-ray  operator  produced  in 
court  a  negative  that  clearly  showed  a  supposed  fracture,  while 
another,  equally  competent,  perhaps  more  so,  for  reasons  could 
produce  from  the  same  subject  a  negative  showing  no  trace  of  a 
supposed  fracture.  With  evidence  of  such  a  character  it  was 
no  wonder  that  the  a?- ray  fell  into  disrepute,  especially  in  legal 
cases. 

At  the  present  time  a  Roentgen-ray  negative  that  admits  of 
no  doubt  as  to  the  reading  or  even  the  interpretation  by  judge 
and  jury  can  be  produced  by  experts. 

The  mere  introduction  of  a  negative,  however,  should  not  be 
sufficient.  The  ability  of  the  operator,  to  produce  as  well  as  to 
interpret  the  same  should  be  questioned.  The  operator  himself 
should  be  required  to  testify  sis  to  the  technique  employed,  as 
well  as  to  the  developing,  especially  as  to  the  use  of  any  means 
whereby  the  plate  has  artificially  been  changed  to  bring  into  re- 
lief certain  features.  Again,  one  view  should  not  be  sufficient; 
two  plates  with  their  prints  should  be  exhibited  whenever  the 
anatomical  conformation  of  the  parts  allows  it ;  these  two  plates 
should  represent  views  at  right  angles  to  each  other.  In  other 
words,  in  a  supposed  fracture  of  one  of  the  long  bones,  one  view 
taken  antero-posteriorly  and  the  other  taken  laterally  should 
be  exhibited.  The  force  of  this  statement  will  become  apparent 
by  consulting  the  plates  where,  in  the  one  instance,  a  fracture 
appears  to  be  present,  while  in  the  same  bone,  observed  from  a 
different  viewpoint,  no  fracture  is  visible. 

Again,  it  is  quite  possible  with  the  photographer's  art  to 
produce  what  appears  to  be  a  typical  fracture  in  a  bone  where 


780  X-RAYS  AND   SKIAGRAPHS— GEYSER. 

in  reality  no  fracture  exists ;  in  the  same  manner,  a  fracture  that 
really  exists  may  be  thoroughly  retouched  and  shaded  so  as  to 
remove  all  semblance  of  its  existence.  When  an  #-ray  photo- 
graph is,  therefore,  brought  into  court,  it  may  be  for  the  sole 
purpose  of  establishing  the  fact  that  a  fracture  does  or  does  not 
exist,  or  it  may  be  for  the  purpose  of  showing  to  what  extent 
the  continuity  is  severed.  A  patient  may  have  been  treated  for- 
a  fracture ;  if  an  #-ray  has  been  taken  immediately  after  putting 
on  the  splints  and  dressings  it  may  show  the  fracture  to  be  prop- 
erly coaptated,  or  through  intervening  tissues  between  the  sev- 
ered ends  coaptatiou  is  impossible ;  it  may  be  shown  that  the  orig- 
inal treatment  was  or  was  not  properly  carried  ont.  Where, 
therefore,  it  is  found  that  complete  reduction  is  impossible,  the 
patient  should  have  the  choice  of  either  the  open  operation  or 
the  endurance  of  such  interferences  as  may  be  caused  later  to 
the  function  of  the  limb. 

It  is  exceedingly  common  that  an  apparently  perfect  physio- 
logical function  has  been  re-established  after  a  fracture,  yet  an 
a;- ray  will  show  incomplete  reduction  or  severe  overlapping  of 
the  fractured  surfaces.  It  is  well,  therefore,  that  every  case  of 
fracture  or  similar  injury  be  subjected  to  the  #-ray  photo- 
graph, if  for  no  other  purpose  than  future  record.  The  admissi- 
bility  of  ar-ray  photographs  under  all  the  above-mentioned  cir- 
cumstances is  clearly  put  forth  in  the  following  decision  of  the 
court : l 

"It  is  within  the  discretion  of  the  trial  judge  to  admit  in  evi- 
dence an  a;- ray  photograph;  and  his  determination  whether  it  is 
sufficiently  verified,  or  appears  to  be  representative  of  the  object 
portrayed,  and  may  be  thereby  useful  to  the  jury,  is  not  open  to 
exception." 

For  the  purpose  of  elucidation  it  is  well  to  quote  the  Hon. 
W.  W.  Goodrich,  Presiding  Justice,  Appellate  Division  of  the 
Supreme  Court  of  the  State  of  Xew  York,  second  judicial  de- 
partment:2 

"  The  general  rule  with  regard  to  ordinary  photographs  has 
long  been  that,  wherever  the  person  or  thing  would  under  gen- 
eral rules  be  relevant  if  produced  in  court,  or  the  jury  would  be 

'Jameson    vs.  Weld,  45  a  229;  93          2 Brooklyn  Medical  Journal   Dec., 
Me.  345 ;  American  Digest  1900.    A.       1903. 
August  to  March. 


THE  X-RAY   IN  FORENSIC   MEDICINE.  781 

permitted  to  see  it  if  convenient,  a  photograph  of  such  person 
or  thing,  if  properly  authenticated,  is  admissible  when  the  orig- 
inal cannot  be  seen.  Whenever  the  jury  are  likely  to  be  mate- 
rially aided  by  the  opinions,  on  matters  of  fact,  of  persons  spe- 
cially qualified,  they  should  have  them ;  and,  for  the  purpose  of 
illustrating  and  making  clear  the  testimony  of  medical  and 
surgical  experts,  photographs  taken  by  the  Roentgen  or  a--ray 
process  have  been  admitted  as  evidence  in  the  courts  of  several 
of  the  States.  A  reference  to  these  cases  will  show  the  present 
status  of  the  law  upon  the  subject.  The  first  case  in  which  the 
question  arose  in  this  country  is  unreported,  but  there  is  a  sum- 
mary of  it  in  the  Chicago  Legal  News.  It  was  decided  in  Colo- 
rado, in  1896,  and,  in  admitting  the  x-ray  photograph,  the 
learned  Judge  Lefevre  said : 

"  'During  the  last  decade  at  least,  no  science  has  made  such 
mighty  strides  forward  as  surgery.  It  is  eminently  a  scientific 
profession,  alike  interesting  to  the  learned  and  the  unlearned. 
It  makes  use  of  all  science  and  learning.  It  has  been  of  inesti- 
mable value  to  mankind.  It  must  not  be  said  of  the  law  that  it  is 
wedded  to  precedent;  that  it  will  not  lend  a  helping  hand. 
Rather,  let  the  court  throw  open  the  door  to  all  well -considered 
scientific  discoveries.  Modern  science  has  made  it  possible  to 
look  beneath  the  tissues  of  the  human  body,  and  has  aided  sur- 
gery in  telling  of  the  hidden  mysteries.  We  believe  it  to  be  our 
duty  in  this  case  to  be  the  first,  if  you  please  to  so  consider  it,  in 
admitting  in  evidence  a  process  known  and  acknowledged  as  a 
determinate  science. ' ' 

Again  showing  the  advisability  of  not  only  presenting  to  the 
jury  an  ar-ray  photograph,  but  also  and  at  the  same  time  the 
operator  who  took  the  same,  we  quote  Judge  Beard  in  the  case 
of  Bruce  v.  Beall  (99  Tenu.,  303),  September  30th,  1897,  decision 
rendered  as  follows : 

"In  the  progress  of  the  trial,  one  Dr.  Galtman  was  intro- 
duced as  a  witness,  and  he  was  permitted  to  submit  to  the  jury 
an  avray  photograph  taken  by  him,  showing  the  overlapping 
bones  of  one  of  the  plaintiff's  legs,  at  a  point  where  it  was 
broken  by  his  fall.  This  was  objected  to  by  the  defendant's 
counsel.  This  picture  was  taken  by  the  witness,  who.  was  a 
physician  and  surgeon,  not  only  familiar  with  fractures,  but 
with  the  new  and  interesting  process  by  which  this  particular 


782  X-RAYS   AND    SKIAGRAPHS — GEYSER. 

impression  was  secured.  He  testified  that  this  photograph  ac- 
curately represented  the  condition  of  the  leg  at  the  point  of  the 
fracture  in  question,  and,  as  a  fact,  that  by  the  aid  of  a-rays 
he  was  enabled  to  see  the  broken  and  overlapping  bones  with 
his  own  eyes,  exactly  as  if,  stripped  of  the  skin  and  tissues,  they 
were  uncovered  to  the  sight.  We  might,  if  we  so  desire,  rest 
our  conclusion  on  the  general  character  of  the  exception  taken 
to  this  testimony,  but  we  prefer  to  place  it  on  the  ground  that, 
verified  as  was  this  picture,  it  was  altogether  competent  for  the 
purpose  for  which  it  was  offered.  New  as  this  process  is,  ex- 
periments made  by  scientific  men,  as  shown  by  this  record,  have 
demonstrated  its  power  to  reveal  to  the  natural  eye  the  entire 
structure  of  the  human  body,  and  that  its  various  parts  can  be 
photographed,  as  its  exterior  surface  has  been,  and  now  is. " 

In  the  Pennsylvania  courts  the  above  is  the  sentiment,  that 
whenever  the  a;-ray  photograph  is  sufficiently  corroborated  to 
the  satisfaction  of  the  trial  judge  it  may  be  admitted  as  evi- 
dence. 

Massachusetts,  on  the  other  hand,  maintains  that  it  is  impos- 
sible for  any  one  to  swear  to  such  facts  as  the  x-ray  photograph 
may  show,  on  the  ground  that  no  human  eye  has  seen  the  exact 
condition  as  portrayed  by  the  photograph.  In  our  opinion  this 
is  stretching  and  hair-splitting;  as  physicians  we  know  very 
nearly  the  conditions  in  most  cases  of  fracture  or  similar  injury ; 
when,  therefore,  the  #-ray  photograph  corroborates  our  belief, 
we  have  every  reason  to  think  that  the  conditions  as  shown  by 
the  photograph  are  actually  there.  Of  course,  we  are  justified  in 
considering  the  possibility  of  intentional  distortion  on  the  part 
of  the  operator. 

The  highest  court  of  the  State  of  Nebraska  maintained  that 
a  Eoentgen-ray  photograph  may  be  admitted  as  evidence  even 
though  the  operator  was  not  a  physician,  but  it  does  maintain 
that  such  an  operator  must  be  competent  and  must  indisputa- 
bly assert  that  the  condition,  as  shown  by  his  #-ray  photograph, 
does  without  reasonable  doubt  exist. 

In  the  case  of  malpractice  of  Carlson  v.  Benton  the  court  de- 
cided that  a  properly  taken  ic-ray  picture"  could  be  offered  in 
evidence,  although  the  operator  was  admittedly  not  an  expert  in 
this  line  of  work. 

Three  competent  physicians,  however,  maintained,  and  theii 


RADIO-DERMATITIS.  783 

testimony  remained  uncontradicted,  that  the  x-ray  photograph 
showed  exactly  the  condition  they  believed  to  exist  prior  to  see- 
ing the  same,  and  that  in  their  opinion  the  photograph  was  a 
correct  reproduction  of  the  anatomical  structures  there  shown. 
The  court,  therefore,  ruled  that  the  x-ray  photograph  under 
such  conditions  was  corroborative  evidence,  and  as  such  was 
admissible. 

RADIO-DERMATITIS. 

It  is  evidently  more  a  certain  change  or  reaction  to  the  a?- ray 
that  takes  place  in  the  tissues  than  the  result  of  a  direct  trau- 
matic agent  like  heat  or  cold,  acid  or  alkalies,  in  contact  with 
the  tissues.  In  fact,  we  may  assert  emphatically  that  the  so- 
called  x  ray  burn  is  not  in  the  first  place  the  result  of  the  x-ray 
at  all ;  and,  in  the  second  place,  the  reaction  of  the  tissues  is  not, 
in  fact  hardly  resembles,  a  burn.  We  must,  therefore,  state 
that  in  reality  there  is  no  such  thing  as  an  x-ray  burn. 

For  the  present,  then,  we  will  consider  a  certain  reaction 
which  takes  place  or  manifests  itself  about  one  week  to  ten  days 
after  a  certain  patient  has  been  exposed  to  the  x-ray. 

The  x-ray  as  an  inducing  agent  ceases  to  act  the  very  moment 
the  current  is  shut  off;  close  examination  of  the  exposed  tissues 
shows  absolutely  no  change,  nor  for  several  days  after.  What- 
ever then  happens  later  must  be  in  the  nature  of  a  reaction, 
within  the  tissues,  to  a  something  that  has  been  able  to  call 
forth  such  a  reaction.  Some  days  after  an  exposure  to  an  x-ray 
there  appear  redness,  swelling,  and  pain.  These  three  conditions 
are  the  cardinal  symptoms  of  inflammation.  We  know  that 
inflammation  is  a  reparative  process,  for  no  healing  ever  took 
place  in  any  tissue  or  organ  without  inflammation  of  a  greater 
or  lesser  degree  being  present.  This  is,  then,  to  all  intents  and 
purposes  a  reparative  process  or  a  reaction  to  an  injury.  Micro- 
scopic sections  of  tissue  reacting  to  the  effects  of  the  x-ray  show 
all  the  characteristic  qualities  of  inflammatory  tissue  anywhere, 
with  this  addition :  the  various  cellular  elements  seem  to  be  more 
broken  up,  the  nucleus  and  nucleolus  stain  badly  or  are  absent 
altogether,  while  the  fibrous  and  protoplasmic  constituents  of  the 
cell  apparently  have  increased. 

The  cell  elements  depend  upon  the  nucleus  for  their  vitality ; 
for  the  moment  the  nucleus  is  destroyed,  that  moment  the  cell 


784  X-RAYS   AND    SKIAGRAPHS— GEYSER. 

disintegrates,  other  and  neighboring  cells  appropriate  the  ele- 
ments set  free,  and  so  cause  an  increase  in  fibrous-tissue  forma- 
tion. 

What,  then,  has  destroyed  the  nucleus?  Whenever  an  electric 
current  passes  through  any  compound  substance,  decomposition 
of  the  molecules  takes  place  with  the  setting  free  of  atoms  to  form 
new  molecules  and  combinations.  If  we  have  in  a  cylinder  two 
parts  of  hydrogen  gas  and  one  part  of  oxygen  gas,  and  cause  an 
electric  spark  to  pass  through  the  same,  we  have  at  once  the  for- 
mation of  a  combination  of  H2O  or  water.  On  the  other  hand, 
if  a  current  of  electricity  passes  through  water,  a  decomposition 
takes  place,  setting  free  hydrogen  and  oxygen.  This  separation 
of  atoms  and  recombination  to  form  new  molecules  is  known  as 
electrolysis.  Should  this  process  be  carried  infinitely  further, 
so  that  even  though  the  oxygen  and  hydrogen  be  still  further 
broken  up  into  their  component  positive  and  negative  ions,  we 
would  have  ionization  taking  place. 

If  there  is  one  agent  that  possesses  the  power  of  ionization  to 
a  marked  degree  it  is  the  a;- ray.  Let  an  electroscope  be  charged 
with  either  negative  or  positive  ions ;  the  moment  the  a?-ray  is 
thrown  upon  it,  even  at  a  distance  of  eight  to  ten  feet,  immediate 
discharge  takes  place.  There  are  only  a  few  substances  known 
to  possess  such  a  power.  Eadium  in  a  minor  degree  possesses  the 
same  power,  hence  its  similar  action  to  the  x- ray.  The  effects  of 
the  application  of  radium  are  identical  with  those  of  the  a?-ray. 
Both  of  these  agents  possess  ionizing  power  to  a  marked  degree, 
and  we  are  justified  in  the  belief  that  the  ionizing  or  decomposing 
properties  of  both  of  these  agents  are  in  large  measure  responsi- 
ble for  the  change  or  the  reaction  which  takes  place  in  the  tissues. 
The  only  difference  between  the  two  reactions  is  this:  radium 
requires  direct  contact  with  the  tissues  and  longer  application, 
while  almost  the  same  results  might  be  obtained  with  the  ie-ray 
if  held  at  some  distance  from  the  parts  and  in  less  than  one-tenth 
of  the  time.  This  difference  must  be  accounted  for.  It  will  not 
do  to  say  that  we  have  a  greater  quantity  of  the  x-ray  than  we 
have  in  radium,  for  it  has  been  shown  most  conclusively  that  the 
lower  the  tube,  the  fewer  and  the  less  powerful  are  the  rays,  and 
the  greater  is  their  destructive  effect;  while  the  greater  and 
more  powerful  the  #-rays  the  less  is  their  destructive  action. 
It  is,  then,  at  least  not  a  question  of  quantity.  We  know  that 


RADIO-DERMATITIS.  785 

the  #-ray  tube  acts  as  a  converter ;  that  is,  it  converts  the  high- 
tension  electric  current,  when  passed  through  more  or  less  of  a 
vacuum,  into  rays  of  luminosity.  In  doing  this  the  tube  is 
surrounded  by  a  static  charge ;  this  static  charge  is  again  the 
passing  of  an  electric  current  through  a  complex  substance,  the 
air ;  this,  as  all  other  substances,  follows  the  law  of  decomposition 
and  recouiposition.  There  is  formed  in  the  immediate  neighbor- 
hood a  large  amount  of  nitrous  acid  and  ozone,  both  substances 
markedly  irritating  to  the  tissues.  Not  only  that ;  but  this 
static  charge  induces  through  the  agency  of  the  dielectric,  the 
air,  in  the  body,  currents  of  electricity  of  opposite  polarity  to 
those  surrounding  the  tube. 

When  the  human  body  thus  acts  as  a  container  charged  with 
electricity  of  polarity  opposite  to  that  of  a  near-by  charged 
body,  a  stress  is  set  up  in  the  immediate  neighborhood,  and  each 
cell,  as  well  as  the  component  parts  thereof,  shares  in  this  stress. 
Under  such  circumstances  of  electrical  stress  within  the  cell 
body  the  ionizing  power  of  the  #-ray  becomes  most  energetic. 
The  nucleus  of  the  cell  is  the  trophic  element,  consequently  the 
most  highly  vitalized  part  of  the  cell,  and  is  therefore  affected 
sooner  and  to  a  greater  degree  than  all  other  parts  of  the  cell. 
There  is  still  another  element  to  consider  that  has  been  lost  sight 
of  by  most  #-ray  operators :  a  common  law  in  physics  states  that 
arrested  motion  results  in  heat. 

When  a  projectile  has  been  fired  from  a  gun,  the  point  of 
impact  suffers  according  to  the  speed  of  the  bullet  at  the  time 
of  such  impact.  A  plank  is,  therefore,  not  only  traversed,  but 
may  be  set  on  fire  from  the  friction  or  arrested  motion.  The 
bullet  itself  may  be  melted.  X-ray  radiations  are  matter  in 
motion — in  fact,  the  speed  of  this  motion  is  enormous ;  whenever, 
therefore,  the  speed  is  arrested  we  have  the  dual  effect  of 
the  arrested  motion  and  the  ionizing  property  of  the  #-ray. 
This  combined  effect,  if  continued  for  a  sufficient  length  of  time, 
will  destroy  the  nuclei  of  the  ceils  most  acted  upon.  These  dead 
nuclei  cause  disintegration  of  the  cell  components.  These  cell 
components  become  dead,  putrid,  albuminous  substances,  forming 
leucomaines  to  which  the  system  reacts  in  the  usual  manner  by 
heat,  increased  blood-supply,  swelling,  and  pain,  or  all  the  ordi- 
nary symptoms  of  an  inflammation.  If  the  local  vitality  is  great 
enough,  recovery  will  take  place;  if,  on  the  other  hand,  the  local 
III.— 50 


786  X-RAYS   AND    SKIAGRAPHS— GEYSER. 

and  systemic  reaction  is  insufficient,  necrosis  and  sloughing  of 
the  devitalized  tissue  is  sure  to  follow. 

•  Now  we  can  account  for  the  various  factors  entering  into 
the  so-called  x-ray  burns.  A  high  tube  or  one  with  great  pene- 
trating power  does  not  burn  so  easily,  because,  in  the  first  place, 
the  tube  is  kept  at  a  great  distance  from  the  body,  thereby  more 
or  less  destroying  the  inductive  influence ;  secondly,  the  rays  are 
not  arrested  superficially,  but  exercise  their  effect  upon  the  deeper 
tissues  and  cover  a  greater  volume  in  depth.  The  ionizing  power 
may  be,  and  no  doubt  is,  even  greater  than  in  a  low  tube,  yet  no 
burn  is  apparent.  We  know,  however,  that  cell-destruction 
goes  on  just  the  same;  which  accounts  for  the  death  of  many 
patients  (with  deep-seated  or  internal  malignant  growths)  from 
septicaemia,  when  subjected  to  treatment  by  #-rays. 

Again,  when  a  tube  of  low  penetration  is  used,  it  is  necessary 
to  bring  such  a  tube  rather  close  to  the  tissues,  thereby  subject- 
ing the  local  area  to  the  inductive  influence,  plus  the  arresting 
of  the  emanations  upon  or  just  below  the  surf  ace;  this,  with  the 
ionizing  effect  of  the  x-ray,  is  sure  to  bring  about  such  a  reaction 
in  the  tissues  as  has  been  termed  an  #-ray  burn. 

The  #-ray,  like  any  other  agent,  is  capable  of  calling  forth 
from  the  system  responses  differing  with  the  amount  and  strength 
of  the  dose  and  the  individual  susceptibility  of  the  patient. 

What  may  be  a  small  or  insufficient  dose  for  an  immune 
individual  may  be  an  overdose  for  a  highly  susceptible  or  re- 
sponsive individual. 

It  was,  however,  considered  of  importance  to  establish  a 
method  of  measurement  and  dosage. 

MEASUREMENT  AND  DOSAGE. 

Since  we  cannot  take  into  consideration  the  personal  equa- 
tion or  idiosyncrasy  of  the  patient,  any  system  of  dosage  must 
lack  this  essential  element  and  be  to  a  greater  or  lesser  extent 
useless. 

1.  An  attempt  was  made  to  measure  the  current  in  the  pri- 
mary of  the  coil,  and  so  establish  the  resultant  measure  in  the 
secondary.  It  was  found  that  over  50  per  cent,  of  current  was 
lost  in  passing  through  the  interrupters,  that  it  depended  mate- 
rially upon  the  speed  of  the  interruptions  and  the  size  of  wire 


MEASUREMENT  OF   DOSAGE.  78? 

and  number  of  tarns  in  the  primary.     No  satisfactory  guide 
could  therefore  be  established. 

2.  D' Arson  val  placed  iu  series  with  a  valve  tube  a  milliampere- 
meter,  thus  measuring  the  amount  of  current  that  was  passing 
from  the  secondary  through  the  #-ray  tube.     This  instrument, 
while  it  records  exactly  the  amount  of  current  passing  through 
the  tube,  does  not  inform  us  as  to  the  amount  of  x-ray  conver- 
sion.    A  tube  may  offer  such  a  high  resistance  as  to  allow  no 
current  to  pass  through,  as  far  as  the  milliamperemeter  is  con- 
cerned, yet  such  tubes  have  caused  most  violent  reactions  to  the 
parts  exposed  by  the  experimenter.     On  the  other  hand,  with  a 
tube  so  low  as  to  show  a  cathode  stream  and  giving  a  reading  of  5 
milliamperes  no  x-rays  could  be  detected  by  the  fluoroscope. 

3.  Beclere,  of  Paris,  introduced  the  sjnntermeter.    This  method 
measured  the  parallel  spark-gap  of  the  secondary ;  it  was  then 
concluded  that  a  given  tube,  offering  a  resistance  equal  to  a 
given  spark-gap,  was  of  a  definite  intensity. 

The  spark-gap  of  the  secondary  depends  upon  the  voltage 
present ;  this  voltage  depends  upon  that  in  the  primary,  and  the 
ratio  between  the  ampere  turns  of  the  primary  to  the  secondary. 
With,  therefore,  a  very  high  voltage  in  the  secondary,  the 
spark-gap  of  the  tube  would  differ  from  that  of  a  coil  with  a 
lower  voltage  in  the  secondary.  Again,  frequently  a  tube  with 
a  parallel  spark-gap  of  2  to  3  inches  will  give  greater  penetra- 
tion than  a  tube  with  5  to  6  inches  of  spark-gap.  This  system, 
like  the  preceding,  does  not  take  into  consideration  the  conver- 
sion into  a-- rays  of  the  current  passing  through  the  tube. 

4.  The  Radiochromonieter  of  Benoist.  — Several  instruments  are 
upon  the  market  for  the  purpose  of  measuring  the  penetrative 
power  of  the  x-rays. 

An  arrangement  like  the  dial  of  a  clock  is  made,  each  num- 
ber consisting  of  layers  of  tinfoil  placed  upon  each  other,  so  that 
No.  1  represents  one  layer  of  a  certain  thickness  of  tinfoil,  while 
No.  12  represents  twelve  such  layers  superimposed  upon  eacli 
other.  This  method  does  in  a  measure  indicate  the  depth  to 
which  the  ray  will  penetrate,  and  so  materially  assists  in  the 
selection  of  a  high  or  low  tube.  Experiments,  however,  have 
shown  that  the  actual  power  of  penetration  is  not  a  constant 
factor  with  the  chemical  qualities  of  the  tube.  The  results  of 
a  therapeutic  application,  as  well  as  the  effect  upon  a  sensitized 


788  X-RAYS   AND    SKIAGRAPHS — GEYSER. 

plate  depend  principally  upon  the  chemical  nature  of  the  ray  -, 
only  sufficient  penetration  being  necessary  to  reach  the  parts  to 
be  acted  upon ;  hence  the  dictum,  that  a  low  tube  gives  a  better 
picture  than  a  high  one.  The  penetration  method,  therefore, 
does  not  furnish  us  with  the  necessary  information  as  to  the 
chemical  and  therapeutic  effect  of  a  certain  tube. 

5.  Chromoradiometer  of  Holzkneclit.  — A  capsule  made  of  cellu- 
loid material  contains  a  certain  salt,  whose  composition  so  far  has 
been  held  a  secret  by  its  inventor.     This  chemical  is  exposed  to 
the  action  of  the  #-ray,  and,  in  a  certain  time,  changes  its  color 
according  to  the  chemical  effect  of  the  x-ray.    Standards  are  estab- 
lished by  acquired  shades  of  these  capsules  previously  tested. 
By  comparing  the  capsule  which  has  been  placed  upon  the  skin  of 
the  patient  where  the  treatment  was  directed  with  the  standards, 
it  may  be  stated  that  a  certain  number  of  units  of  this  method 
constituted  the  dose  employed  as  compared  with  a  known  shade. 
Like  all  other  methods  of  a  similar  nature,  this  method  of  arriv- 
ing at  the  desired  dose  does  not  hold  good  for  all  patients,  dis- 
regarding the  fact  that  the  chemicals  employed  change  with  age, 
and  that  the  element  of  a  personal  equation  enters  largely  into 
the  color-comparing  test. 

6.  The  Radiometer  of  Sabouraud  and  Noire. — This  does  not  dif- 
fer from  the  preceding  one,  except  that  the  chemical  disks  used 
are  known  to  be  barium  platino-cyanide.     It  is  well  known  that 
this  chemical  changes  to  a  darker  hue  when  exposed  to  #-rays, 
and  again  returns  almost  to  its  original  color  when  exposed  to 
bright  daylight.     By  comparing  a  pastille  to  a  certain  known 
shade,  the  chemical  units  of  the  x-ray  may  be  established.     It 
is  then  open  to  the  same  objection  as  the  "Holzknecht"  method, 
and  even  to  greater  ones,  because  the  disks  of  barium  platino- 
cyanide  are  affected  by  heat,  moisture,  and  light.      Sabouraud, 
however,  insists  upon  one  precaution,  which  it  is  well  to  bear 
in  mind  at  this  time,  although  it  will  be  again  referred  to.     It  is 
this:  "  If  the  tube  is  placed  at  six  inches  from  the  patient,  as  it 
should  be  with  his  method,  the  pastilles  must  be  placed  mid- 
way, or  only  three  inches  from  the  tube ;  otherwise  the  disks 
will  change  color  very  much  more  slowly  or  perhaps  not  at  all." 

7.  The  Chromoradiometer  of  Bordier. — The  Chromoradiometer 
of  Bordier  differs  from  the  preceding  one  in  some  particulars. 
Bordier  recognized  the  fact  that  the  barium  platiuo-cyanide  was 


MEASUREMENT  OF   DOSAGE.  789 

subject  to  the  constant  changes  previously  referred  to,  as  caused 
by  moisture,  heat,  the  dehydrating  influence  of  the  x-ray,  day- 
light, and  strong  artificial  light.  Bordier,  therefore,  suspended 
barium  platiuo-cyanide  in  a  solution  of  flexible  collodion,  making 
thin  wafers;  these  were  placed  upon  the  skin  or  in  the  immedi- 
ate neighborhood  of  the  part  to  be  treated.  A  scale  of  previ- 
ously determined  shades  served  as  an  index  to  the  dosage. 
While  Bordier's  method  possesses  points  of  merit,  the  same 
general  objections  as  those  against  that  of  "Holzknecht"  are, 
however,  present. 

8.  The  Quantimeter   of  Kienbdck. — In  1905  all   the   various 
methods  for  measuring  the  dosage  did  not  appeal  to  Dr.  Kien- 
bdck as  meeting  the  necessary  requirements;  he  recognized  the 
utter  unreliability  of  each  of  the  instruments  previously  de- 
scribed, and  originated  a  new  method.     It  was  the  intent  this 
time  to  bring  out  an  instrument  which  would  at  once  combine 
the  penetrative  power  with  the  chemical  power  of  the  x-ray  in  its 
recording  element.     Strips  of  paper,  sensitized  with  chloro-bro- 
mide  of  silver  in  gelatin,  were  exposed  to  the  action  of  the 
x-ray ;  and,  after  being  developed  and  fixed  in  the  usual  manner, 
these  various  shades  were  calibrated  into  three  classes:  shade 
No.  1  representing  a  very  mild  dose  of  the  x-ray  from  which  no 
reaction  would  occur;  shade  No.  2,  a  medium  dose  which  would 
cause  a  reddening  of  the  skin  and  shedding  of  the  hair  (recov- 
ery would  usually  take  place) ;  shade  No.  3,  a  maximum  dose 
which  usually  brought  on  symptoms  of  reaction  in  four  to  six 
days  after  exposure,  with  redness,  heat,  swelling,  formation  of 
blisters,  and  ultimately  sloughing  of  the  parts.     All  the  various 
degrees  of  dosage  between  these  three  were  then,  at  least  theo- 
retically, possible.     This  system,  being  more  complicated  than 
the  preceding  ones,  suffers  a  great  loss  in  value  from  the  fact  that 
it  is.  necessary  to  develop  and  fix  each  sample  before  the  dose  is 
known;  not  only  therefore  causing  a  loss  of  time,  but  involving 
too  many  conditions  and  factors  in  the  developing  process  to 
make  it  of  real  value.     Again,  assuming  that  all  the  intricacies 
of  the  dark-room  had   been   complied  with,  there  would  still 
remain  the  objection  of  the  element  of  personal  equation  in  the 
color-reading  and  interpretation  of  the  different  shades. 

9.  The  Radiometer  of  Freund. — This   meter  consists  of  pure 
iodoform  dissolved  in  chloroform.     When   this  solution  is  ex- 


790  X-RAYS   AND   SKIAGRAPHS— GEYSER. 

posed  to  the  action  of  the  x-ray,  an  almost  immediate  change 
takes  place  in  the  color  tint ;  in  fact,  this  test  is  so  delicate  that 
when  this  solution  is  exposed  for  even  three  minutes,  a  distinct 
difference  in  color  can  be  seen  between  a  shaded  and  an  exposed 
portion  in  a  test-tube.  The  objection  to  this  system  is,  in  the 
first  place,  the  instability  of  the  mixture ;  forty-eight  hours  being 
sufficient  to  spoil  it  for  the  test,  even  when  most  carefully  pro- 
tected from  all  light.  In  the  second  place,  it  does  not  record  the 
reaction  of  the  tissues  to  the  x-ray  and  is,  therefore,  of  very  little 
more  value  than  the  mere  statement  that  so  many  minutes 
with  a  certain  kind  of  a  tube  constitute  so  much  of  a  dose  in 
any  given  case. 

10.  Precipitation  Test. — Schwarz,  of  Vienna,  recognized  the  in- 
stability of  the  iodof orm  in  chloroform  reagent,  and  set  about  to 
overcome  this.     A  mixture  of  ammonium  oxalate  and  corrosive 
sublimate  contains  some  calomel,  and  makes  a  perfectly  clear 
fluid,  which,  when  protected  from  the  effects  of  daylight,  keeps 
indefinitely.     When  this  mixture  is  exposed  to  daylight  or  the 
x-rays,  cloudiness  and  the  formation  of  a  precipitate  appear 
at  once.     The  amount  of  precipitation  depends  upon  the  lu- 
minosity of  the  #-ray.     The  precipitate  can  then  be  estimated 
by  centrifuging  in  a  capillary  tube  which  has  been  calibrated  for 
the  purpose.     This  entire  reaction  evidently  depends  upon  the 
luminosity  or  light  effect,    and,   as   the   x-rays   are   invisible, 
the  glass  of  the  tube,  its  composition,  and  the  thickness  of  the 
wall  cause  the  differences  in  luminosity.    This  system  cannot  re- 
cord the  effect  of  the  x-ray. 

11.  The  Ionizing  Power  of  the  X-Eay. — J.  J.  Thompson  as  well 
as  Professor  Eoentgen  thought  it  possible  to  make  use  of  this 
power  to  measure  the  quality  of  the  ray.     For  some  time,  ra- 
dium, and,  in  fact,  all  radio-active  substances,  have  been  judged 
by  their  ionizing  qualities.  An  electroscope  is  charged  with  either 
plus  or  minus  electricity.    It  is  then  brought  within  the  field  of 
x-ray  influence;  and  the  time  consumed  in  the  discharging  of  the 
filaments  is  taken  as  a  unit  of  measurement.     The  objection  pe- 
culiar to  this  method  is  that,  before  the  electroscope  can  be  dis- 
charged, the  air  must  have  been  ionized  in  order  to  become  a 
conductor  of  electricity;  and  as  the  conditions  of  heat  and  moist- 
ure vary  from  hour  to  hour,   the  unit  established   by  such  a 
method  would  be  subject  to  continuous  variation.     Were  it  not 


MEASUREMENT   OF   DOSAGE.  791 

also  open  to  all  the  other  objections  cited,  for  this  reasou  alone 
this  method  cannot  establish  a  unit. 

12.  The  Radiometer  of  Courtade. — All  operators  observed  the 
fact  that  radium,  so  far  as  strength  and  steadiness  of  radiations 
are  concerned,  is  practically  uniform ;  it  was,  therefore,  thought 
that  this  substance  might  be  useful  in  furnishing  the  necessary 
unit  of  penetration,  as  \vellas  of  ionizing  and  chemical  effects  of 
the  x-ray.     For  this  purpose,  radium  of  known  strength  was  fixed 
upon   a  screen  of  barium  platino-cyanide,  and  the  x-ray  was 
allowed  to  fall  upon  the  same  screen  through  an  aperture  made 
for  the  purpose.     The  two  illuminations  were  then  compared,  and 
by  moving  the  tube  nearer  to  or  farther  from  the  screen,  the  dis- 
tance and  the  strength  of  the  x-ray  were  determined.     This  again 
meets  with  all  of  the  objections  above  cited,  and  possesses  none 
of  the  real  merits  necessary  to  establish  a  system  of  units. 

13.  The  Cruilleminot- Courtade  Modification.     14.   The  Fluorom- 
cter  of  Williams.     15.   The  Method  of  Contremoulim. — These  three 
methods  are  but  slight  modifications  of  the  original  radiometer 
system.     They  do  not  present  any  special  feature  of  merit  with- 
out at  the  same  time,  by  overcoming  one  obstacle,  obscuring  other 
points  of  value. 

16.  The  Selenium  Cell  as  a  Photometer.  — R.  Levy  presented  at 
the  Berlin  Congress  in  1905  a  selenium  cell  through  which  a 
current  from  two  ordinary  dry  cells  was  passing.     The  current 
so   passing  was  then  recorded  by  an  amperemeter.      If  this 
arrangement  is  brought  within  range  of  an  active  x-ray  tube,  the 
ionizing  power  of  the  x-ray  changes  the  resistance  within  the  cell 
to  the  passage  of  the  current  from  the  two  dry  cells.     This  vari- 
ation of  current-reading  is  then  taken  as  a  guide  to  the  strength 
of  the  raj*.     It  must  now  be  borne  in  mind  that,  when  dry  cells 
are  connected  in  the  manner  described,  there  ensues  in  a  very 
short  time  a  noticeable  deterioration  of  the  cells,  and  the  read- 
ing will  consequently  change  from  time  to  time,  which  would 
absolutely  prevent  the  fixing  of  a  unit. 

17.  Dunham' 8  Instrument.    18.  G.  C.  Johnston's  X-Bay  Meter. 
—Both  of  these  instruments  are  modifications  of  the  selenium- 
cell  type  with  the  addition  of  the  fluorescent  screen.     The  lumi- 
nosity of  the  screen  decreases  the  resistance  in  the  selenium  cell, 
and  allows  a  greater  flow  of  current  during  the  time  in  which  such 
a  screen  is  excited  to  luminosity  by  the  x-ray.     Here  we  are  in- 


792  X-RAYS  AND   SKIAGRAPHS— GEYSER. 

t  reducing  still  more  elements  of  unknown  quantities  and  doubtful 
value,  on  account  of  their  ever-changing  proclivities. 

It  must  be  apparent  from  the  foregoing  rSsumS  that  the 
meter  for  x-rays  has  not  yet  been  found,  much  as  it  may  be 
desired.  In  fact,  when  such  a  meter  is  finally  evolved  it  must 
of  necessity  be  something  entirely  different  from  the  present 
appliances.  It  should  not  be  inferred,  however,  that  the  meth- 
ods enumerated  possess  no  points  of  merit,  as  far  as  measuring 
either  the  penetration,  or  the  chemical  qualities,  or  the  ionizing 
power  of  the  x-ray.  On  the  contrary,  for  the  purpose  of  x-ray 
photography  some  of  these  systems  for  computing  the  value  of, 
or  assisting  in  the  selection  of  a  particular  kind  of  tube  have 
most  decided  value.  Under  such  circumstances,  we  are  dealing 
entirely  with  inert  materials ;  their  composition  being  a  known 
factor,  their  chemical  reaction  can  be  almost  mathematically 
figured  out.  For  therapeutic  purposes,  however,  we  are  dealing 
with  unknown  compositions,  therefore  unknown  reactions,  and 
the  lesions  or  the  pathological  states  are  ever- varying  factors. 
It  is  not,  therefore,  a  system  of  measuring,  nor  the  establishment 
of  therapeutic  doses  which  is  desired,  but  rather  something  that 
will  rob  the  x-ray  of  its  undesirable  qualities. 

If  a  keg  of  powder  and  a  lighted  caudle  be  kept  in  the  same 
room,  we  need  not  so  much  a  system  whereby  we  may  measure  the 
explosion  that  is  liable  to  occur,  but  rather  something  that  will 
eliminate  the  possibility  of  such  an  explosion.  We  know  the 
keg  of  powder  by  itself  is  harmless  enough,  and  under  ordinary 
circumstances  the  lighted  candle  is  a  source  of  but  small  danger. 
But  when  these  two  agents  act  in  concert,  there  is  liable  to  be 
discord.  In  this  instance,  of  course,  we  are  dealing  with  famil- 
iar agents,  and  the  remedy  is  simple :  either  remove  the  powder 
or  extinguish  the  candle;  or,  if  both  must  remain,  then  shield 
either  one  or  both  in  such  a  manner  that  their  united  effect 
cannot  take  place. 

It  has  been  shown  that  the  reaction  of  normal  as  well  as 
pathological  tissue  depends  upon  the  presence  of  several  factors, 
as  the  ionizing  qualities  of  the  x-ray,  the  penetration,  and  the 
chemical  effects ;  all  of  which  are  enhanced  by  the  static  inductions 
surrounding  the  tube.  It  is  a  well-recognized  fact  that  when 
a  plate  of  aluminum  is  placed  between  the  patient  and  the  tube, 
especially  if  the  aluminum  is  grounded,  the  superficial  reac- 


MEASUREMENT   OF   DOSAGE.  793 

tion  is  materially  lessened.  The  reason  for  this  is  twofold: 
The  static  field  surrounding  the  tube  exerts  its  influence  upon 
this  shield,  instead  of  upon  the  patient ;  secondly,  only  the  more 
penetrative  rays  pass  through  the  aluminum,  and  are  therefore 
not  arrested  upon  the  surface  of  the  skin.  Again,  as  Phaler,  of 
Philadelphia,  has  shown,  when  a  piece  of  sole  leather  or 
a  piece  of  silver  is  placed  in  front  of  an  x-ray  tube,  the  skin 
reaction  is  almost  nil,  regardless  of  the  dose.  The  only  thing 
accomplished  here  is,  as  with  the  aluminum  plate,  an  interference 
with  the  static  induction  and  the  avoidance  of  arresting  certain 
low  rays  upon  the  surface  of  the  skin. 

It  has  been  the  author's  privilege  to  combine  several  of  these 
last-named  methods  into  one,  and,  instead  of  complicating  the 
results,  simplifying  them.  Let  us  take  a  tube  made  entirely  of 
lead  glass;  opposite  the  anode,  and  at  right  angles  to  the  cathode 
stream,  is  a  projection  also  made  of  lead  glass ;  which  projec- 
tion is  then  closed  by  a  window  made  of  crown  glass.  It  must  at 
once  be  apparent  that  such  a  tube  possesses  all  the  requisites  of 
any  ordinary  tube  plus  the  advantage  that  no  rays  will  be  emitted 
from  the  tube  anywhere  excepting  through  the  crown-glass  win- 
dow. The  operator,  therefore,  is  safe  to  remain  in  close  proxim- 
ity to  a  working  tube  without  being  himself  affected  by  the  ray ; 
which  is  of  considerable  importance  from  a  medico-legal  point  of 
view,  since  under  such  circumstances  the  operator  can  remain 
close  to  his  patient  and  properly  observe  the  working  of  the 
tube  at  all  times.  The  next  point,  and  of  equal  importance,  is 
the  distance  of  the  tube  from  the  patient.  When  this  tube  is 
placed  in  direct  contact  with  the  skin,  we  accomplish  several  very 
important  results:  the  tube  becomes  grounded  to  the  patient, 
thereby  doing  away  in  a  large  measure  with  the  static  induction 
(the  static  field  surrounding  the  tube),  the  formation  of  nitrous 
acid  and  ozone,  as  well  as  the  ultra-violet  ray ;  all  of  which  fac- 
tors depend  directly  upon  the  fine  sparks  which  are  continuously 
leaving  the  outer  surface  of  the  tube.  Such  an  arrangement  then 
robs  the  x-ray  of  everything  save  one  factor,  and  that  is  its 
ionizing  qualities.  The  very  moment  that  the  z-ray  exerts 
no  action  other  than  to  ionize  the  various  substances  with 
which  it  may  come  in  contact,  there  exists  little  or  no  dif- 
ference between  it  and  radium.  Practical  experience  has 
proved  this  to  be  a  fact.  Radium  must  remain  in  close  contact 


794  X-RAYS   AND   SKIAGRAPHS— GEYSER. 

with  the  tissues  for  hours  before  any  decided  reaction  will  occur. 
The  x-ray  used  under  the  above-named  conditions  practically 
acts  in  the  same  manner,  and  may  be  left  in  direct  contact  any 
reasonable  time  without  deleterious  effect  upon  sound  tissue. 
Pathological  tissue  has,  of  course,  not  the  necessary  resistive 
power,  hence  breaks  down  easily  under  the  influence  of  such  an 
agent,  and  if  a  ready  means  for  escape  of  the  broken-down  tissue 
is  afforded,  there  will  be  no  undesirable  reaction ;  on  the  con- 
trary, many  lesions  clear  up  and  return  to  normal  the  moment 
all  the  abnormal  cells  have  been  disintegrated.  We  are,  there- 
fore, justified  in  putting  forth  the  claim  that  the  term  x-ray  burn 
should  be  replaced  by  the  term  "radio-dermatitis." 


THE   X-RAY   IN    THERAPEUTICS    AND   ITS    LIABILITY    TO 
CAUSE   DERMATITIS. 

An  unusually  large  number  of  damage  suits  have  occupied 
the  courts  during  the  last  two  or  three  years  as  a  result  of  in- 
juries received  from  exposures  to  the  x-ray.  Nearly  every 
known  lesion  of  the  skin  as  well  as  several  constitutional  derange- 
ments have  been  from  time  to  time  exposed  to  the  influence  of 
the  x-ray.  The  fact  that  the  x-ray  possessed  a  peculiar  influence 
in  its  behavior  toward  the  normal  skin  was  noticed,  during  the 
very  early  days  of  its  discovery,  by  Schiff  and  Freund,  of 
Vienna. 

At  that  time  it  was  necessary  to  expose  the  hand  for  thirty 
minutes  in  order  to  obtain  a  photograph  of  the  bones  of  the  hand. 
After  a  number  of  such  exposures  had  been  made,  a  peculiar 
skin  lesion  made  its  appearance,  differing  materially  from  any 
known  lesion  of  a  similar  nature.  It  was  discovered  that  the 
part  of  the  body  exposed  to  the  ray  showed  no  untoward  effect 
until  a  week  or  ten  days  after  an  exposure.  The  skin  became 
red,  with  an  intense  itching  or  burning,  sometimes  without  any 
sensation  of  discomfort ;  after  another  week  or  two,  if  no  further 
exposures  were  made,  a  normal  condition  re-established  itself. 
If,  however,  the  exposures  were  continued  after  this  primary 
reaction,  then  a  more  violent  reaction  took  place,  blisters  formed, 
which  opened  (leaving  open  areas  of  denuded  tissue  which  re- 
fused to  respond  to  all  ordinary  measures  of  treatment),  some- 
times persisting  for  months  and  even  years  without  showing  any 


THE   X-RAY   IN  THERAPEUTICS.  795 

tendency  to  heal.  Skin-grafting,  when  resorted  to,  was  seldom 
successful.  Finally,  after  more  or  less  sloughing  had  taken 
place,  the  area  had  a  characteristic  appearance  of  a  mottling  of 
white  anaemic  and  red  hyperaemic  areas.  The  white  areas  were 
found  to  be  due  to  scar-tissue  formation,  a  hyperplasia  of  con- 
nective tissue,  while  the  red  areas  were  due  to  the  destruction  of 
the  intima  of  the  smaller  blood-vessels  and  the  arterioles  forming 
areas  of  dilated  blood-vessels  not  unlike  a  telangiectasis. 

Later,  when  the  tubes  and  generating  machines  were  im- 
proved, these  same  lesions  appeared  even  more  quickly,  if  any- 
thing, than  of  old,  because  the  rays  were  focussed,  and  they  were 
very  much  stronger.  Many  and  varied  are  the  opinions  as  to 
the  nature  of  this  reaction  by  the  tissues  to  the  ray. 

1.  THE  FORCING  OF    METALLIC  SUBSTANCES    INTO    THE 
SKIN. — From  the  fact  that  an  electric   current,   when  passed 
through  any  substance,  decomposes  that  substance,  some  observ- 
ers were  led  to  think  that  the  metallic  terminals  within  the  glass 
tul>e  became  decomposed,  that  this  metal  in  such  a  fine  state  of 
division  could  be  forced  through  the  walls  of  the  tube  and  into 
the  tissues,  and  there  set  up  this  peculiar  manifestation.     Very 
careful  work  with  the  microscope  and  chemical  tests  for  the 
metal  have  failed  to  reveal  even  the  slightest  trace.     This  theory, 
therefore,  had  to  be  abandoned.     Not  only  that,  but  any  glass 
wall  capable  of  allowing  metallic  particles  to  pass  through  it, 
would  of  necessity  allow  the  ingress  of  air  and  so  tend  to  destroy 
the  vacuum,  which,  as  we  know,  does  not  take  place.     On  the 
contrary,  the  newer  the  tube  the  quicker  it  will  cause  a  reaction, 
while  the  more  seasoned  the  tube  the  less  liable  it  is  to  cause  a 
burn. 

2.  ULTRA-VIOLET  EATS. — Some  observers,  especially  Stine 
and  Goldstein,   as  reported  by  Holzknecht,   suppose  that  the 
ultra-violet  rays  generated  in  connection  with  an  excited  x-ray 
tube,  and  not  the  x-ray,  were  the  causes  of  the  burn.     When, 
however,  we  stop  to  reflect  that  the  ultra-violet  rays  refuse  to 
pass  through  glass,  we  are  limited  to  the  violet  rays  formed  upon 
the  outside  of  the  tube  during  action.     The  electric  current  pass- 
ing through  the  tube  sets  up  a  static  field  around  the  outside; 
this  static  field,  the  same  as  all  high-tension  discharges,  produces 
a  certain  amount  of  the  ultra-violet  rays  on  the  outside  of  the 
glass  sphere.     If  this  supposition,  however,  were  true,  then  we 


796  X-RAYS   AND   SKIAGRAPHS — GEYSER. 

ought  to  produce  a  large  amount  of  burning  in  the  tissues  when 
the  spray  is  used  from  a  metallic  conductor  or  from  the  glass- 
vacuum,  high-frequency  electrodes.  Such  is  not  the  case,  and 
the  ultra-violet  may  therefore  be  considered  as  not  the  prime 
agent  in  the  production  of  the  burn. 

3.  CATHODE   BAYS. — Before    Roentgen's   discovery   of  the 
x-ray,  Lenard  studied  and  experimented  with  the  cathode  rays ; 
he  found  that  they  would  not  pass  through  the  glass  walls  of  the 
tube,  though  they  could  be  bent  out  of  their  path  by  the  action 
of  a  strong  magnet.     Before  Lenard  could  properly  study  the 
cathode  rays,  it  was  necessary  to  insert  an  aluminum  window  into 
the  side  of  the  glass  tube  to  allow  these  rays  to  pass  outward. 
Lenard  demonstrated  their  effect  upon  the  negative  photographic 
plate,  upon  various  salts,  etc.,  but  does  not  record  any  untoward 
effect  upon  the  tissue.    It  must,  however,  be  borne  in  mind  at  this 
time  that  when  the  cathode  stream  is  most  abundant,  as  in  a  tube 
with  a  low  vacuum,  where  the  x-rays  are  few,  we  have  the  great- 
est liability  for  burns. 

The  moment  the  cathode  stream  ceases  to  exist,  the  or-rays 
increase  in  number,  and  the  liability  to  produce  burns  disappears 
in  exact  ratio.  It  is  necessary  then  to  consider  either  a  tube 
with  a  low  vacuum  or  the  cathode  rays  at  least  component  fac- 
tors. 

4.  THE   STATIC   FIELD    SURROUNDING   THE    TUBE. — The 
Electrical  Review,  January  5th,  1898,  published  an  article  to  the 
effect  that  Rollins  exposed  his  hand  to  a  tube,  the  vacuum  of 
which  was  so  high  that  no  current  would  pass  through  it,  conse- 
quently no  x-rays  were  generated,  yet  he  sustained  a  severe  burn 
of  the  hand  exposed.     This  experiment  would  lead  us  to  consider 
the  static  field  as  a  contributory  agent  only,  because  the  same 
static  field  exists  in  the  neighborhood  of  all  high-tension  appa- 
ratus, yet  no  burn  results  from  the  static  induction  alone ;  an- 
other element  or  several  are  necessary  to  produce  such  effects. 

5.  THE  PRODUCTION  OF   OZONE  UPON  THE  SKIN. — When- 
ever electrical  discharges  take  place  in  the  air  there  is  a  forma- 
tion of  ozone  and  nitrous  pentoxide.     Either  one  or  both  of  these 
substances  may  accumulate  upon  the  surface  of  the  skin,  and 
cause  more  or  less  local  reaction,  that  differs,  though,  materially 
from  that  state  or  condition  known  as  the  x-ray  burn.     The 
ozone  and  acid  effect  would  take  place  almost  at  once  and  would 


1HE   X-RAY    IN   THERAPEUTICS.  791 

of  necessity  be  limited  to  a  surface  action,  while  the  x-ray  burn 
does  not  show  any  immediate  effect ;  days  and  weeks  may  pass 
before  the  first  symptom  is  manifested.  Again,  the  x-ray  burn 
seems  to  begin  in  the  deeper  tissues  and  work  outward,  while  the 
effects  from  an  agent  like  ozone  or  an  acid  would  work  from  the 
outside  inward.  Tesla  held  that  the  ozone  and  the  nitrous  acid 
were  responsible  for  the  burn,  he,  therefore,  placed  between  the 
patient  and  the  x-ray  an  aluminum  shield ;  this  seemed  to  lessen 
the  burning  qualities  very  materially.  Later,  in  order  further  to 
increase  the  protecting  value  of  such  a  metallic  screen,  a  chain 
or  metallic  grounding  was  connected  with  the  aluminum  plate  for 
the  purpose  of  doing  away  with  the  static-induction  influence  as 
well  as  protecting  against  the  ozone  and  nitrous-acid  formation 
upon  the  skin.  This  combined  procedure  seemed  to  lessen  the 
number  of  burns,  still  a  certain  number  would  appear  with  un- 
pleasant regularity ;  we  were  forced  to  the  conclusion  that  all 
the  factors  had  not  yet  been  eliminated. 

6.  IDIOSYNCRASY. — All  x-ray  operators  are  agreed  upon  one 
fact:  that  all  persons  do  not  offer  the  same  susceptibility  to  the 
x-ray.     This,  of  course,  is  not  strange,  since  it  is  an  accepted 
dictum  in  medicine  that  no  two  persons  react  alike  to  either 
infection  or  therapeutic  measures.     Unfortunately,  it  is  impossi- 
ble for  the  physician  to  know  in  advance  which  person  is 
destined  to  be  burned  with  a  minimum  dose  and  which  patient 
may  not  be  affected  at  all  with  even  massive  therapeutic  doses, 
so  that  when  the  idiosnycrasy  is  discovered  the  burn  is  present. 

7.  FAULTY  TECHNIQUE. — As  has  been  pointed  out,  there  are 
certain  conditions  that  seem  to  be  more  or  less  directly  connected 
with  the  production  of  x-ray  burns.     First  among  these  is  the 
presence  of  the  cathode  stream,  which  means  very  few  x-rays  or 
a  tube  with  a  very  low  power  of  penetration.    A  so-called  soft  tube 
will  cause  a  reaction  more  quickly  and  oftener  than  a  hard  tube. 
When,  therefore,  a  soft  tube  is  used  the  time  should  be  accord- 
ingly shortened.     Again,  sufficient  time  should  be  allowed  be- 
tween the  treatments,  since  the  effect  of  the  raying  may  not  show 
for  several  days  after  the  exposure,  and  the  undoubted  cumula- 
tive effect  thereby  avoided.     Whatever  may  be  faulty  technique 
in  one  instance  may  be  absolutely  correct  technique  in  another, 
and  vice  versa.     The  general  rules  in  medicine  apply  as  much 
here  as  elsewhere.     A  healthy,  robust  person  would  be  expected 


798  X-RAYS   AND    SKIAGRAPHS — GEYSER. 

to  resist  the  action  of  the  x-ray  more  thau  a  sickly,  delicate  per- 
son. Blondes  seem  to  burn  more  quickly  than  brunettes;  in 
fact,  the  action  of  the  x-ray,  generally  speaking,  is  much  like 
that  of  the  sun's  rays:  some  persons  become  severely  burned  and 
never  tan,  while  others  tan  only  and  seldom  or  never  suifer  from 
actual  sun-burns. 

THE  PHYSICIAN'S   RESPONSIBILITY  IN   CASES    OF   X-RAY 

DERMATITIS. 

Shortly  after  Professor  Boeutgen  showed  to  the  world  the 
possibility  of  photographing  the  hitherto  unseen  structures  of 
the  human  body,  a  peculiar  form  of  dermatitis  made  its  appear- 
ance. 

All  those  who  were  interested  in  this  newly  discovered  agent, 
especially  for  photographic  purposes,  noticed,  usually  about  one 
week  or  ten  days  after  an  exposure,  a  reddening  of  the  part  so 
exposed  to  the  #-ray. 

During  those  days  it  was  necessary  to  expose  a  hand  for  thirty 
minutes  in  order  to  produce  the  proper  effect  upon  a  sensitized 
plate.  It  is  therefore  no  wonder  that  dermatitis  was  rather  the 
rule  than,  as  it  is  to-day,  the  exception.  Schiff  and  Freund,  two 
Vienna  dermatologists,  became  much  interested  in  this  new  dis- 
ease of  the  skin ;  from  its  resemblance  to  an  ordinary  sunburn 
they  gave  this  lesion  the  term  #-ray  burn. 

We  recognize  two  conditions  of  this  lesion.  In  one  instance 
it  is  the  result  of  a  diagnostic  examination,  in  which  instance  one 
of  two  factors,  or  perhaps  both  factors,  operated.  Either  the 
exposure  was  too  prolonged,  or  the  patient  was  possessed  of  a 
marked  idiosyncrasy  to  the  ray.  In  either  case  a  radio-derma- 
titis may  result,  and,  according  to  the  conditions  present,  go 
through  its  various  stages,  lasting  from  a  few  days  to  months 
and  even  years  before  recovery  takes  place. 

Whenever  therefore  a  radio-dermatitis  follows  as  the  result 
of  the  use  of  the  #-ray,  it  is  always  unintentional  but  not  always 
unavoidable.  This  is  especially  the  case  in  patients  who  are  in- 
clined to  an  over-amount  of  fatty  tissue  as  well  as  in  those  who 
suffer  from  water  in  the  tissues,  either  general  or  local  dropsies, 
and  (jedematous  swellings.  Whether  the  tissues  just  enumerated 
are  under  such  conditions  more  responsive,  or  whether  the  inter 


PHYSICIAN'S  RESPONSIBILITY  IN  DERMATITIS.        799 

ference  with  the  local  circulation  and  depressed  state  of  the  part 
under  examination  is  responsible  for  the  greater  reaction,  is  at 
present  mere  conjecture.  The  fact,  however,  remains  that  all 
tissues  devitalized  by  trauma  or  other  agencies  respond  physi- 
ologically to  the  action  of  the  j?-rays  sooner  than  normal  tissues. 
Another  element  enters  into  consideration  here  and  that  is  the 
time  necessary  for  the  exposure.  When  such  factors  as  fat, 
serous  effusion,  pus,  water,  or  even  congestion  in  any  part  under 
examination  exist,  there  is  an  obscure  shadow  upon  the  fluoro- 
scope,  and  it  is  necessary  frequently  to  prolong  the  tiiue  of  ex- 
posure beyond  the  limit  of  safety.  In  fact,  it  often  happens 
that  a  diagnosis  cannot  be  made  with  the  fluoroscope.  It  is  bet- 
ter practice,  therefore,  to  waste  no  time  in  exposing  a  patient 
under  such  circumstances,  but  after  the  first  look  at  once  take  a 
radiograph.  With  all  these  precautions  there  is  still  a  possibil- 
ity of  causing  an  accidental  dermatitis  as  the  result  of  exposure 
to  the  x-ray  for  diagnostic  purposes. 

In  the  second  condition  the  ray  is  used  for  therapeutic  pur- 
poses. Under  certain  circumstances,  with  lesions  of  a  degenera- 
tive type,  especially  where  the  skin  has  already  broken  down,  it 
seems  logical  at  least  to  attempt  to  set  up  a  certain  amount  of 
reaction  in  such  tissues.  Should  such  a  reaction  from  any  cause 
get  beyond  the  control  of  the  operator,  or  spread  to  neighboring 
parts,  a  radio-dermatitis  would  be  the  result.  On  the  other  hand, 
if  sound  skin  is  overlying  a  pathological  condition,  and  in  the 
attempt  to  affect  this  deeper-lying  tissue  the  skin  becomes  in- 
volved as  the  result  of  the  use  of  the  x-ray,  then  we  have  again 
produced  a  radio-dermatitis,  which  can  in  no  way  assist,  but 
rather  retard  the  effect  of  the  x-ray  treatment  in  such  a  case. 

It  is  therefore  evident  that  there  exist  two  distinct  classes 
among  ar-ray  malpractice  suits:  the  one  where  the  ray  is  used  for 
diagnostic  purposes,  and  the  other  where  it  is  used  as  a  thera- 
peutic agent.  In  the  application  of  the  principles  of  law,  no 
distinction  can  be  drawn  between  these  two  classes,  and  while 
the  legal  rules  are  plain,  concise,  and  adequate,  yet  it  is  some- 
times difficult  to  apply  the  rules  to  the  case  in  hand. 

Personal  responsibility  and  liability  to  a  patient  for  damages 
caused  by  the  use  or  misuse  of  the  x-ray  rest  upon  the  same 
principles  of  law  as  any  other  branch  of  medicine  or  surgery. 
The  same  rules,  so  far  as  malpractice  is  concerned,  must  be  ap- 


800  X-RAYS  AND   SKIAGRAPHS — GEYSER. 

plied  as  laid  down  in  our  court  of  last  resort,  to  guide  the  medi- 
cal and  surgical  practitioner. 

Illustrative  of  these  two  great  classes,  the  following  are  rep- 
resentative : 

THE  X-RAY   USED  FOB  DIAGNOSTIC  PURPOSES. 

In  April,  1901,  an  action  was  brought  by  a  brewer  living  in 
Brooklyn  against  a  surgeon  who  has  become  eminent  in  his  pro- 
fession .and  now  resides  in  Manhattan  Borough,  for  $50,000,  to 
recover  damages  for  a  so-called  #-ray  burn  received  on  his  abdo- 
men while  the  operator  was  attempting  to  confirm  a  diagnosis  of 
a  calculus  in  the  kidney.  The  result  of  the  examination  with 
the  tf-ray,  so  far  as  it  was  confirmatory,  was  unsatisfactory, 
though  there  appeared  a  slight  shadow  on  the  plate.  The  skia- 
graph, however,  was  never  considered  of  sufficient  value  to 
warrant  an  operation  into  the  abdomen.  The  patient  was  a 
strong  adult  weighing  approximately  250  pounds,  and  the  appa- 
ratus used  was  one  of  the  earlier  Crookes  tubes  energized  by  a  coil 
from  a  street  current. 

There  is  no  doubt  but  that  the  patient  was  burned,  and  it  is 
certain  that  the  appliances  in  use  at  the  time  that  the  action  was 
brought  (1901)  for  protecting  the  body,  the  proper  distance 
from  the  tube  as  laid  down  in  the  earlier  writings  of  the  English 
and  German  authorities,  and  the  ordinary  time  of  exposure  were 
used ;  in  fact,  every  precautionary  measure  was  adopted,  yet  the 
patient  was  burned.  The  suit  followed  and  was  successfully  de- 
fended. 

This  action  was  the  pioneer  case,  so  far  as  I  have  been  able 
to  learn,  in  the  United  States,  involving  this  question  of  the  use 
of  the  ic-rays  for  diagnostic  purposes,  and  the  rules  of  care  and 
caution  ordinarily  applied  were  used  in  this  case. 

THE  X-RAY  USED  AS  A  THERAPEUTIC  AGENT. 

This  case  was  in  many  respects  a  very  peculiar  and  extraordi- 
nary one,  as  it  evidenced  the  astonishing  personal  and  individual 
idiosyncrasy  which  must  always  be  considered  in  the  application 
of  #-rays. 

The  patient  in  this  case  was  a  man  about  seventy  years  of 
age,  residing  in  New  York,  and  was  treated  with  the  arrays  for 


X-RAYS   USED   AS  A   THERAPEUTIC  AGENT.  801 

locomotor  ataxia  following  syphilis,  and  two  questions  were  raised 
by  the  plaintiff  in  his  pleadings,  first,  as  to  the  propriety  of 
the  treatment,  and  second,  lack  of  experience  of  the  operator. 
It  was  claimed  by  the  patient  that  he  was  exposed  to  the  #-ray 
for  upward  of  thirty  minutes,  on  two  different  occasions,  with 
the  tube  within  an  inch  or  two  of  his  back,  and  that  the  operator 
left  the  room.  It  was  also  charged  by  the  patient  that  the 
operator  had  not  sufficient  knowledge  of  the  mechanical  part  of 
his  work  properly  and  safely  to  apply  the  rays. 

The  action  involved  $25,000  and  was  successfully  defended. 

It  was  begun  in  April,  1904. 

It  was  claimed  and  affirmatively  proved  by  the  physician  that 
he  exposed  the  patient's  back  to  the  rays  for  from  ten  to  twelve 
minutes,  at  a  distance  of  about  eight  inches,  and  that  he  moved 
the  tube  up  and  down  the  entire  length  of  the  spine,  and  that  this 
exact  treatment  had  been  repeated  after  the  expiration  of  three 
days. 

It  appeared  that  the  patient  returned  in  about  eleven  days 
with  what  seemed  to  be  the  very  mildest  form  of  an  .r-ray  derma- 
titis. The  patient  was  then  told  that  he  was  extremely  suscepti- 
ble to  the  rays  and  that  the  treatment  would  be  discontinued, 
and  thereupon  local  treatment  was  applied  for  the  purpose  of 
relieving  the  dermatitis. 

The  appearance  of  the  skin,  however,  and  the  symptoms  at- 
tending it  were  not  relieved  by  treatment,  and  a  slight  dermatitis 
continued  for  upward  of  five  mouths  without  change.  At  the 
end  of  five  months,  and  without  apparent  reason,  there  appeared 
in  the  area  marked  by  the  dermatitis  a  small  abrasion  of  the 
skin,  which  was  promptly  followed  by  a  necrotic  condition,  ul- 
ceration,  and  gangrene,  which  subsequently  and  after  careful 
and  extended  treatment  was  healed. 

When  the  case  was  brought  to  trial  the  patient's  back  was 
exhibited  to  the  jury  and  disclosed  a  scar  over  the  length  of  the 
spine,  two  inches  wide  by  sixteen  in  length.  The  scar  itself 
afforded  conclusive  proof  that  the  operator  had  moved  the  tube 
up  and  down  the  spine.  The  general  condition  of  the  patient 
was  improved. 

It  appeared  at  the  trial  of  the  action  that  the  operator  had 
had  a  very  wide  experience  in  the  treatment  of  diseases  of  the 
skin,  that  he  had  applied  the  x-ray  several  thousand  times,  and 
III.— 51 


802  X-RAYS  AND   SKIAGRAPHS— GEYSER. 

that  the  machine  made  use  of  was  the  ordinary  static  machine  in 
use  to-day,  which  he  had  purchased  some  few  months  before  the 
patient  came  to  him  for  treatment. 

The  grave  question  involved  in  this  case  was  the  propriety  of 
the  use  of  the  a?- ray  in  a  case  of  this  kind,  tabes  dorsalis. 

Scientfic  experimentation  with  the  x-ray  for  improvement  of 
this  condition  has  been  reported,  and  experienced  writers  have 
published  in  standard  works  clinical  histories  of  the  successful 
application  and  beneficial  results  in  this  disease,  but  the  uncertain 
question  is  whether  or  not  the  therapeutic  value  of  the  #-rays  is 
of  sufiicient  certainty  or  efficacy  to  bring  it  within  the  rule  of  re- 
sponsibility as  an  approved  method  of  treatment. 

The  Court  of  Appeals  say  that  the  physician  is  bound  to  keep 
abreast  of  the  times,  meaning  that  he  must  possess  and  make  use 
of  such  medical  literature  as  would  keep  him  in  pace  with  medi- 
cal and  "surgical  progress,  and  continues,  "And  a  departure 
from  the  approved  methods  in  general  use,  if  it  injures  the 
patient,  will  render  him  liable,  however  his  intentions  may  have 
been. " 

Assuming  that  the  operator  uses  an  approved  tube,  approved 
machine,  at  an  approved  distance,  for  an  approved  time,  has  the 
treatment  itself  been  sufficiently  approved  and  in  general  use  for 
the  exact  purpose  to  which  it  is  applied,  and  can  it  be  safely  said 
that  it  has  been  accepted  and  approved  by  those  conversant  with 
the  use  of  the  particular  agent  of  cure,  and  that  it  is  as  certain  in 
its  beneficial  results  as  many  Of  the  surgical  and  medical  agents 
have  now  been  proven  to  be  ? 

In  the  second  class  of  cases  we  find  still  another  subdivision, 
namely,  those  cases  or  pathological  conditions  where  the  use  of 
the  aj-ray  has  been  generally  acknowledged,  by  those  who  are  in 
a  position  to  know,  as  a  superior  agent  or  means  of  treatment ; 
yet  during  an  application  or  as  an  after-result  a  radio-dermatitis 
is  established,  causing  the  patient  pain  and  leaving  more  or  less 
disfiguring  scars.  The  following  case  will  bear  more  or  less 
directly  upon  such  a  condition. 

In  the  early  part  of  the  year  of  1907  a  New  York  physician 
became  the  defendant  in  a  suit  for  $10,000  damages  as  the  result 
of  ar-ray  treatment  for  tuberculous  glands  of  the  neck. 

The  plaintiff,  a  young  woman  domestic,  claimed,  and  her  ap- 
pearance seemed  to  bear  out  her  statements,  that  she  had  suffered 


X-RAYS    USED    AS   A   THERAPEUTIC   AGENT.  803 

the  loss  of  her  hair  on  the  left  side  of  the  head  as  well  as  having 
been  severely  burned  over  the  entire  left  side  of  her  fact'. 

The  Facts. — The  patient  some  time  prior  had  suffered  from 
tuberculous  glands  of  the  neck  upon  her  left  side ;  these  were 
removed  by  operation.  A  large  scar  was  visible  as  the  result. 
Subsequently  the  glands  upon  her  right  side  began  to  enlarge ; 
the  patient  was  advised  to  have  a  similar  operation  performed ; 
she  refused  this,  she  having  become  possessed  of  the  knowl- 
edge that  the  ar-rays  were  satisfactorily  employed  in  such  con- 
ditions. 

In  1903  the  plaintiff  applied  at  a  hospital  clinic  for  a?- ray 
treatment.  After  several  exposures  a  slight  dermatitis  developed ; 
the  patient  was  advised  to  discontinue  the  treatment  until  the 
reaction  should  have  disappeared,  which  took  about  two  weeks. 

As  soon  as  treatment  at  the  clinic  was  resumed  the  plaintiff 
engaged  the  services  of  the  defendant  in  this  action,  and  both 
physicians  treated  the  patient  contemporaneously,  each  remain- 
ing in  total  ignorance  of  the  other's  treatment. 

In  the  fall  of  1903  she  had  three  treatments  from  the  defend- 
ant at  intervals  of  about  ten  days.  A  16-plate  Waite  and  Bart- 
lett  machine  was  used,  with  a  five-inch  General  Electric  tube. 
The  surface  of  the  tube  was  not  less  than  eight  inches  from  the 
plaintiff's  neck,  and  the  exposure  on  each  occasion  lasted  eight 
minutes.  Her  head  and  shoulder  were  protected  by  sheets  of 
lead  foil,  with  an  aggregate  thickness  of  about  one-twelfth  inch. 
Four  or  five  days  after  the  third  treatment  a  dermatitis  of  the 
second  degree  began  to  develop,  extending  from  the  bottom  of 
the  neck  to  above  the  ear,  and  embracing  the  whole  left  cheek. 
She  called  on  the  defendant,  who  prescribed  an  antiseptic  dress- 
ing and  urged  her  to  call  again  in  a  day  or  two.  He  saw  her 
only  once  more,  about  ten  days  later,  when  the  wound  was  puru- 
lent and  dirty,  and  the  hair  about  the  ear  had  fallen. 

At  the  time  of  the  trial  she  had  a  network  of  telangiectases 
over  the  glands  in  her  neck  and  extending  into  her  cheek,  and 
a  slight  sclerosis  behind  the  ear.  Her  hair  had  grown  again. 
The  glands  were  still  slightly  enlarged  on  both  sides  of  the  neck. 
She  had  been  examined  in  October,  1904,  after  suit  began,  and 
it  appeared  that  the  telangiectases  had  increased  considerably 
since  that  time.  She  had  had  further  x-r<\y  treatment  from  a 
third  physician  in  the  interval. 


804  X-RAYS   AND  SKIAGRAPHS — GEYSER. 

The  Expert  Evidence. — The  evidence  of  experts  on  both  sides 
was  that  the  duration  of  the  treatment  and  the  distance  of  the 
tube  from  the  neck  were  regarded  as  safe,  that  the  static  machine 
was  deemed  safer  than  a  coil,  that  the  quantity  and  quality  of 
the  ar-ray  continually  varied,  not  merely  from  day  to  day,  but  in 
the  course  of  a  single  application,  that  the  protection  by  a  lead 
sheet  was  the  best  known  to  science,  and  that  no  means  was 
known  to  science  of  accurately  measuring  either  the  quantity  or 
quality  of  the  x-ray. 

The  Law. — On  this  state  of  facts  the  judge  charged  the  jury 
upon  the  question  of  the  physician's  duty  according  to  the 
familiar  rule  (Pike  v.  Housiuger,  155  N.  Y.,  201).  First,  he 
must  possess  "  only  that  reasonable  degree  of  learning  and  skill 
relating  to  #-ray  treatment  commonly  belonging  to  a  physician 
and  surgeon  using  the  treatment  in  the  city  of  New  York  in 
November,  1903."  Second,  he  must  use  "only  reasonable  care 
and  diligence  in  the  exercise  of  his  skill  and  the  application  of 
his  learning  in  the  treatment  by  a--ray. "  Third,  he  was  bound 
to  treat  the  plaintiff  "according  to  his  best  judgment."  The 
judge  pointed  out  that  the  defendant  was  here  charged  with  neg- 
ligence or  breach  of  duty  only  in  the  actual  treatment,  the  second 
branch  of  the  duty  imposed  on  him  by  law,  as  above  defined. 
The  possession  of  adequate  skill  and  learning,  and  the  exercise 
of  best  judgment  were  thus  not  in  the  case.  Eeasonable  care 
and  diligence  in  the  treatment  meant  "  such  ordinary  care  and 
diligence  as  is  usually  given  by  a  physician  in  good  standing. 
It  does  not  mean  the  highest  possible  care  and  diligence,  or  such 
care  and  diligence  as  might  have  been  used  by  some  other  phy- 
sician, or  even  by  the  defendant  himself."  The  physician  is  not 
an  insurer  or  guarantor,  and  "in  #-ray  he  does  not  insure  the 
patient  against  a  burn. " 

The  part  of  chief  significance,  however,  was  that  in  which  the 
judge  dealt  with  the  doctrine  known  as  res  ipsa  loquitur.  Briefly 
stated,  that  doctrine  means  that  the  accident  and  the  surrounding 
circumstances  speak  for  themselves,  and  afford  prima  facie  proof 
of  negligence.  A  common  instance  of  the  application  of  the 
doctrine  is  found  in  a  railroad  collision  between  two  trains.  The 
court  knows,  and  everybody  knows,  that  when  trains  are  operated 
with  ordinary  and  reasonable  care  they  do  not  collide,  and  the 
mere  fact  of  a  collision,  therefore,  affords  evidence  of  negligence ; 


X-RAYS  USED   AS   A  THERAPEUTIC   AGENT.  805 

the  accident  speaks  for  itself.  But  the  court  here  holds  that  the 
mere  happening  of  an  x-ray  burn  is  not  evidence  of  negligence, 
and  it  reached  the  conclusion  doubtless  in  view  of  the  evidence 
of  the  uncertain  state  of  ar-ray  science  and  by  analogy  to  cases 
of  bursting  flywheel  of  an  electric  machine,  bursting  oil  tank, 
etc.  (Piehl  v.  Albany  E.  E.,  30  App.  Div.,  166;  affirmed,  162  N. 
Y.,  617;  Losee  v.  Buchanan,  51  N.  Y.,  76;  Cosnlichv.  Standard 
Oil  Co.,  128  N.  Y.,  103).  In  cases  of  this  kind  the  accident  does 
not  speak  for  itself,  because  it  may  happen  notwithstanding  the 
use  of  reasonable  and  ordinary  care.  In  the  case  of  the  bursting 
flywheel,  Judge  Landon,  afterward  of  the  Court  of  Appeals,  said 
the  doctrine  of  res  ipsa  loquitur  did  not  apply :  "  Because  such  are 
the  limitations  upon  human  foresight  that  every  reasonable  care 
does  not  always  prevent  accidents,  and  that  such  is  the  nature  of 
steam  and  electricity,  and  the  engines  by  or  upon  which  they 
operate,  that  when  such  an  explosion  as  this  occurs  our  experi- 
ence, or  even  expert  experience,  is  not  sufficiently  uniform  to 
justify  us  in  presuming  that  negligence  is  the  cause.  The  ex- 
plosion does  not,  in  fact,  speak  for  itself  and  tell  us  its  cause." 

If  this  is  true  of  steam  and  electricity,  a  fortiori  it  is  true  of 
the  much  more  uncertain  science  of  a:- ray.  Upon  this  subject 
the  judge  charged  as  follows:  "If  the  jury  find  that  the  plaintiff 
received  the  burn  of  which  she  complains  in  consequence  of  the 
treatment  by  the  defendant,  they  cannot  infer  that  the  defend- 
ant was  negligent  merely  because  the  plaintiff  afterward  suffered 
from  #-ray  burn,  for  the  cause  of  the  burn  may  be  beyond 
human  knowledge,  and  even  expert  experience  may  not  be  suffi- 
ciently uniform  to  indicate  a  sure  means  of  preventing  it. 
Owing  to  the  limitations  of  human  knowledge,  the  exercise  of 
every  reasonable  care  does  not  always  prevent  accidents,  and 
this  is  especially  true  in  dealing  with  such  comparatively  little 
known  forces  as  electricity  and  #-rays.  The  jury  cannot  find 
the  defendant  guilty  of  the  negligence  alleged  in  the  complaint 
unless  it  can  find  in  the  proofs  some  particular  act  of  negligence 
which  caused  the  burn.  To  punish  the  defendant  because  he 
cannot  explain  the  cause  of  the  burn  is  not  necessarily  to  punish 
him  because  he  has  done  wrong,  but  may  be  to  punish  him  be- 
cause he  does  not  know  something  which  science  cannot  find  out 
or  has  thus  far  been  unable  to  find  out." 

This  charge  is  the  only  judicial  expression  of  the  law  of  this 


806  X-RAYS  AND  SKIAGRAPHS — GEYSER. 

State  upon  this  subject  so  far  as  the  reports  show.     It  appears 
to  be  logically  deduced  from  the  analogies  above  referred  to. 

Naturally  there  are  several  other  elements  which  enter  into 
the  application  of  the  #-ray,  depending  on  the  purpose  for 
which  it  is  applied  as  a  therapeutic  agent.  The  question  of  the 
tube,  shield,  time  of  exposure,  repetition  of  treatment,  all  these 
are  elements  which  must  be  considered ;  but  assuming  that  the 
operator  has  sufficient  experience  and  has  acquired  sufficiently 
accurate  knowledge  of  the  mechanical  parts,  in  order  that  the 
operator  may  avoid  responsibility  in  a  bad  result,  there  must  be 
an  acceptance  and  approval  of  the  treatment  by  the  profession 
generally,  otherwise  damages  may  be  demanded,  however  good 
the  physician's  intentions  may  have  been. 


MEDICO-LEGAL   EXAMINATION   OF 

BLOOD  AND  OTHER  STAINS, 

AND    OF  THE  HAIR. 


BY 

JAMES   EWING,   A.M.,  M.D., 

Prof&taor  of  Pathology  in  Cornell  University  M&lical  College. 


THE   MEDICO-LEGAL  EXAMINATION 
OF   BLOOD. 

EVIDENCE    AND     MATERIAL     GATHERED     BY 
THE   EXAMINER. 

THE  relations  of  blood-stains  found  in  the  locality  of  a  homi- 
cide, on  the  body  or  clothing  of  the  victim,  or  on  the  person  or 
belongings  of  the  suspect,  have  so  often  yielded  vital  evidence 
that  much  responsibility  falls  upon  the  one  whose  duty  it  be- 
comes to  collect  such  evidence. 

The  examination  of  the  premises  should  be  directed  ta  all 
articles  containing  material  which  in  any  respect  suggests  the 
presence  of  blood,  and  this  task  may  involve  considerable  knowl-' 
edge  of  the  physical  changes  to  which  blood  is  susceptible.  It 
should  not  be  undertaken  in  poor  light,  and  it  may  perhaps  be 
made  with  advantage  by  artificial  light,  judging  from  the  fre- 
quently cited  report  of  Ollivier  and  Pillon,1  who  by  lamp-light 
detected  numerous  small  shiny  blood-spots  which  were  over- 
looked by  day. 

THE  NUMBEK  OF  BLOOD-SPOTS  to  be  expected  in  the  vicinity 
of  a  homicide  will  depend  on  the  nature  of  the  wounds  inflicted. 
Severed  arteries  spurt  widely,  ruptured  veins  distribute  much 
blood  over  smaller  areas,  and  while  crushing  wounds  may  not 
l>e  followed  by  external  hemorrhage,  blood  may  be  thrown 
several  feet  by  repeated  blows  in  bleeding  tissues  (Piotrowsky).2 

It  must  not  be  supposed  that  blood-stains  must  necessarily  be 
found  on  the  person  of  the  assailant  in  a  bloody  encounter. 

The  natural  direction  of  spurting  blood  is  away  from  the  hand 
guiding  the  instrument;  an  experienced  person  may  cleverly 
aroid  contamination,  or  thoroughly  remove  any  spots  received; 
criminals  have  been  known  to  strip  to  the  skin  before  attempt- 
ing murder,  or  to  supply  themselves  with  overalls  (Taylor).8 

'Ollivier  and  Pillon,  Archiv.  g£n.  3  Taylor,  "MedicalJurisprudence," 

de  Mdd.,  1833,  2'  S.,  T.  1,  p.  431.  Phila.,  1883,  vol.  i.,  p.  523. 

•  Piotrowsky,  Virchow'sJahresber., 
1895,  Bd.  i.,  p.  449. 

809 


810  BLOOD   AND   OTHER   STAINS — EWINQ. 

Fatal  blows  may  be  delivered  by  blunt  instruments  without 
the  shedding  of  blood,  contact  with  clothing  may  remove  .all  or 
nearly  all  traces  of  blood  from  sharp  instruments,  and  Caspar 1 
believed  that  a  suicide  once  cut  his  throat  with  a  sharp  carpenter's 
knife  which  was  found  entirely  free  from  blood. 

The  possibility  of  cleansing  weapons  once  saturated  with 
blood  will  depend  on  the  character  of  the  weapon,  but  some 
traces  of  blood  will  usually  cling  to  cracks  and  crevices  of  most 
knives  and  instruments,  and  resist  all  but  the  elaborate  methods 
of  cleansing. 

On  the  other  hand,  the  presence  of  several  minute  blood- 
stains on  the  clothing  should  not  necessarily  be  regarded  as 
indicating  the  commission  of  crime.  Small  blood-stains  on  the 
underclothing,  cuffs,  collar,  neck-band  are  very  frequently  seen, 
especially  in  the  lower  classes  of  society,  as  a  result  of  scratches, 
small  wounds,  crushing  of  insects,  slight  epistaxis,  etc. 

THE  LOCATION  OF  BLOOD-SPOTS  is  of  ten  of  great  significance. 
In  a  case  of  Taylor's 2  the  question  of  murder  or  suicide  was 
determined  by  the  discovery  on  the  back  of  the  left  hand  of  a 
victim  of  cutthroat  of  the  bloody  print  of  the  murderer's  left 
hand.  Hoffmann3  reports  the  significant  discovery  on  the  neck, 
both  arms,  and  shirt  of  an  apparent  suicide  by  hanging,  of  blood- 
spots  and  the  bloody  hand-prints  of  an  assailant. 

The  entire  locality  should  be  searched  for  more  distant  evi- 
dences of  a  bloody  encounter. 

Taylor  *  reported  a  case  in  which  the  autopsy  indicated  death 
by  fracture  of  the  skull  from  a  fall  down  cellar  stairs  at  the  bot- 
tom of  which  the  body  lay,  but  the  discovery  of  spurted  blood - 
spots  on  the  wall  at  the  head  of  the  stairs  led  to  the  demonstration 
that  the  chief  wound  of  the  scalp  was  incised  and  through  the 
temporal  artery.  In  numerous  reports  in  literature  significant 
evidence  was  obtained  in  the  discovery  of  bloody  foot-prints, 
hand-marks,  finger-prints,  and  blood  drops,  at  a  distance  from 
the  dead  body,  and  much  care  had  to  be  exercised  in  determining 
whether  or  not  these  stains  were  made  by  attempts  at  suicide,  by 
a  murderer,  or  by  other  parties  coming  upon  the  scene  before  the 
blood  was  dry. 

1  Caspar,  "  Handbook  of  Forensic         *  Hoffmann,  "Lehrbuch  d.  gerichtl. 

Med.,"  1895,  vol.  ii.,  p.  168.  Med.,"  1903,  p.  421. 

1  Taylor,    "Med.    Jurisp.,"    1883,          *  Taylor,  ibid.,  p.  521. 
vol.  i.,  p.  522. 


EVIDENCE   GATHERED   BY  THE   EXAMINER.  811 

The  form  of  the  blood-spots  and  their  relation  to  each  other 
may  signify  the  direction  and,  to  some  extent,  the  distance  from 
which  they  came. 

The  appearance  of  blood  when  smeared  over  an  object  needs 
no  description.  Objects  touched  by  fluid  blood  receive  stains 
with  smooth  outlines.  Blood  dropped  perpendicularly  on  a 
hard  smooth  surface  begins  to  spatter  when  the  height  reaches 


FIG.  28.— Blood  Spatters  on  Paper.    Natural  size.    (Wood,) 

three  or  four  inches,  but  may  not  spatter  from  a  height  of  two 
or  three  feet.  Dropped  from  a  few  inches  on  glass,  the  drop  is 
compact  with  smooth  edge ;  from  a  few  feet,  the  drop  is  flatter, 
the  edges  may  be  moderately  indented,  and  minute  outlying 
drops  may  be  present.  Blood  drops  thrown  obliquely  against  a 
surface  assume  a  characteristic  pear  shape,  the  base  being  nearer 
the  source  and  the  stem  being  formed  by  those  portions  of  the 
drops  which  fail  to  cling  to  the  surface  first  encountered  and  are 
projected  along  sometimes  for  an  inch  or  more.  The  length  of 
these  stems  may  indicate  the  speed  of  the  drops.  Blood  falling 


812  BLOOD  AND  OTHER  STAINS— EWING. 

on  a  vertical  surface  flows  down  till  it  clots,  leaving  a  thick  lower 
rim  and  a  broad  but  thin  streak  above. 

EVIDENCE  OFFICIALLY  HANDED  TO  THE  EXAMINEB. 

The  medical  examiner  usually  first  sees  articles  requiring 
examination  when  they  are  handed  to  him  by  officers  of  the 
court.  Such  articles  should  always  be  received  in  person,  and 
the  date  of  their  receipt,  the  condition  of  the  packages,  and  the 
name  of  the  officer  should  be  noted.  They  must  be  kept  in  the 
custody  of  the  examiner  under  lock  and  key  and  not  exhibited 
to  any  one  without  an  order  of  the  court.  A  thorough  prelimi- 
nary examination  should  promptly  be  made  of  all  the  articles, 
and  the  naked-eye  appearance  of  all  the  important  features  and 
possible  blood-stains  recorded.  A  hand-glass  is  of  value  in  this 
examination. 

If  spots  are  removed  from  any  articles,  their  exact  location 
should  be  noted.  As  the  serum  reactions  of  blood  are  slowly 
altered  by  prolonged  contact  with  certain  woods,  earths,  metals, 
and  leather,  material  on  such  articles  should  be  removed  as  soon 
as  possible  and  kept  in  vials  apart  from  light,  heat,  and  moisture. 

SCHEME  OF  EXAMINATION. 

The  systematic  examination  of  blood-stains  involves: 

(1)  Gross  Examination. 

(2)  Microscopical  Examination. 

(3)  Guaiac  Test. 

(4)  Hemin  Test. 

(5)  Spectroscopic  Examination. 

(6)  Serum  Test. 

GEOSS  EXAMINATION. 

The  extremely  characteristic  qualities  of  fresh  or  recently 
shed  blood  are  so  greatly  altered  by  exposure  to  the  elements, 
by  drying,  heat,  moisture,  bacterial  decomposition,  and  the 
action  of  chemical  agents  that  the  identification  of  old  blood  and 
the  explanation  of  its  changes  require  a  considerable  knowledge 
of  the  composition  and  properties  of  this  fluid  tissue.  Only 
such  portions  of  the  subject  will  be  considered  which  directly 
concern  the  medico-legal  expert. 


COAGULATION.  813 

COAGULATION. 

Shed  blood  on  exposure  to  air  promptly  clots  with  the  forma- 
tion of  fibrin  which  develops  from  the  action  of  the  fibrin  fer- 
ment upon  fibriuogen,  a  fluid  protein  of  the  blood-plasma. 

The  fibrin  ferment  is  contained  in  the  leucocytes  and  red 
cells  (or  their  derivatives,  the  blood-plates),  and  while  there  are 
considerable  variations  in  the  quantity  of  the  fibrin  ferment  in 
health  and  disease,  the  resultant  influence  on  the  clotting  of  the 
blood  is  rarely  of  importance  in  medico-legal  examinations. 

Normal  human  blood  begins  to  clot  in  about  two  minutes  after 
shedding,  and  the  process  is  complete  in  from  seven  to  ten  min- 
utes, but  the  duration  of  the  process  depends  much  upon  the 
quantity  of  blood  and  the  surrounding  conditions.  The  blood 
of  cold-blooded  animals  clots  slowly,  while  that  of  birds  clots 
much  more  rapidly.  The  blood  of  the  fowl  begins  to  coagulate 
in  1.5  minutes;  that  of  the  pig,  sheep,  and  rabbit  in  .5  to  1.5 
minutes ;  that  of  the  dog  in  from  1  to  3  minutes ;  horse  and  beef, 
5  to  13  minutes  (Nasse1). 

Coagulation  is  hastened  by  temperatures  between  37°  and  50° 
C. ;  by  exposure  to  air,  as  when  it  collects  in  small  amounts  or 
in  shallow  containers;  by  dilution  with  less  than  twice  its  bulk 
of  water ;  by  contact  with  corrosive  chemicals  or  rough  surfaces ; 
and  by  agitation  or  stirring. 

Coagulation  is  delayed  by  cold,  and  fresh  blood  drawn  in 
test  tubes  and  immediately  cooled  to  0°  C.  remains  fluid  for  an 
hour  or  more,  while  heating  such  a  specimen  to  56°  C.  destroys 
the  fibrin  ferment  and  prevents  coagulation.  Blood  is  perma- 
nently kept  fluid  by  addition  of  neutral  salts,  as  sodium  or  mag- 
nesium sulphate  or  ammonium  oxalate,  since  they  combine  with 
the  calcium  salts  of  the  plasma  which  are  necessary  for  coagu- 
lation. Contact  and  especially  covering  with  oily,  waxy,  or 
syrupy  substances  delays  coagulation. 

It  will  be  seen  that  blood  which  requires  medico-legal  identi- 
fication has  usually  been  exposed  to  conditions  which  favor  its 
coagulation,  considerable  dilution  with  water  being  the  only 
frequent  exception. 

After  clotting  the  fibrin  slowly  contracts,  pressing  out  drops 
of  serum  after  fifteen  to  twenty  minutes,  and  continuing  to  expel 
1  Nasse,  Wagner's  "Handbuch  tl.  Physiol.,"  1842,  vol.  i.,  p.  75. 


814  BLOOD   AND   OTHER   STAINS — EWING. 

serum  for  several  days  if  desiccation  is  prevented.  This  con- 
traction diminishes  the  bulk,  but  not  the  area  of  the  original  mass. 
The  progress  of  desiccation  is  influenced  by  the  humidity  and 
temperature  of  the  atmosphere,  and  by  the  character  of  the  sur- 
face receiving  the  blood.  Blood  dries  more  slowly  than  water 
on  account  of  its  viscous  character. 

Wood's 1  experiments  showed  that  a  drop  of  blood  falling  from 
the  finger  upon  smooth  glass,  and  forming  a  spot  f  inch 
in  diameter  at  71°  F.,  began  to  show  contraction  of  the  edges 
in  10  minutes ;  the  outer  half  of  the  drop  was  partially  dry  in 
35  minutes,  and  the  whole  drop  completely  dry  in  70  min- 
utes. On  cotton  cloth  a  similar  drop  was  completely  dry  in  30 
minutes.  On  a  smooth,  soft  pine  board  at  65°  F. ,  the  drop  re- 
mained unchanged  for  30  minutes,  began  to  shrink  in  1  hour, 
and  the  moist  appearance  at  the  centre  disappeared  in  2  hours. 
Larger  quantities  of  blood  dry  much  more  slowly. 

When  blood  falls  on  a  smooth  vertical  surface,  coagulation 
does  not  occur  until  the  fluid  portions  have  gravitated  to  the 
lower  edge  of  the  spot ;  but  if  the  surface  is  rough,  rapid  coagu- 
lation usually  prevents  this  gravitation,  and  the  drop  is  more 
uniform  in  thickness. 

Dried  blood  is  stiff  and  extremely  brittle,  and  flexible  mate- 
rials saturated  with  it  have  a  peculiar  stiffness  like  that  of  heavily 
starched  cloths.  On  manipulation  the  stiffness  is  only  partly 
destroyed  and  the  blood  breaks  oif  in  fine  scales. 

Blood  mixed  with  mucus  or  pus  is  usually  rendered  more  co- 
hesive, does  not  spread,  flow,  or  spatter  like  pure  blood,  and  on 
drying  is  usually  more  irregular  and  compact.  Blood  diluted 
with  watery  fluids  yields  broad,  pale,  thin  spots  with  denser 
edges. 

Dry  blood-stains  on  cloths  usually  require  very  thorough 
washing  to  remove  all  traces  of  blood  pigment,  and  the  faint 
outlines  of  such  stains  can  frequently  be  detected  on  white  cloths 
after  the  ordinary  cleansing  of  the  laundry. 

The  outer  edge  of  such  washed  stains  is  usually  more  distinct 
than  the  centres. 

1  Wood,  Witthaus  and  Becker,  "Medical   Jurisprudence,"   etc.,    1st  ed., 
vol.  ii.,  p.  11. 


COLOR  AND   AGE.  815 

COLOR   AND   AGE. 

Arterial  blood  is  bright  crimson,  venous  blood  dark  crimson, 
and  capillary  blood  presents  an  intermediate  shade. 

Very  light  cherry-red  blood  is  seen  in  cases  of  CO  poisoning, 
chocolate  color  in  poisoning  by  phosphorus,  potassium  chlorate, 
and  coal-tar  products.  In  anaemia  the  blood  is  pale,  and  in  as- 
phyxia it  is  very  dark.  Yet  the  original  color  of  the  blood  can 
seldom  be  traced  in  the  dry  blood-stain,  since  exposure  to  air 
transforms  all  blood  to  a  uniform  dark-red  shade,  which  becomes 
progressively  darker  with  age  and  finally  almost  black.  As  this 
process  is  very  slow  and  subject  to  many  disturbing  influences, 
it  is  very  difficult  to  determine  the  age  of  a  stain  from  its  color. 
The  solubility  of  the  albumens  and  pigments  is  a  more  reliable 
guide  to  the  age  of  the  stain.  A  large  stain  six  months  old  which 
had  saturated  a  coat  was  found  by  the  writer  very  dark  on  the 
outer  side  of  the  cloth,  but  much  brighter  on  the  inner  side  where 
it  was  protected  by  several  layers  of  lining.  Exposure  to  sun- 
light may  bleach  the  pigment. 

Hamnierl  exposed  a  piece  of  blood-stained  linen  to  direct 
sunlight  for  five  days,  when  its  upper  surface  exhibited  a  faded 
gray  color,  and  after  three  weeks  neither  red  cells  nor  crystals 
could  be  obtained. 

According  to  Pfaff l  some  indication  of  the  age  of  blood-stains 
on  cloths  may  be  obtained  by  noting  their  solubility  in  dilute 
arsenious  acid  (1-120)  which  dissolves  fresh  blood  in  a  few  min- 
utes; after  1  to  2  days  in  15  minutes;  after  8  days  in  30  min- 
utes ;  after  2  to  4  weeks,  in  1  to  2  hours ;  after  4  to  6  months  in 
3  to  4  hours;  after  1  year  in  4  to  8  hours.  Tamassia,2  however, 
found  that  Pfaff 's  scale  is  quite  unreliable.  Drageiidorff s  states 
that  the  fibrinous  coagula  of  fresh  clots  decolorize  in  chlor- 
ine water  in  about  1  hour ;  after  6  months  in  about  2  hours ; 
after  8  months  in  about  4  hours;  after  1  year  in  about  5  hours. 

Conclusions  regarding  the  solubility  of  old  and  altered  blood- 
stains have  depended  chiefly  on  the  method  used  to  determine 
the  results  of  attempted  solution.  Heating  to  135°  to  143°  C. 
prevents  the  guaiac  reaction,  and  at  140°  to  145°  C.  Teichmann's 

'Pfaff,    Vierteljahr.   f.  ger.  Med.,          » Dragendorff,     Maachka,      "Ger. 
1862,  Bd.  xxi.,  p.  266.  Med.,"  18X1,  Bd.  i.,  p.  500. 

2  Tamassia,    cit.    by    Souther-hind, 
"Blood  Stains,"  1907,  p.  5. 


816  BLOOD    AND    OTHER   STAINS — EWINQ. 

test  usually  fails  (Hanmierl *).  Southerland,2  however,  obtained 
hsemin  crystals  from  stains  heated  2  to  3  hours  at  140°  C.  Kata- 
yauia3  found  that  dried  blood  on  porcelain  heated  to  100°  C.  for 
one  hour  was  soluble  in  distilled  water  in  24  hours ;  heated  to 
120°  C.  for  one  hour,  it  required  for  solution  24  hours  in  strong 
caustic  potash  or  glacial  acetic  acid,  or  a  week  in  ammonia,  cya- 
nide of  potash,  or  dilute  sulphuric  acid  and  alcohol ;  while  heated 
to  140°  C.  for  one  hour,  it  yielded  only  to  strong  potash  or 
glacial  acetic  acid.  Yet  Mirto4  found  blood  heated  to  120°  C. 
for  one  hour,  130°  C.  for  30  minutes,  or  to  150°  to  160°  C.  for  10  to 
15  minutes,  is  still  soluble  in  normal  salt  solution,  as  determined 
by  the  precipitin  test.  In  experiments  of  Hammerl,  exposure  to 
direct  sunlight  for  7  to  8  hours  daily  rendered  blood  on  linen  in- 
soluble after  3  days  in  distilled  water,  after  6  days  in  ammonia, 
after  16  days  in  cyanide  of  potash,  while  after  3  weeks  Teich- 
manii's  test  failed,  but  glacial  acetic  acid  gave  a  solution  permit- 
ing  spectroscopic  analysis.  Concentrated  sulphuric  acid  will 
always  extract  pigment  from  heated  stains,  and  this  solution 
will  always  give  the  spectrum  of  hseinatoporphyrin  (Wood5). 

SUBSTANCES  RESEMBLING  DRIED  BLOOD. 

There  are  many  substances  which  resemble  blood-stains, 
some  of  which  may  be  excluded  by  a  careful  gross  examination, 
while  others  require  microscopical  or  chemical  tests  for  their 
identification.  It  is  usually  desirable  to  determine  positively  the 
nature  of  such  materials. 

Iron  rust  varies  greatly  in  its  appearance,  and  some  forms 
closely  resemble  dried  blood,  but  it  seldom  presents  a  dark  red 
and  glazed  appearance.  Knives  used  to  cut  acid  fruits  may  pre- 
sent dark  reddish  stains  resembling  blood,  but  containing  dried 
vegetable  cells  colored  with  iron  salts.  A  microscopical  exami- 
nation reveals  absence  of  red  blood  cells  and  the  presence  of 
vegetable  cells  and  detritus.  The  presence  of  iron  may  be  de- 
termined by  dissolving  the  stain  in  warm  HC1,  and  adding  a  drop 
of  potassium  ferrocyanide  which  yields  the  Prussian-blue  reac- 

1  Hammerl,     Vierteljahr.     f.     ger.  *  Mirto,    Riforma    Medica,    1901, 
Med.,  1892,  Bd.  iv.,p.  44.  pp.  855,  866. 

2  Southerland,      "Blood     Stains,"  s  Wood,  This  Work,  1st  ed.,  vol. 
New  York,  1907,  p.  8.  ii.,  p.  17. 

3  Katayama,    Vierteljahr.    f.    ger. 
Med.,  1888,  Bd.  xlix.,  p.  209. 


COMPARATIVE   MORPHOLOGY  OF  RED   CELLS.  817 

tion.  As  salts  of  iron  are  employed  as  mordants,  this  test 
should  be  controlled  by  applying  it  to  unstained  portions  of  any 
colored  cloth  on  which  the  stain  may  be  found. 

Vegetable  dyestuffs  and  extracts  of  tan  bark  may  produce 
stains  resembling  dry  blood.  Most  of  these  contain  tannin,  which 
blackens  when  to  a  solution  of  the  stain  is  added  a  drop  of  tinc- 
ture of  iron.  Extract  of  logwood  becomes  reddish  on  addition 
of  mineral  acids,  and  blue  with  alkalies.  Most  of  the  bright  red 
dyes  become  deep  red  on  addition  of  ammonia.  Madder  is 
changed  to  a  yellow  color  by  acids,  and  brown  by  tincture  of 
iron.  Vegetable  dyes  are  bleached  by  chlorine  water,  which,  if 
not  too  strong,  has  little  effect  on  blood.  Fruit,  tobacco,  and  other 
vegetable  stains  are  best  identified  by  microscopic  examination 
and  the  detection  of  characteristic  vegetable  cells.  Spots  of 
grease  and  tar  are  insoluble  in  water  or  in  acids,  but  dissolve  in 
naphtha,  turpentine,  or  xylol.  When  a  piece  of  filter-paper  is 
pressed  over  grease  spots  with  a  hot  iron,  the  paper  absorbs  some 
greasy  material. 

Bed  paint  can  usually  be  detected  by  its  color.  It  is  insoluble 
in  water,  but  soluble  in  naphtha  and  turpentine.  It  usually 
contains  red  oxide  of  lead  or  iron. 

MICROSCOPICAL    EXAMINATION. 

By  the  use  of  the  microscope  the  examiner  is  enabled  to 
identify  any  red  blood  cells  that  may  be  present,  to  determine 
the  probable  origin  of  these  red  cells,  the  presence  and  probable 
origin  of  leucocytes,  and  the  nature,  of  any  material  with  which 
the  blood  may  have  been  mixed  or  for  which  it  may  have  been 
mistaken.  Since  the  microscope  furnishes  extremely  definite 
and  reliable  information  regarding  the  minute  characters  of  the 
material  examined,  it  will  always  remain  the  most  generally  use- 
ful, as  it  is  by  far  the  most  delicate  instrument  for  the  detection 
of  the  presence  of  blood,  as  it  usually  occurs  in  stains.  More- 
over, it  may  prove  the  only  method  applicable  to  extremely 
minute  stains. 

COMPARATIVE   MORPHOLOGY   OF  RED   CELLS. 

The  red  cells  of  all  healthy  mammals  are  circular,  homoge- 
neous, non-nucleated,  biconcave,  disk-shaped  bodies,  with  the 
III.— 52 


818 


BLOOD   AND   OTHER   STAINS — EWING. 


exception  of  the  camel,  dromedary,  llama,  and  alpaca,  whose 
cells  are  oval,  while  those  in  the  Mexican  deer  are  circular, 
heart-shaped,  and  crescentic.  In  the  freshly  smeared  blood  of 
healthy  new-born  infants,  a  few  nucleated  red  cells  may  usually 
be  found,  and  in  various  diseases  of  the  adult  nucleated  red 
cells  may  be  rather  numerous. 

Dresbach x  has  published  a  remarkable  case  of  a  mulatto  the 
majority  of  whose  blood  cells  were  distinctly  oval  or  elliptical 


FIG.  29.— Elliptical  Red  Cells  in  a  Healthy  Human  Subject.     X  1,000.    Dresbach's  case. 

in  shape.  The  accompanying  figure  shows  the  appearance  of  the 
blood  spread  which  Dr.  Dresbach  kindly  allowed  me  to  have 
photographed.  The  subject  appeared  to  be  healthy  and  was  not 
suffering  from  any  symptoms  of  anaemia.  The  elliptical  shape 
of  the  cells  was  observed  in  the  fresh  condition  and  over  a  period 
of  two  months. 

1  Dresbach,  Science,  1904,  vol.  xix.,  479;  1905,  vol.  xxi.,  p.  473. 


COMPARATIVE   MORPHOLOGY   OF  RED   CELLS.  819 

The  red  cells  of  birds,  fishes,  and  reptiles  (ovipara)  are  oval 
and  nucleated,  except  in  the  lamprey  and  some  fishes  (cyclo- 
stomata)  whose  cells  are  circular.  In  the  fresh  condition  red 
cells  are  very  elastic,  folding,  indenting,  and  greatly  elongating 
without  rupture,  but  when  roughly  manipulated  they  may  split 
up  into  fragments  each  of  which  tends  to  assume  a  biconcave 
discoidal  shape.  These  properties  are  in  accordance  with  the 
view  that  the  red  cell  is  composed  of  an  elastic  stroma  with  con- 
densed outer  border  and  holding  haemoglobin  in  compact  form, 
not  by  means  of  a  hollow  membrane,  but  by  virtue  of  a  chemi- 
cal union  between  the  haemoglobin  and  the  stroina  (Rollett1). 

Red  cells  exhibit  a  strong  tendency  to  cohere  to  one  another 
by  their  flat  surfaces,  forming  long  rows  (rouleaux),  and  when 
these  rouleaux  are  compressed  in  drying,  the  shape  and  size  of 
the  red  cells  may  be  greatly  altered. 

The  Osmotic  Relations  of  the  red  cells  are  very  delicately 
balanced.  Human  red  cells  begin  to  absorb  water  and  swell  up 
into  spheroidal  bodies  and  discharge  haemoglobin  in  solutions  con- 
taining less  than  .46  per  cent  NaCl,  while  they  contract  and 
creuate  in  solutions  containing  more  than  .9  per  cent  of  NaCl. 
These  limits  vary  with  each  animal  species,  and  in  each  individ- 
ual some  red  cells  are  more  resistant  and  some  less  resistant  than 
the  average.  After  brief  drying,  red  cells  are  promptly  dissolved 
by  normal  salt  solutions.  When  red  cells  have  absorbed  water 
and  become  spheroidal  their  diameter  lessens,  to  a  degree  esti- 
mated experimentally  by  Fonnad2  at  one-third  the  original 
dimension. 

When  red  cells  are  exposed  to  certain  haemolytic  agents  such 
as  snake  poison,  haemolytic  serum,  and  various  taking  chemicals 
they  become  very  cohesive,  are  drawn  out  into  elongated  forms, 
fused  together  in  homogeneous  masses,  some  of  them  are  in- 
creased in  diameter  on  drying,  and  some  may  be  subdivided  so 
that  their  original  size  and  form  are  greatly  obscured.  This 
process  is  called  agglutination  and  haemolysis.  Alterations  of 
this  type  are  not  infrequently  encountered  in  the  study  of  red 
cells  restored  from  blood-clots,  especially  when  these  dote  are 
large  and  have  dried  slowly,  or  where  partially  dried  clots  have 
suffered  from  the  access  of  moisture  or  laking  fluids. 

1  Rollett,    Hermann's  "  Handbuch          *  Formad,  Journal  of  C-omn.  Medi- 
d.  Physiol.,"  1880,  Bd.  iv.,  Abt.  i.          cine  and  Surgery,  1888,  p.  254. 


820  BLOOD   AND   OTHER  STAINS — EWING. 

Hence  in  estimating  the  size  of  red  cells  only  those  portions 
of  the  clot  should  be  selected  that  have  dried  rapidly. 

If  moist  blood  is  heated  to  50°  or  56°  C.  the  red  cells  are  grad- 
ually split  up  into  fragments  and  destroyed.  In  dry  blood-stains 
also  the  red  cells  may  be  destroyed  by  exposure  to  sunlight  for 


FIG.  30.— Human  Red  Cells  Treated  with  Agglutinating  Serum. 

five  days,  but  if  dried  in  a  thin  layer  on  glass  they  are  not  af- 
fected by  direct  sunlight  in  three  weeks  (Hammerl !). 

STAINING  PROPERTIES. 

The  staining  properties  of  red  cells  are  among  the  most  reli- 
able indications  of  their  identity.  The  living  red  cell  has  a  yel- 
lowish refractive  lustre,  and  is  achromatic.  When  fixed  by  heat 
or  drying,  it  retains  its  yellowish  color  and  develops  a  strongly 
acidophile  staining  tendency  which  resides  in  the  haemoglobin. 
1  Hammerl,  Vierteljahrschr.  f.  gerichtl.  Med.,  1892,  Bd.  iv.,  p.  44-61. 


SIZE.  821 

Iii  large  clots,  or  when  exposed  to  decomposition,  the  tendency 
to  stain  bright  red  with  eosin  may  be  lost,  arid  the  whole  cell  or 
its  central  portion  may  become  basophile  and  stain  readily  with 
basic  dyes  as  haematoxylon  and  methylene  blue.  Overheated 
cells  stain  faintly  with  acid  dyes  or  only  by  basic  dyes.  Cells 
subjected  to  traumatism  before  drying  may  extrude  a  central 
nuclear  substance  in  the  form  of  "blood  plates"  which  may 
sometimes  be  demonstrated  by  basic  dyes  within  the  cell  where 
they  may  be  mistaken  for  nuclei. 

SIZE. 

The  determination  of  the  size  of  the  red  cells  has  long  been 
one  of  the  most  essential  as  well  as  difficult  problems  in  the 
medico-legal  examination  of  blood-stains,  since  the  size  of  these 
cells  once  furnished  the  only  means  of  distinguishing  human  blood 
from  that  of  other  mammals.  Since  the  discovery  of  the  biolog- 
ical or  serum  test  for  blood  the  exhaustive  study  of  the  size  of 
red  cells  restored  from  stains  has  been  reduced  to  a  secondary 
position.  Yet  this  topic  can  never  lose  its  importance,  since  it 
will  always  furnish  valuable  corroborative  evidence  of  the  origin 
of  red  cells,  and  it  may  still  be  found  the  only  method  applicable 
to  extremely  minute  stains. 

The  diameter  of  the  red  cell  varies  throughout  the  animal 
kingdom  from  that  of  the  musk-deer,  -^^^^  of  an  inch,  to  that 
of  Amphiuma  tridactylum,  a  Louisiana  reptile,  ^,  of  an  inch,  which 
can  be  seen  with  the  naked  eye  (Gulliver1). 

Regarding  the  size  of  human  red  cells  authorities  differ  but 
slightly,  all  agreeing  that  the  average  diameter  lies  between  3,^^ 
and  7,3^  inch.  In  each  individual  a  few  red  cells  vary  consid- 
erably from  the  average  diameter.  Formad  2  states  that  90  per 
cent  of  human  corpuscles  measure  between  ^.^  and  7^nr»  fcne 
maximum  being  ?,8Y(7  and  the  minimum  7,^s  inch. 

"VVormley,3  in  three  series  of  500  corpuscles  each,  found 
only  three  that  measured  more  than  7,^yT  inch  and  four  less  than 
•j^-j-j-  inch,  while  77  per  cent  of  the  first  series,  72.2  per  cent  of 
the  second,  and  81.2  per  cent  of  the  third  fell  between 


'Gulliver,    Proc.    Zoological  Soc.,          *  Wormley,     "Microchemifltry     of 
London,  1875,  p.  474.  Poisons,"  Philadelphia,  1885. 

2  Formad,  Jour,  of  Compar.  Med. 
and  Surg.,  1888,  vol.  ix.,  p.  254. 


822 


BLOOD   AND   OTHER  STAINS — EWING. 


and  7,^5-5  inch.  It  is  therefore  obvious  that  a  large  number  of 
cells  must  be  measured,  and  conclusions  drawn  only  from  their 
average  size.  This  rule  and  also  the  variations  in  the  size  of  red 
cells  in  individual  animals  are  well  illustrated  in  the  following 
table  prepared  by  White : 

TABLE  SHOWING  VARIOUS  SIZES  OP  RED  BLOOD  CORPUSCLES  (MEASURED 
IN  MICRONS)  IN  MAN  AND  DOMESTIC  ANIMALS. 


Microns. 

Man. 

Dog. 

Pig. 

Ox. 

Sheep. 

Goat. 

9  50  

9  25     

1 

9  00         

5 

8  75            

3 

8.50  

15 

8.25  

32 

2 

8.00  

28 

1 

7.75  

51 

5 

5 

7.50  

48 

14 

4 

7.25  

10 

21 

6 

7  00  

2 

45 

10 

6  75  

4 

56 

15 

1 

1 

6  50  

0 

26 

13 

1 

0 

6.25  

1 

11 

19 

0 

0 

6.00  

16 

44 

29 

0 

5,75  

5 

19 

16 

0 

5.50  

1 

13 

20 

3 

5.25  

1 

17 

71 

9 

5.00  

10 

34 

30 

4.75  

6 

19 

38 

4.50  

4 

8 

71 

4.25  

4 

1 

26 

2 

4.00  

3 

12 

11 

3.75  

5 

3 

94 

3.50  

7 

63 

3.25  

24 

3.00  

6 

Number  of  corpuscles  .... 
Maximum  

200 
9.31 

200 

7.85 

200 
8  39 

200 

6  77 

200 

6  77 

200 
4  31 

Minimum     

6.39 

5  46 

3  85 

4  46 

3  85 

3  16 

Mean   .        .          

8.01 

6.87 

6  07 

5  44 

4  75 

3  69 

Racial  differences  in  the  size  of  red  eells  are  very  slight. 
Richardson l  measured  100  red  cells  from  individuals  of  fourteen 
nationalities,  finding  insignificant  variations.  Daubler2  finds 
that  the  red  cells  of  the  African  negro  and  of  the  Zulus  are  uni- 


1  Richardson,  Amer.  Jour,  of 
Med.  Sciences,  1887,  vol.  Ixxiii.,  p. 
112. 


2  Daubler,  Vierteljahrsschr.  f. 
gerichtl.  Med.,  1899,  Bd.  xviii.,  p. 
258. 


MEDICAL   JURISPRUDENCE-PLATE   VII. 
Gulliver's  micrometry  of  red  blood  corpuscles,  all  to  a  uniform  scale. 

I.   MAN.  II.    QUADRUMANA.        III.   CHEIROPTERA. 


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V.    CETACEA  VI.    PACHYDERMATA. 

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VII.    RUMJNANTIA 


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VIM     RODi-.NTIA  IX.    EDENTATA       X.  MARSUP    XI.  MONOTR 


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XII. 


I          2 


3         1        f)         6         7        8         9          10 
XIII.    REPTII.IA.  KT    BATHACHIA. 


Crocodil   Lacert  Anguis.  Coluber.  Python.    Bufo 


XIV. 


Pcrc».            Tinea.       Esox.         Sal-mo.       Gyn.notui. 
th  ofan^uth     .    .   . 


G.  Gulliver  ad.  nat.  del. 


VARIOUS  SIZES   OF  THE  RED  CORPUSCLES.  823 

formly  larger  than  in  the  Caucasian  race,  averaging  9//,  while 
the  average  obtained  from  Germans  was  8. 12^. 

Among  domestic  animals  those  whose  blood  is  most  likely  to 
be  mistaken  for  human  blood  are  the  dog,  beef,  pig,  horse,  cat, 
sheep,  and  goat,  while  among  the  common  wild  animals  some- 
times domesticated  are  the  monkey,  opossum,  guinea-pig,  rabbit, 
rat,  and  mouse.  The  average  diameter  of  the  red  cells  among 
these  animals  varies  from  -j.^nnr  i^h  (dog)  to  ^,^-y  inch 
(goat). 

The  following  table,  modified  from  Wood,  presents  the  aver- 
age measurements  of  red  cells  in  various  classes  of  animals. 

Gulliver's  table  is  an  excellent  graphic  comparison  of  verte- 
brate red  cells,  which  is  reproduced  together  with  the  explana- 
tion of  the  plate  taken  from  Forniad's  article  upon  "The  Com- 
parative Studies  of  Mammalian  Blood. " 

Gulliver  does  not  claim  for  his  table  absolute  accuracy,  but 
says  that  "the  relative  value  of  the  measurements,  though  prob- 
ably not  unexceptionable,  may  be  entitled  to  more  confidence  as 
fair  approximation  to  the  truth. " 

Explanation  of  the  Figures  upon  Gulliver's  Plate. — All  the  ob- 
jects are  red  blood  corpuscles  drawn  to  one  and  the  same  scale, 
which  is  at  the  foot  of  the  drawing.  The  whole  length  of  the 
scale  represents  T>TrVjr  °f  an  English  inch,  and  each  one  of  the  ten 
divisiohs  y^, J^  of  an  inch.  Only  corpuscles  of  the  average  sizes 
and  quite  regular  shapes  are  given ;  and  they  are  all  magnified 
to  the  same,  to  wit,  about  900  diameters.  For  details  see  descrip- 
tion below. 

A.— VERTEBRATA  APYREN^EMATA  (SEE  PLATE). 

I.  HOMO  (MAN) .1-3,200 

1.  Corpuscles  lying  flat. 

2.  The  same  on  edge. 

3.  Membranous   base   of  same  after  removal  by  water  of  coloring 

matter  ;  it  shows  diminution  in  diameter  on  account  of  acquired 
spherical  shape. 

II.  QUADRUMANA    (MONKEYS). 

4.  Simia  troglodytes  (chimpanzee) 1-8,412 

5.  Ateles  ater  (black -faced  spider  monkey) 

6.  Lemur  anguanensis 1-4,003 

III.  CHEIROPETERA  (BATS). 

7.  Cynoncteris  collaris  (fruit  bat) 1-3,88 

8.  Vespertilio  noctula  (large  bat) 

9.  Vespertilio  pipistrellus  (common  bat) 


824 


BLOOD   AND   OTHER  STAINS— EWING. 


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826  BLOOD    AND   OTHER   STAINS  —  EWING. 

IV.  FEIUE  (BEASTS  OF  PREY). 

(P)  10.  Sorex  tetragonurus  (shrew)  .........................  1-4,571 

(•>)  11.  Ursus  labiatus  (lipped  bear)  ........................     1-3,728 

(r)   12.  Bassaris  astuta  (civet  cat)  .........................  1-4,  033 

(•)    13.  Cercoleptus  caudi  volvulus  (kinkajou)  ..............  1-4,  573 

(')    14.  Trichechus  rosmarus  (walrus)  ....................  1-2,  769 

(•)   15.  Canis  dingo  (dog,  Australian)  .....................  1-3,  395 

(w)  16.  Mustella  zorilla  (weasel)  ..........................  1-4,270 

(•)    16.  Felis  leo  (lion)  ....................................  1-4,322 

0>)   16.  Felis  leopardus  (leopard)  ..........................  1-4,319 

(')   17.  Felis  tigris  (tiger)  ...............................  1-4,206 

(y)  18.  Paradoxurus  pallasii  (Pallas  paradoxure)  ..........  1-5,485 

(•)    19.  Paradoxurus  bondar  (Bondar  paradoxure)  ..........  1-5,  693 

(•)    19.  Hyena  striata  (striped  hyena)  .....................  1-3,  735 

V.  CETACEA  (WHALES). 

30.  Bataena  (boops—  whale)  ................................  1-3,099 

21.  Delphinus  globiceps  (ca1  ing-  whale)  ...................  1-3,  200 

22.  Delphinus  phocaena  (porpoise)  ...............  .  .........  1-3,  829 

VI.  PACHYDERMATA. 

23.  Elephas  indicus  (elephant)  ............................  1-2,  745 

24.  Rhinoceros  indicus  (rhinoceros)  .......................  1-3,  765 

25.  Tapirus  indicus  (tapir)  ................................  1-4,  000 

26.  Equus  caballus  (horse)  ................................  1-4,  600 

27.  Dicotyles  torquatus  (peccary)  .........................  1-4,  490 

28.  Hyxar  capensis  (Cape  hyrax)  ..........................  1-3,  308 

VII.  RUMINANTIA  (RUMINANTS). 

(•)  29.  Tragulus  javanicus  (Javan  chevrotain,  musk-deer)  .  1-12,  325 

(b)  30.  Tragulus  meminna  (Indian  chevrotain)  ............  1-12,  325 

(c)  31.  Tragulus  Stanleyanus  (Stanleyan  chevrotain)  .......  1-10,825 

(d)  32.  Cervus  nemorivagus  (deer)  ........................  1-7,  060 

(")  33.  Capra  Caucasica  (Caucasian  ibex)  .................  1-7,  045 

(f)  34.  Capra  hircus  (domestic  goat)  ...................  ....  1-6,  366 

(K)  35.  Bos  urus  (represented  by  Chillingham  cattle)  .......  1-4,  267 

(b)  36.  Camelopardalis  giraffa  (giraffe)  ...................  1-4,  571 

0)  37.  Auchenia  vicugna  (vicuna)..                       .  .  •!  Lt    D'  1~3>555 

<Sh.  D.  1-6,587 


(k)  38.  Auchenia  paca  (alpaca)..  \  L-    D- 

ISh.  D. 

(')  39.  Auchenia  glama  (llama)  .  .  j  L.    D. 

(Sh.  D. 


1-6,229 
1-3,  361 
1-6,229 


(m)  40.  Camelusdromedarius  (single-hump  camel).  -I  L*    D'  i"3'254 

<Sh.  D.  1-6,931 

(n)  41.  Camelus  Bactrianus  (double-hump  camel)      -I  L-    D<  1~3>  123 

'(Sh.  D.  1-5,876 

(°)  42.  Cervus  Mexicanus  l  (deer—  Mexican)  ...............  1-5,  175 

'The  only  animal  in  which  the      riety  of  shapes  in  the  same  individ- 
red  blood  corpuscles  present  a  va-      ual.—  GULLIVER. 


LEUCOCYTES.  827 

RODENTIA    (RODENTS). 

43.  Hydrochcerus  capybara  (capybara) 1-3, 190 

44.  Castor  fiber  (beaver) 1-3,325 

45.  Sciurus  cinereus  (squirrel) 1-4, 000 

46.  Mus  messorius  (harvest  mouse) 1-4,268 

IX.  EDENTATA. 

47.  Myrmecophaba  jubata  (ant-eater) 1-2, 769 

48.  Bradypus  didactylus  (sloth) 1-2,865 

49.  Dasypus  villa  (armadillo) 1-3,315 

X.  MARSUPIALIA. 

50.  Phascolomys  (wombat) 1-3, 456 

51.  Hypsiprymnus  setosus  (kangaroo  rat) 1-4,000 

XI.  MONOTREMATA. 

52.  Echidna  histrix  (echidna) 1-3,840 

B.— VERTEBRATA  PYREN^MATA. 

XII.  AVES  (BIRDS).  L.D.  SH.D. 

1.  Struthio  camelus  (ostrich) 1-1,649  1-3,000 

2.  The  same  made  round  and  deprived  of  color  by  water. 

3.  Vanga  destructor  (East  India  shrike) 1-2,019  1-3,892 

4.  Lanius  excubitor  (great  gray  shrike) 1-1, 989  1-5, 325 

5.  Bubo  virginianus  (horned  owl) 1-1, 837  1-4, 000 

6.  Syrnea  nyctea  (snowy  owl) 1-1, 555  1-4, 042 

7.  Columba  rufina  (rufous  pigeon) 1-2, 314  1-3, 329 

8.  Columba  migratoria  (wild  pigeon) 1-1,909  1-4,626 

9.  Dolichonyx  oryzivorus  (rice  bird) 1-2,400  1-4, 167 

10.  Buceros  rhinoceros  (rhinoceros  hornbill) 1-1, 690  1-3, 230 

11.  Psittacus  augustus  (August  amazon) 1-2, 085  1-3, 606 

12.  Phasianus  superbus  (barrel- tailed  pheasant) 1-2, 128  1-3,587 

13.  Pelecanus  onocrotalus  (white  pelican) 1- 1, 777  1-3, 369 

14.  Trochilus  sp.  (humming  bird) 1-2, 560  1-4, 000 

Figs.  XII. ,  XIV.,  XVI. ,  XVIL,  and  XVIII.  represent  red 
blood  corpuscles  of  Reptilia  and  Batrachia;  while  under  Fig. 
XIX.,  those  of  the  fishes  are  given. 


LEUCOCYTES. 

The  leucocytes  of  vertebrates  are  very  characteristic  blood 
cells,  and  if  their  minute  structure  could  be  demonstrated  from 
blood-stains  the  information  thus  acquired  might  serve  to  dis- 
tinguish the  origin  of  the  blood.  It  is  frequently  possible  to 
identify  in  blood-stains  leucocytes  which  are  indistinguishable 
from  human  white  cells,  but  the  mononuclear  basophile  cells  are 
nearly  identical  in  appearance  in  many  vertebrates,  while  the 


828  BLOOD  AND   OTHER  STAINS— EWING. 

nentrophile  aiid  eosinophile  cells  of  man  and  lower  animals  are 
nearly  alike  in  structure  and  can  seldom  be  demonstrated  with 
such  distinctness  of  detail  as  to  warrant  any  certain  statement 
regarding  their  origin.  A  partial  exception  to  the  general  rule 
is  found  in  cases  where  blood  is  mingled  with  pus  in  which  it  is 
frequently  possible  to  demonstrate  a  large  number  of  polynu- 
clear  neutrophile  leucocytes  with  such  distinctness  as  to  leave 
little  doubt  that  the  cells  are  of  human  origin.  It  would  hardly 
be  wise,  however,  to  pass  a  positive  opinion  on  such  evidence. 

MISCELLANEOUS     MICROSCOPICAL     OBJECTS     IN     BLOOD- 
STAINS. 

Besides  the  presence  of  blood  cells  one  should  carefully  note 
in  the  microscopical  examination  of  stains  the  presence  of  all  ob- 
jects of  whatever  nature  which  are  foreign  to  blood.  It  is  often 
of  great  importance  as  indicating  the  origin  and  history  of  the 
stain  to  detect  in  it  epithelial  cells,  fat  cells,  muscle  fibres,  frag- 
ments of  bone,  hairs,  mucus,  fecal  detritus,  vegetable  cells  or 
fibres,  and  threads  of  cotton,  wool,  or  hemp,  and  even  minute 
bits  of  wood  or  earth. 

TECHNIC   OF   MICROSCOPICAL   EXAMINATION. 
FRESH  BLOOD. 

When  dealing  with  fresh  blood  or  blood  contained  in  isotonic 
fluids  it  is  only  necessary  to  place  a  suitable  drop  of  the  fluid  on 
a  clean  glass  slide  and  cover  it  with  a  cover-glass.  A  more  per- 
manent preparation  may  be  secured  by  sealing  the  cover-glass 
by  cement  or  vaselin.  The  drop  should  be  of  small  dimensions 
so  that  the  cells  are  separated  from  the  rouleaux  and  lie  flat  and 
isolated. 

Fresh  blood  is  more  satisfactorily  studied  in  dry-stained 
preparations.  The  glass  slides  should  be  thoroughly  washed 
with  soap  and  water  and  dried.  Passing  them  through  the  free 
flame  facilitates  the  even  spreading  of  the  cells.  To  spread  the 
blood,  the  edge  of  one  slide  should  be  touched  to  the  blood  drop, 
then  applied  to  the  surface  of  a  second  slide,  and  after  the  blood 
has  flowed  to  the  edge  of  the  slide  it  is  slowly  drawn  over  the 
surface  of  this  receiving  slide.  The  depth  of  the  layer,  which 
should  be  thin,  may  be  controlled  by  the  pressure.  The  specimen 


DRY  BLOOD.  829 

should  be  then  dried  in  the  air,  and  afterward  fixed  in  strong 
alcohol  for  15  to  20  minutes,  or  by  dry  heat  120°  C.  for  10  min- 
utes. 

STAINING 

may  be  accomplished  by  any  of  the  methods  employed  in  clinical 
work,  of  which  eosin  and  methyleue  blue,  and  Ehrlich's  triacid 
solution,  are  most  frequently  used. 

EOSIN  AND  METHYLENE  BLUE. 

Flood  the  slide  for  one  minute  with  .1-per-cent  watery  solu- 
tion of  water-soluble  eosin,  wash  in  water,  and  flood  again  with 
1-per-cent  watery  solution  of  Ehrlich's  rectified  inethlyene 
blue.  This  method  is  superior  to  all  others  for  most  purposes, 
and  may  be  recommended  for  medico-legal  work,  but  it  does 
not  demonstrate  the  neutrophile  granules  of  leucocytes. 

EHRLICH'S  TRIACID  SOLUTION. 

This  method  requires  that  the  specimen,  fixed  by  heat,  be 
flooded  with  the  solution  for  one  minute  and  then  washed  in 
water.  Its  sole  advantage  is  the  clear  demonstration  of  neutro- 
phile granules  in  leucocytes. 

In  dry -stained  preparations  some  distortion  of  many  cells 
commonly  occurs,  but  such  artificial  changes  are  recognizable 
under  the  microscope.  There  is  a  distinct  uniform  increase  in 
the  diameter  of  those  cells  which  are  very  thinly  spread,  and  if 
possible  only  such  cells  should  be  selected  for  measurement  as 
show  perfectly  rounded  forms  and  light  staining  centres. 

DRY   BLOOD. 

It  is  usually  a  very  difficult  undertaking  satisfactorily  to  re- 
store red  cells  from  a  dry  clot,  which  fact  accounts  for  the  great 
variety  of  expedients  suggested  for  the  purpose.  One  should 
select  from  the  spot  a  portion  which  gives  evidence  of  most  rapid 
drying,  usually  from  the  edge,  and  by  means  of  a  clean  knife 
blade  transfer  some  of  the  powdered  or  scaly  substance  to  a  clean 
glass  slide.  To  this  should  be  added  one  or  two  drops  of  some 
fluid  which  will  isolate  the  coherent  cells  and  tend  to  restore 


830  BLOOD  AND   OTHER  STAINS— EWING. 

their  original  form,  and  the  specimen  covered  with  a  cover  - 


The  following  chief  menstrua '  have  been  recommended: 

Virchoic's  Fluid :  Caustic  potash,  30  to  33  per  cent  in  water. 

Puppe's  Fluid :  Equal  parts  of  caustic  potash,  32  per  cent, 
and  formalin. 

Rouwn>8  Fluid :  Glycerin,  3  parts ;  sulphuric  acid,  1  part ; 
water  enough  to  yield  a  fluid  of  s.g.  1028. 

Eanvier's  Iodized  Fluid :  Potassium  iodide,  2  gms. ;  water,  100 
gms. ;  iodine  sufficient  to  saturate  the  solution. 

ViberVs  Fluid:  Corrosive  sublim.,  5  gms. ;  common  salt,  2 
gins. ;  water,  100  gms. 

Puccini*  8  Fluid :  Corrosive  sublimate,  1  gm. ;  common  salt,  2 
gms. ;  glycerin,  100  gins. ;  water,  300  gms. 

Mutter's  Fluid:  Bichromate  of  potash,  2  parts;  sulphate  of 
sodium,  1  part ;  water,  100  parts. 

Potaiii's  Fluid:  Equal  parts  of  solution  of  gum  arable,  sul- 
phate of  sodium,  and  common  salt,  each  solution  of  s.g.  1020. 

Richardson  employed  a  .75-per-ceut  solution  of  common  salt. 

Welcker  used  a  solution  of  glycerin  in  water,  1  part  to  7,  or 
a  mixture  of  common  salt,  4  parts;  egg  albumen,  300  parts; 
water,  2,700  parts. 

Wood  frequently  employed  with  very  satisfactory  results  a 
solution  of  acetate  of  potash,  s.g.  1030. 

Wormley  recommended  distilled  water  in  quantities  not  to 
exceed  the  original  quantity  in  the  blood  mass ;  or  a  solution  of 
glycerin,  s.g.  1030,  which  does  not  evaporate  as  readily  as  water. 
With  very  old  stains  he  recommended  the  addition  of  a  little 
caustic  potash  to  the  water  or  dilute  glycerin. 

It  will  be  seen  that  these  fluids  are  strongly  alkaline,  neutral, 
or  acid  in  reaction;  some  are  of  high  gravity  and  some  of  low; 
some  evaporate  readily  and  some  do  not.  Most  of  them  are 
active  laking  agents  for  recently  dried  red  cells,  but  prolonged 
drying  renders  red  cells  very  resistant  even  to  the  action  of  dis- 
tilled water. 

The  object  to  be  secured  is  the  isolation  of  coherent  red  cells 
without  their  destruction,  and  it  has  been  found  that  the  strongly 
alkaline  fluids  accomplish  this  result  more  rapidly  than  the 

1  For  a  full  list  of  these  formulas,  see  Formad,  Jour,  of  Comp.  Med  and 
Surg.,  1888,  vol.  ix.,  p.  289. 


DRY  BLOOD.  831 

others  and  do  not  lake  dry  red  cells.  Since  the  process  requires 
considerable  time,  there  is  an  advantage  in  adding  glycerin  to  the 
alkali  to  prevent  evaporation,  but  glycerin  extracts  water  from 
red  cells.  As  a  routine  fluid  the  writer  prefers  Virchow's  fluid 
with  formalin  (Puppe)  or  the  strong  solution  of  acetate  of  pot- 
ash, s.g.  1030,  recommended  by  Wood,  evaporation  being  pre- 
vented by  sealing  the  specimen  with  vaselin.  The  older  the 
stain  the  longer  is  the  time  required  for  the  isolation  of  the  red 
cells. 

Fresh  stains  may  yield  isolated  cells  immediately,  but  older 
stains  require  maceration  for  some  hours  or  even  days,  and  the 
process  may  then  be  facilitated  by  placing  the  sealed  specimens 
in  the  thermostat  at  37°  C.  The  strong  alkaline  solutions  are 
apt  to  dissolve  the  red  cells  when  prolonged  maceration  is  re- 
quired, and  in  dealing  with  very  old  stains  common  salt  solution 
is  probably  the  best  fluid  to  use.  Old  blood  and  tissue  cells  are 
often  dissociated  satisfactorily  by  comminution  in  .6-per-cent 
salt  solution  and  placing  the  specimen  under  a  sealed  cover-glass 
in  the  thermostat,  when  the  growth  of  bacteria  seems  to  be  the 
essential  influence  in  separating  the  cells. 

Bichter  finds  that  the  cells  of  old  blood-stains  are  best  isolated 
by  a  mixture  of  pepsin  and  glycerin  (Griibler's  pepsin-glycerin) 
which  digests  the  fibrin  network.  The  swelling  produced  by 
this  method  Daubler  counteracts  by  successive  additions  of  1 -per- 
cent formalin  to  the  specimen. 

The  process  of  maceration  should  be  followed  under  the 
microscope  from  time  to  time,  and  when  a  number  of  isolated 
cells  are  found  they  should  be  measured  at  once.  When  it  is 
desired  to  identify  other  cells  and  detritus  with  which  the  blood 
may  be  mixed  the  cover-glass  may  be  slipped  off  and  the  speci- 
men dried  and  stained  in  the  usual  way. 

A  failure  to  obtain  satisfactory  specimens  of  restored  red 
cells  is  usually  referable  to  changes  which  have  taken  place  in 
the  red  cells  during  or  after  drying,  and  which  have  resulted  in 
the  destruction  or  extreme  distortion  of  the  cells.  Blood  which 
has  fallen  on  a  non -absorbent  surface,  as  glass,  wood,  leather,  or 
paper,  and  has  escaped  the  subsequent  action  of  moisture,  will 
usually  give  an  abundance  of  red  cells  suitable  for  measurement. 
Stains  on  dry  iron  surfaces  also  commonly  contain  well-preserved 
red  cells,  but  progressive  rusting  often  destroys  the  cells  and 


832  BLOOD   AND   OTHER  STAINS — EWING. 

alters  the  haemoglobin.  Cells  from  stains  on  cloth  are  usually 
much  distorted  and  difficult  of  restoration  unless  the  blood  is 
obtained  from  a  portion  of  clot  which  has  not  penetrated  the 
cloth  and  become  intimately  adherent  to  the  fibres.  When  blood 
penetrates  cotton  or  linen  cloth  in  small  amounts,  microscopical 
examination  usually  shows  that  the  red  cells  are  very  closely 
adherent  to  the  smallest  fibres,  which  are  coated  by  a  layer  of 
homogeneous  red-cell  detritus  or  badly  distorted  red  cells  which 
cannot  be  restored.  Greasy  or  starched  cloths,  wool,  felt,  and 
hair  do  not  absorb  blood  so  readily,  and  stains  on  such  material 
may  be  expected  to  yield  some  perfect  red  cells. 

APPEAKANCE  OF  CELLS  IN  WASHED  STAINS. 

The  prolonged  access  of  moisture  causes  dried  red  cells  to 
fuse  together  to  some  extent  and  prevents  their  satisfactory  res- 
toration. Further  access  of  water,  as  in  washing,  may  com- 
pletely remove  all  traces  of  formed  cells  and  leave  a  very  little 
red-cell  detritus  on  cloth  fibres  to  which  the  blood  was  adherent, 
and  yielding  in  the  gross  the  characteristic  diffuse  reddish  or 
brownish  discoloration  of  washed  stains.  Thorough  washing, 
however,  is  required  to  remove  all  traces  of  red  cells,  especially 
if  these  have  had  time  to  dry  thoroughly  before  the  washing. 
Sea  water  is  much  less  effective  than  fresh  in  removing  blood- 
stains, and  hot  soapy  water  much  more  effective. 

OBJECTS  SIMULATING  BED  CELLS. 

There  are  many  bodies  in  nature  which  closely  resemble  red 
blood  cells  and  which  in  some  notable  recorded  instances  have 
led  expert  microscopists  into  erroneous  conclusions  regarding 
the  presence  of  blood  cells  in  stains.  Animal  tissues,  and  their 
detritus  especially,  contain  a  host  of  particles  which  cannot  pos- 
itively be  distinguished  from  red  cells  and  their  fragments  even 
by  the  most  experienced  pathologists  who  are  constantly  en- 
countering them.  The  biconcave  discoidal  form  must  be  re- 
quired as  an  essential  character  of  mammalian  cells  by  one  who 
would  avoid  error  in  this  field,  and  as  these  features  are  not 
always  retained  by  red  cells  one  must  ignore  many  imperfectly 
restored  cells  in  the  identification  of  blood  from  dry  stains. 

Vegetable  spores,  especially  those  of   an  alga  Porphyridium 


METHOD    OF   MEASURING   RESTORED   RED    CELLS.  833 


cruentum  which  measure  ^,7^-5  ^°  "3".TW  ^nc^  *n  diameter  and  the 
spores  of  Achorion  Schonleinii,  have  been  mistaken  for  red  cells, 
but  are  not  disk-shaped;  they  resist  the  action  of  strong  acids, 
and  they  do  not  stain  like  red  cells.  Vegetable  spores  may  de- 
velop in  some  of  the  macerating  fluids  employed,  and  are  com- 
monly found  in  blood-stains  mixed  with  earth  or  contaminated 
with  moulds.  These  and  many  other  similar  bodies  encountered 
in  the  examination  of  miscellaneous  stains  are  fully  described 
in  works  on  microscopy  (Carpenter's). 

METHOD   OF  MEASURING  RESTORED   RED   CELLS. 

The  accurate  measurement  of  red  cells  requires  the  use  of  a 
screw  micrometer  eye-piece  and  a  stage  micrometer.  The  mi- 
crometer eye-piece  contains  a  circular  glass  plate  ruled  with  fine 
lines  which  is  fastened  upon  a  movable  brass  plate  and  inserted 
through  a  slit  in  the  eye-piece  between  the  two  lenses.  The  lat- 
eral movements  of  the  brass  plate  are  controlled  by  an  accurately 
graduated  screw.  The  value  of  the  ruled  spaces  on  the  microm- 
eter depends  on  the  objective  used  and  the  tube  length  to  which 
the  eye-piece  is  adj  usted.  A  TV  immersion  lens  is  commonly 
employed,  and  a  Ramsden  eye-piece  of  about  f  inch  focal  length, 
magnification  12  diameters,  is  combined  in  the  micrometer  eye- 
piece furnished  by  Zeiss.  To  determine  the  value  of  the  ruled 
spaces  a  stage  micrometer  is  used,  which  is  a  glass  plate  ruled 
with  fine  lines,  y.f^  inch  apart,  and  moved  by  a  screw. 

When  viewed  through  a  micrometer  eye-piece,  the  lines  of 
the  stage  micrometer  include  several  lines  of  the  eye-piece  mi- 
crometer. 

If  five  of  the  lines  of  the  eye-piece  micrometer  are  included 
in  one  division  of  the  stage  micrometer  each  division  of  the  eye- 
piece micrometer  measures  -g-J-jnr  inch.  If  one  division  of  the 
stage  micrometer  does  not  cover  any  full  number  of  spaces  on 
the  eye-piece  micrometer,  the  tube  length  may  be  increased  until 
such  a  result  is  reached.  As  a  rule  it  is  desirable  to  adjust  the 
instrument  so  that  ten  or  twenty  divisions  of  the  micrometer  eye- 
piece are  exactly  included  in  a  single  division  (y^^  inch)  of  the 
stage  micrometer,  when  it  becomes  possible  accurately  to  meas- 
ure in  units  of  TTr,fjnr  or  2^0^^  inch,  or  even  less.  If  now  a  red 
cell  is  brought  into  the  field  its  size  can  be  read  off  by  bringing 
III.—  53 


834  BLOOD  AND  OTHER  STAINS — EWING. 

one  edge  of  the  cell  in  juxtaposition  with  one  line  of  the  eye- 
piece micrometer  and  counting  the  number  of  divisions  covered 
by  the  diameter  of  the  cell.  If  this  number  proves  to  be  6  with 
a  microinetry  of  ^^  the  dimensions  of  the  cell  is  ^.forr  or  7>^ 
inch.  The  accuracy  of  this  work  depends  on  the  reliability  of 
the  micrometer  and  the  definition  furnished  by  the  lens.  As  it 
has  not  been  found  possible  to  construct  micrometer  scales  with 
perfect  accuracy,  a  new  instrument  must  be  carefully  tested  to 
determine  if  the  T)1JVo--incn  dimensions  are  of  equal  value,  and 
a  new  micrometer  should  be  compared  with  an  old  one  which  is 
known  to  be  accurate. 

Some  observers  have  endeavored  to  secure  greater  accuracy 
in  measurements  by  using  very  high  power  lenses.  Eichardsou 
secured  a  magnification  of  3,700  diameters  with  a  TVincn  im- 
rnersioii  objective.  There  is,  however,  a  progressive  loss  of 
definition  with  lenses  of  very  high  power,  and  it  is  generally 
doubted  if  that  source  of  error  is  more  than  balanced  by  the  high 
magnification,  so  that  most  authorities  prefer  a  -fa  immersion 
lens. 

High-power  photography  has  been  found  valuable  by  many 
observers  in  permitting  the  measurement  of  red  cells  under  more 
stable  conditions  than  can  usually  be  obtained  by  direct  exami- 
nation under  the  microscope. 

Photographs  of  animal  red  cells  magnified  2,500  or  5,000 
diameters  are  permanent  exhibits,  showing  very  striking  differ- 
ences in  size,  but  it  is  doubtful  if  measurements  of  these  photo- 
graphs by  an  expert  in  micro-photography  are  as  reliable  as 
measurements  of  red  cells  by  an  equally  expert  microscopist. 

CONCLUSIONS    WARRANTED    BY    MICROSCOPICAL    EXAM- 
INATION  OF  BLOOD   CELLS. 

It  is  obvious  that  the  microscopical  examination  will  in  the 
great  majority  of  instances  warrant  a  positive  opinion  that  a 
stain  does  or  does  not  contain  blood,  and  will  determine  whether 
the  blood  is  from  a  mammal  or  from  an  oviparous  animal.  The 
further  claim  that  careful  average  measurements  of  restored  red 
cells  may  in  favorable  cases  warrant  a  positive  opinion  that  the 
cells  are  human  has  not  been  indorsed  by  the  majority  of  con- 
servative authorities.  A  review  of  the  opinions  expressed  by 


BLOOD   CELLS. 


835 


B 


C  D 

FIG.  31.— PhotoRraphs  of  Blood  Cells.    X  2,500.    After  Wood.  A,  Human ;  B,  dopr ;  C,  ox ;  A  sheep. 


836  BLOOD    AND   OTHER  STAINS— EWING. 

competent  authorities  reveals  three  forms  in  which  it  is  claimed 
opinions  from  measurements  of  red  cells  may  be  given. 

Masson,1  of  the  French  army,  and  Eeyburn,2  of  the  American 
Microscopical  Society,  claimed  that  under  favorable  conditions 
human  blood  cells  can  be  distinguished  from  those  of  any  domes- 
tic animal,  except  the  rabbit  and  guinea-pig. 

Massoii  states:  "Our  experience  has  demonstrated  that  with 
reference  to  human  blood  the  diagnosis  from  the  blood  of  the 
pig,  ox,  and  cat  is  easy,  from  that  of  the  dog  is  difficult,  from 
that  of  the  rabbit  uncertain,  and  from  that  of  the  guinea-pig  im- 
possible. As  a  matter  of  fact,  in  examining  preparations  of 
dried  blood  of  unknown  origin  we  have  always  obtained  such 
figures  that  we  have  been  able  to  decide  with  certainty  (between 
human  and  dog  cells)." 

Eeyburn  states:  "If  the  average  diameter  of  the  blood  cor- 
puscles in  any  specimen  of  blood  containing  at  least  100  or,  bet- 
ter, 500  corpuscles  is  less  than  ¥>  oVrr  incn  i*  cannot  possibly  be 
human  blood. 

"If  the  blood  corpuscles  have  an  average  diameter  of  from 
xuW  to  7,Ttnr  inch  then  it  *s  human  blood,  excluding  the  blood  of 
the  beaver,  guinea-pig,  kangaroo,  monkey,  musk-rat,  porcupine, 
seal,  and  wolf.  None  of  these  are  domestic  animals,  and  stains 
produced  by  their  blood  can  scarcely  ever  be  met  with  under 
such  circumstances  as  to  be  confounded  with  stains  of  human 
blood.  Blood  corpuscles  from  the  dog,  rabbit,  ox,  pig,  horse, 
sheep,  and  goat  can,  by  the  use  of  high  magnifying  power  and 
the  careful  counting  of  100  to  500  corpuscles,  be  differentiated 
from  human  corpuscles,  both  in  recently  shed  blood  and  in  dry 
blood-stains." 

Most  experienced  workers  are  slightly  more  reserved  in  their 
conclusions.  Wormley,3  Formad, 4  Wood,5  Eeese,6  and  others 
state  that  human  blood  can  be  positively  distinguished  from  that 
of  some  domesticated  animals,  but  not  from  that  of  several  others. 
The  domestic  animals  whose  cells  are  less  than  1,-^-$  inch  are  the 
beef,  horse,  sheep,  goat,  pig,  and  cat,  while  those  the  diameter 

1  Masson,  Annal.  d'Hygiene  Publ.,  4  Formad,    Jour,    of   Comp.    Med. 
1885,  xiii,  385.  and  Surg.,  1888,  p.  284. 

2  Reyburn,      The       Medico-Legal  6  Wood,  This  Work.   1st  ed.,  vol. 
Journal,  1892,  p.  167.  ii.,  p.  68. 

'Worrnley.     "  Microchemistry     of          "Reese,    Taylor,    "Med.    Juris.," 
Poisons,"  1885,  p.  736.  8th  Amer.  ed. 


MICROSCOPICAL  EXAMINATION  OP  BLOOD   CELLS.         837 


of  whose  cells  is  more  than  f,^^  inch  are  the  dog,  rabbit,  guinea- 
pig,  monkey,  and  certain  rodents.  If  the  average  diameter  of 
the  cells  in  the  stain  is  distinctly  greater  than  ^,^7  inch,  the 
above  observers  claim  that  the  blood  cannot  be  from  one  of  the 
domestic  animals  whose  cells  measure  less  than  T>15Vu-  inch,  and, 
other  features  being  consistent,  must  be  human  blood  or  that  of 
the  dog,  rabbit,  guinea-pig,  monkey,  or  some  rodent. 

More  explicitly,  if  the  diameters  prove  to  fall  between  ^gVrr 
and  ^,tW  illcn  (Wood)  or  more  than  ^Vir  (Formad),  the  evi- 
dence in  favor  of  human  blood  is  as  certain  as  such  evidence  can 
be  ;  the  blood  must  be  human  or  from  one  of  the  above-named 
animals,  but  the  expert  is  justified  in  claiming  only  that  the 
characters  of  the  blood  are  consistent  with  an  origin  from  man, 
and  in  no  case  can  he  positively  affirm  that  a  given  specimen  is 
human  blood. 

Eichardson,1  who  first  employed  very  high  power  lenses  in  the 
identification  of  blood  cells,  concluded  that  this  method  enables 
us,  under  favorable  conditions,  positively  to  distinguish  stains 
produced  by  human  blood  from  those  caused  by  the  blood  of  the 
pig,  beef,  red  deer,  cat,  horse,  sheep,  and  goat,  but  not  those 
from  animals  whose  cells  are  less  than  j^Vs-  inch  in  diameter. 

Finally,  another  group  of  observers  practically  claim  that 
micrometry  is  of  comparatively  little  value  in  the  positive  de- 
termination of  the  origin  of  blood  cells,  and  that  its  results  only 
justify  the  claim  that  the  specimen  is  mammalian  or  non-mam- 
malian. 

They  point  out  the  sources  of  technical  error  in  micrometry, 
the  difficulty  of  fully  restoring  dried  cells,  and  especially  the 
variations  in  the  size  of  red  cells  in  different  individuals  of  the 
same  animal  species. 

Ewell  2  ruled  a  glass  slide  with  15  lines  spaced  -^  to  y^-j  inch 
apart  and  had  them  measured  by  five  competent  microscopists 
who  took  the  average  of  5  measurements  of  each  space,  using 
standard  micrometers  of  the  same  maker.  The  measurements  of 
the  same  space  varied  from  0  to  7,7^  inch,  which  is  a  greater 
difference  than  that  between  the  average  diameters  of  red  cells 
in  man  and  most  domestic  animals. 

Wormley,   however,   found  that  the  measurements  of    the 

1  Richardson,  Monthly  Microscop-          "  Ewell,  The  Medicolegal  Journal, 
ical  Jour.,  London,  vol.  xiii.,  p.  215.       '892,  p.  175. 


838 


BLOOD   AND  OTHER  STAINS — EWING. 


divisions  of  a  stage  micrometer  by  three  observers  did 
not  vary  beyond  -zinr.Vinr  inch,  and  of  7  human  red  blood  cells,  by 
two  observers,  not  more  than  -^^Voir  inch.  These  and  the  general 
results  of  various  observers  who  have  measured  the  cells  of  the 
same  animals  do  not  support  the  contention  that  the  average 
technical  error  in  micrometry  of  red  cells  is  a  serious  matter. 

The  difficulty  of  restoring  dried  red  cells  with  certainty  to 
their  original  diameters  is  a  more  important  consideration. 

That  the  changes  referable  to  drying  and  subsequent  restora- 
tion are  not  sufficient  seriously  to  alter  the  diameter  of  the  cells 
is  indicated  by  the  following  tables  of  results  obtained  by  Worm- 
ley  and  by  Formad : 

TABLE  OF  PROFESSOR  THEO.  G.  WORMLEY'S  MEASUREMENTS. 
EXAMINATION  OF  OLD  BLOOD  STAINS. 


Animal. 

Age  of  Stain. 

Remarks. 

Average. 

Fresh  Blood. 

(1)  Human  . 
(2)        "       . 
(3)        "       . 
(4)        "       . 
(5)  Elephant 
(0)  Dog  

2  i  in  IT 

F 

19 
13 
4 
18 
16 
32 

4M>y 

18  mo 
17 
18 

itlis  o 

ars 
ths 

,1. 

Stain,  unknown  

l-3358th  in 
l-3236th 
l-3384th 
1  -3290th 
1  2849th 

3h. 

1  -3250th  in 

l-2738th 
1-3561  st 
1  -3653d 
l-4219th 

l-4351st 
1-61  89th 
l-6445th 

;h. 

Stain                             .... 

Stain  

Clot  

Clot 

Trace  of  stain,  unknown. 
Clot  

1  -3026th 
1  -3683d 
1  -4544th 
1  -4495th 
1  -4535th 
1-431  2th 
1  -5897th 
l-G578th 

(7)  Rabbit.... 

(8)  Ox  

Stain 

(9)    "    .... 

Stain,  unknown.  .  .       . 

(10)    "    

Clot    

(11)  Buffalo  
(12)  Goat  

Clot  

Stain  

(13)  Ibex  

Clot  

"  In  the  case  of  the  human  blood,  No.  1,  two  months  old,  the 
deposit  was  in  the  form  of  a  thin  stain  on  muslin,  and  its  nature, 
other  than  that  it  was  mammalian  blood,  was  unknown  at  the 
time  of  examination.  The  corpuscles  were  readily  found,  and 
two  series  of  thirty  corpuscles  each  were  measured.  In  the 
human  blood  two  and  a  half  months  old,  fifty  corpuscles,  ranging 
from  -gjjj  to  -x^t  of  an  inch,  were  measured. 

'  The  blood-stain  of  the  dog,  No.  6,  was  prepared  by  Dr. 
Frankenberg,  and  consisted  of  a  single  stain  so  minute  as  to  be 
barely  visible  to  the  naked  eye ;  its  nature  at  the  time  of  the  ex- 
amination was  unknown.  In  this  instance  only  fifteen  corpuscles 
were  measured. 

"  In  the  ox  blood  four  and  a  half  years  old,  the  corpuscles 
were  rather  readily  obtained,  and  two  closely  concordant  series 
of  measurements  were  made. 


MICROSCOPICAL  EXAMINATION  OF  THE   BLOOD. 


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840  BLOOD   AND  OTHER   STAINS—  EWING. 

"  In  examinations  of  this  kind  it  should  be  borne  in  mind 
that  certain  portions  of  a  deposit  may  fail  to  yield  satisfactory 
results,  while  from  other  portions  the  corpuscles  may  be  readily 
obtained.  " 

Daubler  l  found  that  the  red  cells  of  man,  dog,  rabbit,  and 
guinea-pig  diminish  in  diameter  on  drying  .288,u,  and  Kayser- 
ling  found  an  average  loss  in  diameter  of  dried  cells  of  .34,u. 
The  cells  of  the  above  animals  dried  5  to  12  days  and  treated 
for  2  to  4  hours  with  32  per  cent  KOH  were  found  to  swell 
considerably  beyond  their  original  diameters,  each  type  of 
blood  furnishing  average  diameters  of  many  cells  (30)  over 
10,M,  viz.,  human  blood  (30  cells)  10.6/«,  rabbit  blood  10  to  10.  5;/, 
and  dog  blood  10.  3/>.  Cells  restored  with  water  were  less  swollen, 
the  average  of  human  cells  being  9.  5/*,  while  the  original  average 
size  was  8.  I2fi.  The  swelling  with  caustic  potash  was  diminished 
one-half  by  adding  equal  parts  of  formalin  to  the  fluid  (Puppe's 
fluid).  These  somewhat  contradictory  results  of  Daubler's  in- 
dicate that  the  conclusions  drawn,  from  the  measurements  of 
carefully  prepared  cells  on  glass  slides  are  not  to  be  transferred 
without  great  caution  to  cells  restored  from  blood-stains,  and 
especially  that  conclusions  should  be  drawn  only  from  the 
measurements  of  large  numbers  of  cells. 

Woodward2  and  Ewell3  have  shown  that  the  average  diame- 
ter of  considerable  numbers  of  carefully  prepared  red  cells  may 
vary  between  ^-gSr  an<^  s.*W  incn  f  or  man,  and  between  ^iVr  an<i 
3/6TT7  for  tue  d°g>  an(l  Babcock  4  finds  that  if  we  accept  the  high- 
est average  of  any  observer,  the  list  of  animals  the  size  of  whose 
cells  is  very  close  to  that  of  man's  is  as  follows: 

Elephant  .........  1/2745  Gulliver  Woodchuck  .  .      .  .  1/3484  Gulliver 

Sloth  ............  1/2865  Gulliver  Hare  ............  1/3560  Gulliver 

Whale  ...........  1/3099  Gulliver  Rabbit  ...........  1/3607  Gulliver 

Opossum  .........  1/3145  Wormley  Ass  ..............  1/3620  Wormley 

Capybara  ........  1/3146  Woodward  Rat  ..............  1/3652  Wormley 

.....  1/3246  Woodward  Bear  .............  1/3656  Wormley 

.  .  1/3281  Gulliver  Mouse  ...........  1/3743  Wormley 

Muskrat  ..........  1/3281  Wormley  Mule  .............  1/3760  Wormley 

Beaver  ......  1/3325  Gulliver  Bat  ..............  1/3880  Gulliver 

Porcupine  ......  1/3369  Gulliver  Cat  ..............  1/3922  Welcker 

.  1/3382  Wormley  Raccoon  .........  1/3950  Wormley 

Kangaroo  .....  1/3410  Wormley  Squirrel  ..........  1/4000  Gulliver 

N  olf  .............  1/3432  Wormley 


r,  Vierteljahresschr.  f.  ger.  3  Ewell,     North    American    Prac- 

99,  Bd.  xviii.,  p.  258.  titioner,  1890,  pp.  97-151. 

[ward,  Amer.  Jour.  Med.  Sci.,  «  Babcock,  "  Hamilton's  System  of 

1875,  vol.  Ixix.,  p.  151.  Legal  Med.,"  1900,  vol.  i.,  p.  177. 


EXAMINATION  OP  THE  BLOOD.  841 

Nevertheless,  this  list  may  be  considerably  reduced,  as  the 
majority  of  observers  do  not  attempt  to  claim  a  probable  human 
origin  for  any  blood-stain  the  average  diameters  of  whose  cells 
are  more  than  ^.T^TT  *ncn  or  ^ess  than  -j.-yVfr- 

There  remain  for  consideration  some  other  sources  of  error. 
It  is  a  well-known  fact  that  the  cells  of  new-born  animals  are 
larger  and  show  greater  variations  than  those  of  the  adult. 
Hence,  the  cells  of  a  new-born  guinea-pig,  rabbit,  or  puppy  dog 
approach  the  human  red  cell  more  closely  than  do  those  of  the 
adult  animal.  Woodward  has  shown  that  by  picking  out  groups 
of  large  cells  among  those  of  the  puppy  he  could  secure  averages 
of  considerable  numbers  quite  within  the  limits  of  human  red 
cells,  but  not  if  the  cells  were  taken  without  discrimination  (cf. 
White ').  This  same  source  of  error  doubtless  exists  in  the  case 
of  the  young  monkey,  guinea-pig,  rabbit,  opossum,  etc. 

The  relatively  greater  diameter  of  the  red  cells  of  the  human 
infant  would  tend  to  lessen  the  danger  of  confusing  them  with 
the  cells  of  domestic  animals.  Tread  well's2  examination  of  the 
blood  of  three  infants  at  birth  showed  greater  variations  in  the 
size  of  the  red  cells  (10. 1-4.2,*)  than  in  adults  (9.3-5.7,*),  but 
the  averages  of  200,  or  even  of  50  cells,  were  no  greater  than 
those  of  the  adult.  Ewell  obtained  an  average  from  200  cells  of 
a  male  infant  36  hours  old  of  8.86^,  variations  between  11.39 
and  5.7//,  or  in  groups  of  100  cells,  averages  between  9.06  and 
8.65.*.  v 

In  pernicious  anaemia  the  human  red  cells  are  often  of  consid- 
erably increased  diameter,  and  in  chlorosis  and  many  forms  of 
secondary  anaemia  they  may  be  moderately  diminished  in  size. 
Yet  while  these  changes  might  lead  one  to  mistake  human  blood 
for  the  smaller  cells  of  domestic  animals,  the  occurrence  of  simi- 
lar alterations  in  the  blood  of  domestic  animals  must  be  exces- 
sively rare.  Other  possible  disturbing  factors  are  the  diminished 
size  of  red  cells  in  all  animals  in  high  altitudes,  the  effects  upon 
the  restoration  of  red  cells  of  variations  in  temperature,  moist- 
ure, and  barometric  pressure  of  the  atmosphere,  and  in  the  age, 
specific  gravity  of  the  plasma,  and  state  of  the  peripheral  cir- 
culation of  the  animal. 

'White,  "Reference  Handbook  of          » Treadwell,  see  White,  I.e.,  p.  84. 
Medical    Sciences,"  2d    ed.,  vol.  ii., 
p.  87. 


842  BLOOD  AND   OTHER  STAINS — EWING. 

At  present  there  is  no  evidence  to  show  that  any  of  these  in- 
fluences, if  present,  can  seriously  affect  the  conclusions. 

From  the  foregoing  discussion  it  is  obvious  that  micrometry 
of  red  cells,  while  incapable  of  positively  identifying  restored 
human  blood  cells  from  those  of  some  other  animals  (monkey, 
opossum,  rabbit,  guinea-pig),  may  still  render  evidence  fully  jus- 
tifying the  claim  that  the  characters  of  a  given  specimen  are 
consistent  with  a  human  origin.  In  order  to  obtain  these  results 
the  specimen  must  yield  a  considerable  number  of  well-restored 
cells,  so  that  at  least  50,  or,  better,  100,  can  be  satisfactorily 
measured.  Their  average  diameters,  if  human,  should  fall  be- 
tween 7,3^7  and  ^)TVrr  inch.  In  many  cases  where  the  history 
of  the  stain  is  uncertain  and  the  restoration  of  the  cells  less 
satisfactory,  one  should  not  attempt  to  claim  more  than  a 
mammalian  origin  for  the  blood. 

MENSTEUAL  BLOOD. 

The  gross  and  microscopical  characters  of  menstrual  blood 
vary  greatly  according  to  the  profuseness  of  the  flow,  at  various 
portions  of  the  menstrual  period,  and  with  the  presence  or  absence 
of  catarrhal  conditions  of  the  gen ito- urinary  passages.  Hence 
it  is  often  important  to  secure  the  menstrual  history  of  the  sub- 
ject supposed  to  be  connected  with  the  stain. 

The  location  of  menstrual  stains  is  often  suggestive  of  their 
origin,  while  the  gross  appearance  usually  indicates  a  mixture 
of  blood  and  viscous  material,  or  partly  dissolved  blood.  Men- 
strual stains  are  apt  to  be  repeated  at  each  menstrual  period,  and 
signs  of  imperfectly  washed  stains  may  be  found  in  the  vicinity 
of  the  one  under  examination. 

The  blood  from  a  profuse  menstrual  hemorrhage  may  not 
vary  in  any  demonstrable  respect  from  that  flowing  from  an 
incised  wound.  Usually  menstrual  blood  contains  mucus,  an 
excess  of  leucocytes,  stratified  squamous  epithelium  from  the 
vagina,  occasionally  columnar  cells  from  the  uterus,  and  vaginal 
bacteria.  When  mixed  with  mucous  secretion  or  epithelial 
detritus,  it  clots  less  rapidly  than  pure  blood.  Being  of  ten  mixed 
with  watery  fluids,  the  red  cells  are  usually  less  perfectly  pre- 
served, and  are  less  numerous  in  proportion  to  the  albumen  than 
in  most  blood-stains  (Dragendorff »). 

'Dragendorff,  Maschka,  "Gerichtl.  Med.,"  1881,  Bd.  i.,  p.  483. 


BLOOD-STAINS.  843 

The  presence  of  mucus  may  be  detected  in  the  gross  specimen 
or  in  the  process  of  softening  the  clot,  or  in  microscopical  speci- 
mens stained  by  eosin  and  methyleue  blue. 

The  leucocytes  are  usually  clumped  in  masses  and  entangled 
by  mucus,  indicating  their  presence  in  excess  over  those  found 
in  the  blood,  and  their  origin  from  a  mucous  membrane.  A 
great  excess  of  polynuclear  cells  indicates  a  catarrhal  condition 
of  the  passages.  The  squamous  epithelial  cells  from  the  vagina 
may  be  distinguished  from  those  of  the  skin  by  the  presence  of 
nuclei  stainable  by  methyleue  blue.  Unless  these  cells  are  found 
in  considerable  numbers  and  intimately  mixed  with  the  blood, 
there  can  be  no  certainty  that  they  have  not  come  from  the  anus, 
or  from  the  vagina  or  bladder  and  been  subsequently  mixed  with 
blood  cells  from  another  source,  since  underclothing  that  touches 
the  skin  or  nmco-cutaneous  junctions  commonly  contains  many 
exfoliated  epithelial  cells.  Vaginal  bacteria  are  usually  present 
in  large  numbers  in  the  blood  and  adherent  to  leucocytes  and 
epithelial  cells.  They  are  usually  cocci,  and  in  cases  of  specific 
vaginitis  typical  gouococci  may  be  demonstrated  by  Gram's 
stain. 

In  the  late  stages  of  menstruation  the  admixture  of  leuco- 
cytes, epithelial  cells,  and  mucus  is  increased,  yielding  stains 
that  are  more  readily  identified. 

LOCHIAL  STAINS  are  very  similar  to  those  from  menstrual 
blood.  Leucocytes,  epithelial  cells,  and  masses  of  fibrin  are 
sometimes  more  abundant  in  the  lochia,  while  shreds  of  decidual 
or  placenta!  tissue  are  discharged  for  several  days  after  confine- 
ment and  may  be  detected  as  specific  indications  of  pregnancy. 

It  is  to  be  doubted  whether  the  evidence  obtainable  from  the 
examination  of  a  menstrual  blood-stain  is  ever  sufficient  to 
warrant  a  positive  statement  regarding  the  particular  origin  of 
the  blood.  The  precipitin  test,  however,  may  demonstrate  that 
the  blood  is  human. 

BLOOD-STAINS     OF     NASAL,    BTTCCAL,    PULMONARY,    AND 
GASTRO-INTESTINAL   ORIGIN. 

Abundant  hemorrhage  from  the  nose  or  lungs  may  leave 
stains  which  have  no  distinctive  features.  Their  location,  how- 
ever, may  give  some  indication  of  their  origin.  Blood  from 
such  sources  is  usually  mixed  with  an  abundance  of  mucus, 


844  BLOOD  AND   OTHER  STAINS — EWING. 

which  tends  to  give  the  stain  a  peculiar  compact,  irregular 
appearance,  with  epithelial  cells  from  the  mouth  or  respiratory 
passages,  aud  with  leucocytes  and  bacteria.  Small  nasal  bleed- 
ings forcibly  expelled  usually  contain  much  mucus,  many  leuco- 
cytes, and  columnar  or  ciliated  epithelium.;  blood  expelled  from 
the  mouth  may  contain  flat  nucleated  epithelia  with  excessive 
numbers  of  bacteria;  pigmented  cells  are  characteristic  of  pul- 
monary expectoration  which  may  also  contain  tubercle  bacilli ; 
blood  from  the  stomach  may  be  mixed  with  food,  and  from  the 
bowel  with  fecal  elements. 

THE  GUAIACUM  TEST. 

The  chief  value  of  this  test  is  as  a  preliminary  step  in  the 
examination  of  a  series  of  articles  submitted  as  possible  blood- 
stains. If  the  guaiac  test  is  negative,  the  stain  is  probably  not 
blood ;  but  very  old  blood  may  not  react  satisfactorily. 

In  1863  Van  Deen l  discovered  that  minute  traces  of  blood 
pigment,  even  when  very  old,  yield  a  blue  color  when  treated 
with  tincture  of  guaiac  and  old  oil  of  turpentine  containing  un- 
stable oxygen.  Later  peroxide  of  hydrogen  was  substituted  as  a 
cleaner  and  more  accessible  oxidizing  agent  than  turpentine. 

Eeceutly  it  has  been  shown  that  the  property  of  blood  to  dis- 
sociate hydrogen  peroxide  and  turn  tincture  of  guaiac  blue  is 
referable  to  the  presence  in  the  red  cells  of  a  ferment,  oxydase, 
shared  to  some  extent  by  all  animal  tissues,  but  not  dependent  on 
the  blood  content  of  these  tissues,  residing  in  the  stroma  of  the 
red  cells  (Schonbein2)  and  probably  in  combination  with  an  iron 
albumen  (Jacoby3).  The  blue  color  is  referable  to  an  oxidation 
of  guaiacouic  acid  (Schaer  <).  The  blood  ferment  is  often  called 
peroxidase  as  it  acts  only  in  the  presence  of  oxygen  in  unstable 
form. 

According  to  Lieberman5  fresh  blood  solution  containing 
oxyluemoglobin  oxidizes  gnaiacouic  acid  and  turns  it  blue  very 
slowly,  but  if  the  blood  solution  is  mixed  with  turpentine,  which 
changes  oxyhsemoglobin  to  methoemoglobin,  the  mixture  oxidizes 

1  Van  Deen,  cit.  from  Liman,  3  Jacoby,  Ergebnisse  d.  Physiologie, 
Vierteljahrsschr.  f.  ger.  Med.,  1803,  1902,  Jahr.  L,  Bd.  i.,  Th.  I.,  p.  230. 
Bd.  xxiv.,  p.  193.  «  Schaer,  cit.  from  Jacoby. 

3  Schdnbein,  cit.  from  Jacoby.  5  Lioberman,  Pfliiger's  Archiv, 

1904,  Bd.  104,  p.  227. 


THE  GUAIACUM  TEST.  845 

guaiaconic  acid  rapidly,  i.e.,  it  gives  a  good  gnaiac  test.  When 
guaiac  solution  is  freed  from  oxgyen,  inactivated  by  heating,  he 
finds  that  it  fails  to  give  the  bine  reaction  with  solutions  of  met- 
hseinoglobin.  Hence  inethceinoglobiii  does  not  directly  oxidize 
the  guaiac,  but  merely  transfers  the  oxygen  furnished  by  the  tur- 
pentine, or  contained  in  the  guaiac,  to  the  guaiaconic  acid.  Oil 
of  turpentine  makes  the  necessary  transformation  of  oxyhremo- 
globiuto  methaemoglobin  and  furnishes  oxygen  also  to  unite  with 
the  guaiacouic  acid,  while  the  methjEnioglobin  acts  as  a  ferment. 
Colloidal  solutions  of  platinum  exert  a  similar  influence  on  tinc- 
ture of  guaiac. 

The  delicacy  of  the  test  with  fresh  blood  is  very  great, 
Limau l  demonstrating  a  reaction  in  a  1 :  6,000  solution  of  blood, 
and  Wormley 2  with  1 :  5,000  solution.  The  age  of  the  specimen 
has  important  influence  on  the  result  of  the  test.  Taylor3  ob- 
tained a  successful  reaction  from  blood-stains  on  a  towel  twenty- 
four  years  old ;  but  the  test  has  often  failed  with  much  more 
recent  stains. 

Babcock4  finds  that  stains  more  than  three  years  old  often 
fail  to  react  satisfactorily,  and  he  failed  to  obtain  any  reaction 
from  a  stain  on  cloth  and  one  on  buckskin  after  thirteen  years. 
Wormley  states  that  very  old  stains  yield  the  reaction,  and  even 
when  they  have  been  washed.  As  a  rule,  the  older  the  stain  the 
slower  is  the  blue  color  in  appearing,  and  the  loss  of  the  guaiac 
reaction  is  often  associated  with  marked  insolubility  of  the  blood 
pigment  and  failure  of  the  hflemin  test.  The  fact  that  a  ferment 
is  the  essential  agent  in  the  reaction  may  explain  many  of  the 
failures,  and  while  there  appears  to  have  been  no  systematic 
attempt  to  determine  by  experiment  the  conditions  under  which 
blood-stains  fail  to  react,  these  conditions  are  probably  those 
which  destroy  peroxidases.  Hammerl5  always  obtained  the 
guaiac  reaction  from  blood  heated  one  hour  to  100°  C.,  but 
never  after  exposure  for  an  hour  to  135°  C. 

The  reliability  of  the  test  as  an  indication  of  the  presence  of 
blood  cannot  be  regarded  as  very  great.  Taylor  made  a  large 

1  Liman,    Vierteljahrsschr.    f.    ger.  4  Babcock,  Hamilton's  "System  of 
Med.,  1893,  Bd.  xxiv.,  p.  193.  Legal  Mccl.,"  1900,  vol.  i.,  p.  160. 

2  Wormley,     "Microchemistry     of  6  Hammerl,  Vierteljahrsscnr.  f.  ger. 
Poisons,"  1885,  p.  710.  Med.,  1892,  Bd.  iv.,  p.  4. 

3  Taylor,  Guy's  Hospital  Reports, 
1XG7,  vol.  xiii.,  p.  431. 


846  BLOOD  AND   OTHER  STAINS — EWING. 

number  of  experiments  with  colored  vegetable  substances,  and 
concluded  that  no  red  coloring  matter,  animal  or  vegetable,  ex- 
cept the  red  of  blood,  produces  the  blue  coloration  of  guaiacum 
in  the  presence  of  peroxide  of  hydrogen.  Nevertheless,  the 
peroxidases  are  present  in  all  animal  tissues,  and  the  danger  of 
confusion  of  this  ferment  with  the  oxidases  which  turn  guaiac 
blue  without  the  presence  of  peroxide  of  hydrogen  has  never  been 
submitted  to  thorough  study  from  the  medico-legal  standpoint. 

Among  these  oxidizing  substances  may  be  mentioned  espe- 
cially the  ferric  salt  in  iron  rust,  and  indigo,  the  presence  of  which 
renders  the  test  inapplicable  to  the  examination  of  blood  on  rusty 
knives  and  cloths  treated  with  indigo  blue. 

A  delayed  reaction  from,  the  oxidase  of  dried  vegetable  mat- 
ter may  be  readily  mistaken  for  the  more  specific  reaction  from 
blood.  Animal  secretions  and  excreta  as  well  as  animal  tissues 
yield  the  peroxidase  reaction.  The  oxidase  reaction  is  given  by 
all  oxidizing  metallic  compounds,  and  by  most  vegetable  tissues. 
A  positive  reaction  by  the  guaiac  test,  therefore,  indicates  the 
probable  presence  of  blood  or  other  animal  tissue  or  detritus. 
Negative  results  indicate  the  probable  absence  of  these  substances 
except  when  the  material  is  very  old  or  has  been  subjected  to 
some  influence,  as  heat,  which  destroys  ferments. 

METHOD  OF  PERFORMING   THE   TEST. 

The  suspected  stain  should  be  soaked  in  water,  and  if  very 
old,  should  be  macerated.  If  the  stain  is  bulky,  a  small  fragment 
may  be  separated  and  tested,  otherwise  the  test  may  be  per- 
formed on  the  cloth  or  other  material  containing  the  stain. 

Into  a  small  flat  porcelain  dish  are  placed  a  few  drops  of 
freshly  prepared  tincture  of  guaiac  and  a  few  drops  of  water, 
producing  a  milky  emulsion.  The  watery  solution  of  the  stain 
may  suffice  to  produce  the  emulsion.  If  a  blue  color  develops 
at  once  without  the  addition  of  peroxide,  the  test  is  valueless. 
If  the  solution  remains  colorless  a  few  drops  of  peroxide  of  hy- 
drogen are  added,  when  the  blue  color  developing  promptly  in 
the  solution  or  about  the  edges  of  the  stain  indicates  the  pres- 
ence of  peroxidase  of  blood. 


PRECAUTIONS.  847 

PRECAUTIONS. 

The  tincture  of  guaiac  must  be  freshly  prepared  by  dissolving 
1  or  2  gms.  of  the  resin  in  10  c.  c.  of  alcohol.  It  should  have 
the  color  of  pale  sherry  wine. 

The  emulsion  of  guaiac  must  be  applied  to  the  stain  before 
the  peroxide  is  added.  A  blue  color  appearing  after  the  ad- 
dition of  the  guaiac  alone  shows  the  presence  of  oxidases  of  ani- 
mal, vegetable,  or  mineral  origin. 

After  the  addition  of  peroxide  the  blue  color  must  appear 
promptly,  since  a  few  hours'  exposure  to  the  air  will  suffice  to 
turn  guaiac  blue  which  has  been  dried  upon  cloth  or  paper. 

A  control  test  should  be  performed  on  an  unstained  portion 
of  the  material  containing  the  suspected  blood,  as  it  not  infre- 
quently happens  that  this  material  itself  turns  guaiac  blue. 

An  excellent  method  of  applying  the  guaiac  test  when  blood 
is  mixed  with  some  bulk  of  faeces  or  other  material  is  commonly 
employed  in  clinical  laboratories,  and  has  been  extensively  tested 
by  my  colleague,  Dr.  T.  W.  Hastings. 

Shake  up  the  material  with  ether  to  remove  fats  and  decant 
the  ether.  To  the  residue  add  2-3  c.c.  glacial  acetic  acid,  and 
shake.  Add  several  cubic  centimetres  of  ether,  shake,  and 
decant  the  ethereal  extract  containing  acid  haeniatin.  To  a  few 
cubic  centimetres  of  this  ethereal  extract  add  5-10  drops  of 
freshly  prepared  solution  of  gum  guaiac  in  95  per  cent  alcohol. 
Pour  carefully  down  the  side  of  the  tube  1-2  c.c.  of  old  turpen- 
tine. The  presence  of  blood  is  indicated  by  the  appearance,  at 
the  level  of  contact  of  the  turpentine,  of  a  blue  ring  which  later 
diffuses  through  the  upper  layers  of  the  fluid. 

The  guaiac  may  be  replaced  and  controlled  by  a  fresh  solu- 
tion of  powdered  aloin  in  70  per  cent  alcohol,  which  gives  a  red 
ring  in  five  minutes,  diffusing  through  the  upper  layers.  Or 
H.,0.,  may  be  used  instead  of  guaiac  or  aloin,  provided  it  is  fresh 
and  active. 

This  test  is  extremely  delicate,  but  a  positive  reaction  is 
given  by  the  fteces  of  subjects  on  a  meat  diet. 


848  BLOOD    AND    OTHER   STAINS  —  EWING. 

THE  H^MIN  TEST. 


This,  the  chief  chemical  test  for  blood  pigment,  depends  on 
the  formation  of  characteristic  crystals  of  a  halogen  salt  of 
hivmatin. 

HJEMIN   CRYSTALS. 

These  crystals,  known  as  Teichmaun's  crystals,  cannot  read- 
ily be  mistaken  for  any  other  object  in  nature  occurring  under 
the  same  conditions.  They  are  brownish  rhombic  prisms  vary- 
ing in  size,  form,  arrangement,  and  depth  of  color,  according  to 
the  rapidity  with  which  they  form  and  the  concentration  of  the 
blood  pigment.  Quite  different  forms  are  often  found  in  the 
same  specimen.  Their  formation  is  influenced  by  the  solubility 
of  the  blood  pigment,  by  the  heat  employed,  by  the  proportion 
of  salt  present,  aud  by  the  presence  of  albuminous  and  colloidal 
substances  in  the  mixtures.  Nevertheless,  under  all  conditions 
when  present  they  can  be  positively  identified  by  their  form  and 
color.  Crystals  of  murexide,  purpurate  of  ammonia,  are  very 
similar  in  form  to  haBiniii  crystals,  but  are  bright  red  in  color  and 
change  to  violet  on  treatment  with  caustic  potash,  which  dissolves 
hsemin.  Vibert  believes  that  the  danger  of  mistaking  crystals 
formed  from  indigo  for  Teichmaun's  crystals  is  serious,  and 
reports  that  from  the  washings  of  a  piece  of  flannel  deeply  blued 
with  indigo,  crystals  have  beeu  obtained  having  almost  exactly 
the  form  and  reddish  color  of  haeinin.  Most  observers  do  not 
regard  this  danger  as  real,  and  in  any  such  case  a  cloth  deeply 
stained  by  indigo  may  be  tested  before  applying  the  haemin  test 
to  blood  upon  it. 

The  usual  type  is  an  elongated  prism  with  pointed  ends, 
single,  crossed,  or  radiating  from  a  central  point,  an'd  deep 
reddish  -brown  in  color.  Or  they  are  larger,  broader,  with  more 
irregular  borders,  rounded  ends,  and  lighter  yellowish-brown  in 
color.  When  forming  very  slowly  they  may  be  larger,  quite 
broad,  elliptical,  with  pointed  ends,  and  light  brown  in  color. 

All  of  the  halogen  salts  of  hrematin,  chloride,  bromide,  iodide, 

produce  Teichmann's  crystals  of  typical  form.     When  hydriodic 

acid  is  used,  Stryzowski  l  states  that  the  crystals  are  larger  than 

usual.    In  general,  hsemin  crystals  vary  in  length  from  ^-^  inch 

1  Stryzowski,  Therapeut.  Monatshefte,  1902,  xvi.,  p.  459. 


MEDICAL   JURISPRUDENCE— PLATE    VIII. 


s 


•^ 

I 


FIG.  1. 


i     *  t, 

^-^rw 

S  gl^r        ^ 

1    ^&  #  ^l 


<*. 


FIG,  3.  FIG.  4. 

H^EMIN   CRYSTALS. 


EXPLANATION   OF   PLATE   VIII. 


CRYSTALS  OF  H^MATIN  CHLORIDE  (H^EMIN).       x  400. 


FIG.    1.  —  Crystals  readily  forming  while  warm  from  small  amounts  of 
blood. 

FIG.  2.  —  Crystals  formed  from  strong  concentration  of  blood. 

FIG.  3.  —  Crystals  slowly  formed  from  moderate  concentration  of  blood. 

FIG.  4.  —  Crystals  formed  over  night  from  weak  solution  of  blood. 


H^EMIN  CRYSTALS.  851 

to  f.^y^  inch.  They  are  insoluble  in  water,  ether,  or  alcohol, 
slightly  soluble  in  ammonia,  dilute  sulphuric  and  nitric  acids, 
readily  soluble  in  caustic  potash  and  strong  sulphuric  acid.  In 
polarized  light  they  show  pleochroism  (Rollett1),  and  in  a  dimly 
lighted  field  exhibit  a  star-like  refraction  of  light  (Jaurnes2). 

Very  minute  quantities  of  blood,  if  compact  and  not  dissemi- 
nated in  performing  the  test,  will  suffice  to  yield  the  crystals. 
In  very  old  stains  in  which  the  pigment  is  comparatively  insolu- 
ble it  is  more  difficult  to  obtain  crystals,  and  special  expedients 
may  be  necessary.  Yet  Clement 3  records  a  successful  hosmin  test 
with  blood-stains  on  paper  sixty  years  old. 

Blood-stains  on  rusty  knives  are  often  found  very  insoluble 
owing  to  oxidation  by  ferric  salts,  and  yield  hfemin  crystals  with 
difficulty.  Among  other  influences  rendering  difficult  a  success- 
ful hieniin  test  are  prolonged  exposure  to  sunlight,  decomposi- 
tion, heating  between  100°  and  140°  C.,  and  mixture  with  fats. 
With  decomposing  blood  very  variable  results  have  been 
reported,  some  observers  failing  to  obtain  crystals  from  blood 
decomposed  for  a  few  months  only,  while  others  succeeded  with 
specimens  that  had  decomposed  for  two  to  four  years  (cf.  Wach- 
olz4). 

Harnmerl s  found  that  blood  heated  for  one  hour  to  140°-145° 
C.  could  not  be  made  to  yield  crystals,  and  Wood '  was  unsuccess- 
ful with  blood  smears  on  glass  heated  to  120°  C.,  and  with  blood 
soaked  several  hours  in  naphtha,  or  treated  with  bromo-chloralum 
or  strong  solution  of  aluminum  chloride.  Tamassia7  found  that 
contact  with  iron  rust  begins  to  affect  the  formation  of  haemin 
crystals  within  twenty  to  thirty  days,  after  which  irregular  crys- 
tals or  crystalline  or  amorphous  masses  were  usually  obtained. 
Lewiu  and  Eosensteiu 8  obtained  negative  results  from  fresh  blood 
mixed  for  varying  periods  with  sublimate,  ferric  chloride,  plum- 
bic acetate,  silver  nitrate,  potassium  chlorate,  sulphuric  and 
nitric  acids,  and  animal  charcoal.  Wacholz,4  however,  was  suc- 

1  Rollett,   Hermann's  "Handbuch          d  Hammerl,  Vierteljahrsschr.  f.  ger. 
d.  Physiol.,"  1880,  Bd.  iy.,  Abt.  i.  Med.,  1892,  Bd.  iv.,  p.  4. 

2  Jaurnes,  cit.   by  Kolisko,   "Hoff-          6  Wood,  This  work,  1st  ed.,  vol.  ii., 
mann'd  Lehrbuch  d.  ger.  Med.,"  1903,  p.  17. 

p.  441.  7  Tamassia,    Rivista   sperimerttale, 

3  Clement,  "  Conferences  Pratiques       1890,  T.  xvi.,  p.  155. 

de  M6decine  Ldgale,"  Paris,  1880,  cit.  *  Lewin,  Rosenstein,  Virchow's 
from  Babcock.  Archiv,  Bd.  cxlii.,  p.  134. 

4  Wacholz,  Vierteljahrsschr.  f.  ger. 
Med...  1901,  Bd  xxi.,  p.  227. 


852  BLOOD   AND   OTHER   STAINS — EWING. 

cessful  with  fresh  blood  treated  seven  days  with  all  the  above 
agents  and  others,  but  failed  with  a  mixture  of  blood  and 
hydraziu. 

Richter 1  has  shown  that  in  the  majority  of  cases  failure  of  the 
hsernin  test  is  referable  to  the  formation  of  comparatively  iusol 
uble  haematin,  and  not  to  further  decomposition  products  of 
haemoglobin,  while  Lewin  and  Rosensteiu 2  concluded  that  com- 
plete failure  of  the  haemin  test  occurs  only  when  haemoglobin  has 
been  transformed  into  haematoporphyriu  or  haemochromogeu. 

METHODS    OF  PERFORMING   THE   H-3BMIN   TEST. 

The  method  to  be  employed  in  the  haemin  test  varies  in  some 
details  according  to  the  age  and  condition  of  the  specimen. 
With  dry  blood  of  recent  origin  the  simplest  method  suffices. 
A  small  portion  of  the  clot  or  the  material  containing  it  is  placed 
on  a  glass  slide  and  moistened  with  a  drop  of  .8-per-cent  solution 
of  NaCl  or  a  dilute  solution  of  iodide  of  potassium.  It  is  then 
evaporated  to  dry  ness  by  gentle  heat  which  is  not  sufficient  to 
coagulate  the  albumens  in  the  solution,  covered  with  a  small 
round  cover-glass,  and  a  drop  of  glacial  acetic  acid  is  run  under 
the  cover-glass.  The  specimen  is  then  gently  heated  till  bubbles 
of  acid  appear,  at  which  temperature  it  is  held  until  the  acid  is 
slowly  and  completely  evaporated.  By  this  procedure  the  blood 
pigment  is  dissolved  by  the  acid  and  combined  with  the  chlorine 
of  the  salt  to  form  the  hydrochloride  (Hoppe-Seyler)  or  the 
anhydride  (Nencki3)  of  haematin,  which  crystallizes  on  evapora- 
tion. 

The  dry  specimen  may  be  examined  for  crystals,  or  distilled 
water  or  dilute  glycerin  may  be  run  under  the  cover-glass,  and 
the  glass  sealed  with  cement. 

PRECAUTIONS. 

(1)  In  evaporating  the  salt  solution  the  heat  must  not  be 
sufficient  to  cause  coagulation  of  the  albumens  (140°  F.)  which 
interferes  with  the  solvent  action  of  the  acid.  Excessive  heat 
may  decompose  the  NaCl  and  drive  off  the  necessary  chlorine. 
An  excess  of  salt  is  also  to  be  avoided.  Overheating  at  any 

1  Richter,  Vierteljahrsschr.  f.  ger.          3  Nencki,    Arch.    f.    exper.    Path., 
Med.,  1900,  Bd.  xx.,  p.  22.  1886,  Bd.  xx.,  p.  325. 

2  See  note  8,  p.  851. 


PRECAUTIONS.  853 

stage  of  the  test  causes  sputtering  and  dissemination  of  the  pig- 
ment. In  dealing  with  very  small  specimens  it  is  important  to 
use  a  small  cover-glass  to  limit  the  dimensions  of  the  specimen. 

(2)  Some  observers  claim  that  crystallization   of  hsemin  is 
facilitated  by  the  use  of  acidified  alcohol,  instead  of  glacial  acetic 
acid,   while  the  use  of  alcohol  doubtless  tends  to  prevent  the 
application  of  excessive  heat.     The  alcohol  then  probably  enters 
into  the  composition  of  the  hsemiu  (Nencki).     Wacholz  recom- 
mends the  use  of  90  to  95  per  cent  alcohol  acidified  with  1  in 
10,000  sulphuric,  acetic,  or  lactic  acid. 

(3)  Most  failures  to  obtain  haemiu  crystals  are  referable  to 
insolubility  of  the  hsematin,  and  in  such  cases  Richter's  expedi- 
ent is  of  great  value.     He  prevents  the  evaporation  of  the  acid 
by  using  a  hollow  glass  slide,  and  allows  the  specimen  to  stand 
over  night,  thereby  permitting  the  gradual  solution  of  the  hfema- 
tin.     This  method  is  very  efficient  with  old  and  altered  blood- 
stains, and  may  be  successful  with  faint  washed  stains. 

(4)  When  the  blood  is  mixed  with  much  water,  urine,  or 
earth,  or  in  the  form  of  faint  washed  stains,  and  cannot  be  secured 
in  sufficiently  compact  form  to  be  treated  in  the  usual  way,  it 
may  be  concentrated  by  the  sodium- tuugstate  method,  as  recom- 
mended by  Wood. 

The  dry  blood-stain  should  be  soaked  in  dilute  solution  of 
iodide  of  potassium  or  solution  of  cyanide  of  potassium,  and  all 
the  pigment  removed  by  one  of  these  active  solvents  aided  by 
rubbing  the  specimen  with  a  glass  rod  and  finally  wringing  it  out 
of  the  fluids.  After  filtration,  to.  remove  solid  particles  the  dis- 
solved pigment  is  strongly  acidified  by  acetic  acid  and  precipi- 
tated by  the  addition  of  a  few  drops  of  saturated  solution  of 
sodium  tuugstate,  also  strongly  acidified  by  acetic  acid.  With 
considerable  quantities  of  blood  several  cubic  centimetres  of 
tungstate  solution  are  required,  and  a  bulky  precipitate  forms 
which  should  be  boiled  until  it  collects  in  heavy  flocculi  and  be- 
comes chocolate-colored. 

Minute  quantities  of  pigment  yield  very  slight  precipitate 
which  is  best  concentrated  by  standing  twenty-four  hours  or 
until  a  brownish  sediment  collects,  from  which  the  fluid  may 
be  decanted.  In  either  case  the  precipitate  should  be  well  washed 
with  water,  which  is  decanted  oif  the  larger  specimens  or  absorbed 
by  blotting  paper  from  the  minute  ones.  Finally,  the  washed 


854  BLOOD   AND   OTHER  STAINS — EWING. 

precipitate  is  transferred  to  a  glass  slide  and  tested  in"  the  usual 
way  for  haemin  crystals. 

The  spectroscopic  test  may  also  be  applied  to  the  precipitate 
slowly  dissolved  in  dilute  sodium  hydrate,  when  the  spectrum  of 
alkaline  haematin  is  obtained. 

SPECTEOSCOPIC  EXAMINATION. 

The  very  exact  nature  of  the  evidence  furnished  by  the  spec- 
tra of  blood  pigments,  and  the  applicability  of  the  method  to 
extremely  minute  quantities  of  blood  and  to  all  the  decomposi- 
tion products  of  haemoglobin,  render  the  spectroscopic  method 
extremely  valuable  in  the  medico-legal  examination  of  blood. 

The  spectra  of  blood  pigments  vary  distinctly  with  the  chem- 
ical changes  which  the  pigment  may  undergo. 

OXYHJEMOGLOBIN. 

Fresh  blood  usually  contains  haemoglobin  in  molecular  com- 
bination with  oxygen,  oxyhcemoglobin,  which  contains,  at  room 
temperature  and  15  mm.  Hg.  pressure,  27  c.c.  of  oxygen  per 
gm.,  but  on  drying  in  air  this  is  reduced  to  4  c.c.,  without  any 
change  in  the  spectrum  (Bohr1). 

A  dilute  solution  of  oxyhaemoglobin  shows  two  absorption 
bands  between  Fraunhofer's  lines  D  and  E. 

The  a  baud  at  D  is  narrower,  deeper,  and  sharper,  while  the 
&  baud  at  E  is  broader,  lighter,  and  more  diffuse.  These  bands 
are  still  visible  in  a  solution  1  cm.  in  thickness,  containing  .  1 
per  cent  of  oxyhaemoglobin,  but  in  weaker  dilutions  the  &  band 
at  E  begins  to  disappear.  With  increasing  concentration  both 
bauds  become  broader  and  darker  and  both  ends  of  the  spectrum 
begin  to  show  absorption,  while  with  strong  solutions  the  two 
bands  become  fused  and  all  the  light  is  absorbed  except  between 
the  lines  a  and  D  of  the  violet  and  a  small  area  to  the  right  of  E. 

HEMOGLOBIN. 

Oxyhaemoglobin  readily  loses  its  oxygen  and  darkens  in  color, 
and  is  then  called  reduced  licemoglobin  or  simply  haemoglobin.  This 
change  occurs  when  arterial  becomes  venous  blood,  and  the  oxy- 

1  Bohr,  tit.  by  Hammarsten,  "  Physiol.  Chemie,"  1899,  p.   14L 


MEDICAL  JURISPRUDENCE— PLATE  IX 


A    aS    C 


EXPLANATION  OF  PLATE  IX 

Spectra  1,  2,  3,  and  4,  Oxy-haemoglobin  of  various  degrees  of  concentration; 
Spectrum  5,  Haemoglobin ;  Spectrum  6,  CO-Haemoglobin ;  Spectra  7  and  8,  Ma-matin  in 
alkaline  solution  of  different  degrees  of  concentration;  Spectrum  9,  Heemochromogen 
(Stokes'  reduced  haematin);  Spectrum  10,  Methwinoglobin ;  Spectrum  11,  Acid  haenmtin 
(blood  treated  with  acetic  acid) ;  Spectrum  12,  Ac-id  heematin  in  ethereal  solution ;  Spec- 
trum 13,  Acid  haematoporphyrin ;  Spectrum  14,  Alkaline  hsematoporphyrin. 


HAEMOGLOBIN.  855 

gen  may  be  artificially  removed  by  a  vacuum  pump,  by  a  current 
of  indifferent  gases,  such  as  nitrogen  or  hydrogen,  or  by  addition 
of  reducing  agents,  such  as  ammonium  sulphide  or  Stokes's  re- 
agent, or  by  putrefaction.  Solutions  of  haemoglobin  readily 
absorb  oxygen  if  exposed  to  the  air  or  shaken,  and  the  lib  be- 
comes oxy-Hb.  Haemoglobin  is  readily  soluble  in  water.  When 
its  solutions  are  heated  to  70°  C.  or  treated  with  acids  or  alkalies, 
the  Hb  is  decomposed  into  an  albuminous  body  and  the  iron -hold- 
ing pigment  haematiu. 

When  dry,  heating  for  one  hour  at  120°  C.,  or  for  a  longer 
period  at  100°  C.,  transforms  most  of  the  Hb  into  haematin,  and 
the  pigment  requires  several  days  to  yield  any  solution  in  water, 
although  still  soluble  in  dilute  acids  and  alkalies. 

The  spectrum  of  haemoglobin  shows  a  fusion  of  the  two  bands 
of  oxyhaemoglobin  into  a  single  baud,  less  sharply  defined,  which 
occupies  the  space  between  D  and  E. 

The  transformation  of  the  spectrum  of  oxyhaemoglobin  into 
that  of  reduced  haemoglobin  by  addition  of  ammonium  sulphide 
or  ammonia  to  the  solution  is  commonly  employed  in  the  identi- 
fication of  blood  pigment  by  the  spectroscope. 

METH HEMOGLOBIN  is  a  compound  of  haemoglobin  with  oxygen 
more  firmly  bound  than  in  oxyhaemoglobin  and  not  readily  dis- 
sociable by  weak  reducing  agents.  The  oxygen  is,  therefore,  not 
in  simple  molecular,  but  in  chemical  union  with  the  Hb.  Methae- 
moglobiu  occurs  in  old  bloody  exudates,  in  the  urine  in  haemo- 
globinuria,  and  in  blood  and  urine  in  poisoning  by  potassium 
chlorate  and  many  coal -tar  products,  and  after  death  from  burns. 
It  is  artificially  produced  from  fresh  blood  by  the  action  of 
nascent  oxygen,  potassium  permanganate,  potassium  ferricya- 
nide,  chlorates,,  nitrates,  glycerin,  pyrogallol,  coal-tar  products, 
and  certain  acids.  It  is  found  in  old  blood -stains  exposed  to 
sunlight  and  in  long  decomposed  blood  of  acid  reaction.  Pro- 
longed action  of  most  of  these  reagents  produces  a  further  change 
into  haematin  (Menzies).  Its  acid  and  neutral  solutions  are 
brownish  in  color,  but  ammonium  sulphide  transforms  it  first 
into  oxyhaemoglobin  and  finally  into  haemoglobin,  yielding  a  red 
color. 

In  neutral  or  slightly  acid  solutions  methaemoglobin  gives  one 
absorption  band  between  C  and  D,  while  both  ends  of  the  spec- 
trum are  absorbed.  With  dilute  alkaline  solutions  two  other 


856  BLOOD  AND   OTHER  STAINS — EWING. 

faint  bands  appear,  sometimes  fused  between  D  and  E  in  the 
same  position  as  the  bands  of  oxyhaemoglobin.  With  strongly 
alkaline  solutions  the  band  between  D  and  E  disappears  while 
the  others  become  more  prominent. 

Lankester,1  Araki,2and  Menzies3  believe  that  pure  methae- 
moglobin  gives  only  two  absorption  bands,  one  at  C,  the  other 
between  b  and  F,  and  they  refer  the  others  to  admixture  with 
oxyhaemoglobin  and  haematin. 

The  various  spectra  of  methaemoglobin  may  be  demonstrated 
in  solutions  of  fresh  blood  to  which  have  been  added  a  few  drops 
of  freshly  prepared  concentrated  solution  of  potassium  ferri- 
cyanide.  The  spectrum  of  methaemoglobin  in  weak  acid  solution 
resembles  that  of  haematin  in  acid  solution,  but  addition  of  am- 
monium sulphide  has  no  effect  on  haematin  while  changing  methae- 
moglobin  to  oxyhaemglobin  or  haemoglobin. 

CARBON-MONOXIDE  HEMOGLOBIN  (CO-Hb). 

This  is  an  equimolecular  combination  of  Hb  and  CO,  but  the 
CO  forms  with  haemoglobin  a  firmer  union  than  does  oxygen,  and 
may  displace  the  oxygen  of  haemoglobin  with  the  fatal  effects 
seen  in  illuminating -gas  poisoning.  It  has  a  bright  cherry-red 
color  which  is  very  resistant  to  putrefaction,  and  may  therefore 
long  be  retained  in  the  cadaver,  or  more  permanently  preserved 
in  the  test-tube.  Its  spectrum  is  very  similar  to  that  of  oxy- 
haemoglobin, but  the  two  bands  are  slightly  displaced  toward 
the  violet  end  of  the  spectrum,  and  they  are  not  affected  by  re- 
ducing agents,  which  is  a  certain  method  of  distinction  from  oxy- 
haemoglobin. 

HAEMATIN  is  a  decomposition  product  of  haemoglobin,  occur- 
ring rarely  in  blood  extravasations,  often  in  partly  digested 
bloody  stools,  in  the  faeces  after  a  rich  meat  diet,  in  urine  after 
poisoning  by  arsenic,  and  in  many  old  and  comparatively  insol- 
uble blood-stains.  When  dry  it  is  amorphous  and  dark  brown, 
in  alkaline  solutions  it  is  reddish  if  concentrated,  greenish  if 
dilute,  and  in  acid  solutions  brown.  It  is  insoluble  in  water, 
weak  acids,  or  alcohol,  but  readily  soluble  in  dilute  alkalies, 
slowly  in  warm  acidified  alcohol,  or  cold  glacial  acetic  acid.  It 

1  Lankester,   Quarter.   Jour.   Micr.          3  Menzies,  Jour,  of  Physiol..  1895, 
Science,  1870,  vol.  x.,  p.  402.  vol.  xvii.,  p.  402, 

*  Araki,    Zeit.    f.    physiol.    Chem., 
1890,  Bd.  xiv.,  p.  405. 


H^MOCHROMOGEN   OR  REDUCED   H^EMATIN.  857 

is  therefore  best  dissolved  for  spectroscopic  examination  in 
dilute  sodium  or  ammonium  hydrate,  when  the  spectrum  of 
alkaline  haematiu  is  obtained ;  or  in  acidified  alcohol  with  the 
spectrum  of  acid  haematin. 

Acid  haematin  absorbs  both  ends  of  the  spectrum,  especially 
the  violet.  The  absorption  bauds  demonstrable  vary  with  the 
concentration  and  acidity  of  the  solution.  The  most  prominent  is 
a  sharp  baud  between  Cand  D.  Between  D  and  F  there  usually 
appears  a  broad  diffuse  band  which,  by  varying  the  dilution, 
may  be  resolved  into  two  bands,  one  dark  and  broad,  between 
B  and  F,  and  another  near  E,  faint  and  narrow.  Sometimes  a 
fourth  faint  narrow  band  may  be  detected  just  to  the  right  of 
D.  Usually  one  sees  clearly  only  the  line  between  C  and  D,  and 
a  broad  dark  area  between  D  and  F.  In  alkaline  solution,  which 
is  preferably  employed,  there  is  a  single  band  covering  line  Z> 
and  extending  nearly  to  (7. 

£L£MOCHBOMOGEN  OE  EEDUCED   HAEMATIN. 

Alkaline  solutions  of  hsematin  treated  with  ammpnium  sul- 
phide, Stokes's  reagent,  or  hydrazin  hydrate  yield  alkaline  solu- 
tions of  haemochromogen ;  or  when  haemoglobin  is  heated  to  100° 
C.  with  excess  of  strong  alkali,  haemochromogen  is  thrown  down 
as  a  violet-gray  amorphous  precipitate  which  dissolves  on  cool- 
ing. As  this  substance  gives  a  characteristic  spectrum,  its  de- 
monstration has  proved  of  value  in  the  examination  of  old  and 
impure  blood  from  which  it  is  difficult  to  procure  solutions  of 
haematin.  Its  solutions  readily  absorb  oxygen  and  become  con- 
verted into  haematin.  The  presence  of  weak  acids  in  alcoholic 
solutions  withdraws  the  Fe  of  haemochromogen  and  converts  it 
into  haematoporphyrin.  The  spectrum  presents  two  bands,  one 
the  darker  midway  between  D  and  E,  and  another  fainter  which 
includes  E  and  b. 

H.EMATOPORPHYRIN  is  an  iron-free  pigment  obtained  when 
haemoglobin  or  haematin  is  heated  with  concentrated  hydro- 
chloric acid  or  dissolved  in  concentrated  sulphuric  acid.  It  oc- 
curs in  traces  in  normal  urine,  and  in  larger  quantity  in  the 
urine  after  sulphonal  poisoning.  Treated  with  warm  fuming 
nitric  acid,  the  solution  is  first  reddish,  then  green,  blue,  and 


858  BLOOD   AND   OTHER   STAINS — EWING. 

finally  yellow.     Its  composition  probably  varies  in  different  sol- 
vents, with  corresponding  spectra. 

In  concentrated  sulphuric  or  hydrochloric  acid  there  appear 
two  absorption  bauds,  one  narrow  and  faint,  between  C  and  D, 
and  another,  dark,  broad,  and  sharply  defined,  midway  between 
D  and  E.  Dilute  alkaline  solutions  yield  four  bands:  one  be- 
tween C  and  D;  a  second,  broad  band  covering  D ;  a  third  at 
E;  and  a  fourth  broad  band  extending  from  b  nearly  to  F.  The 
bands  at  D  and  E  recall  those  of  oxyhsemoglobin. 

TRANSFORMATIONS   OF   SPECTRA. 

In  the  routine  examination  of  blood  it  is  always  desirable  to 
demonstrate  the  characteristic  changes  which  blood  pigments 
undergo  and  which  render  their 'identification  absolutely  certain. 

(1)  In  dealing  with  fresh  blood  the  spectrum  of  oxy-Hb  is 
frequently  obtained.     This  spectrum  may  be  transformed  into 
that   of   reduced  Hb  by  addition    of   ammonium   sulphide  or 
Stokes's  reagent. 

Cochineal  gives  a  red  solution  with  alum,  yielding  a  spectrum 
resembling  that  of  oxy-Hb.  On  addition  of  ammonia  the  bands 
of  cochineal  become  more  intense  and  subsequent  action  of  boric 
acid  displaces  these  bands  to  the  left  or  blue  end  of  the  spec- 
trum, while  this  treatment  has  no  effect  on  blood.  Various 
other  vegetable  dyes  yield  spectra  resembling  that  of  oxy-Hb, 
but  they  are  bleached  by  sulphite  of  sodium  or  potassium. 

(2)  Eeduced  Hb  may  be  slowly  changed  to  oxy-Hb  by  shak- 
ing the  solution  in  the  air,  but  this  change  will  not  occur  in 
solutions  containing  excess  of  ammonium  sulphide. 

(3)  If  the  original  solution  yields  the  spectrum  of  methse- 
moglobin  this  may  be  transformed  into  oxy-Hb  or  Hb  by  addi- 
tion of  ammonium  sulphide. 

(4)  Haemoglobin  may  be  changed  into  haematin  by  addition 
of  a  crystal  of  citric  acid.     This  is  a  more  permanent  change, 
and  the  subsequent  addition  ^i  ammonia  fails  completely  to  re- 
store the  bands  of  Hb,  but  if  one  adds  a  crystal  of  sulphate  of 
protoxide  of  iron  and  ammonia  and  a  drop  or  two  of  fresh  am- 
monium sulphide,  shaking  the  solution  protected  from  air,  the 
Hb  bands  will  slowly  reappear. 

(5)  When  alkaline  solutions  of  hsematin  are  obtained  from 


THE   MICRO-SPECTROSCOPE. 


859 


very  old  or  altered  stains,  ammonium  sulphide  or  Stokes's  re- 
agent transforms  the  spectrum  into  that  of  hamioehromogeu. 

(6)  When  alcoholic  solutions  of  hsematin  are  obtained  the 
addition  of  weak  mineral  acid  stransfornis  the  spectrum  of  hae- 
matin  into  that  of  the  iron-free  hfeiuatoporphyrin. 

METHOD  OF   SPECTBOSCOPIC   EXAMINATION. 

When  the  stain  is  large  enough  to  furnish  a  considerable 
quantity  of  solution,  an  ordinary  direct-vision  spectroscope  may 
be  used.  Hoffmann's  or  Vogel's  pocket  spectroscopes  are  sat- 
isfactory instruments,  and  they  are  provided  with  supports  so 
as  to  permit  the  careful  comparison  of  the  spectrum  of  the  fluid 
with  that  of  a  known  solution  of  blood.  Or  a  prism  or  mirror 
may  be  arranged  to  furnish  a  spectrum  for  comparison. 

THE  MICRO-SPECTROSCOPE. 

This  instrument  is  required  for  the  examination  of  small 
quantities  of  solution.  It  consists  of  a  spectroscopic  eye-piece 


FIGS.  33  and  33.— Abba's  Spectroscopic  Eye-Piece. 

which  is  inserted  in  the  tube  of  the  microscope,  and  of  the  two 
models  employed  there  are  advantages  in  either  the  Abbe"  or  the 
Sorby-Browning. 

The   Abbe"   instrument  consists  of  two  main  portions:  the 


860  BLOOD   AND   OTHER   STAINS — EWING. 

drum  A  which  fits  into  the  tube  of  the  microscope,  aud  the  spec- 
troscope J.  The  drum  contains  an  adjustable  slit  worked  by  the 
screws  H  and  F  which  controls  the  length  and  breadth  of  the 
ray  of  light  which  comes  to  the  eye  from  the  object.  By  means 
of  the  screws  the  spectra  are  properly  f  ocussed.  The  drum  also 
contains  a  prism  illuminated  by  a  side  mirror,  and  moved  into  or 
out  of  the  field  by  a  projecting  lever.  With  this  mirror  is  a 
clamp  to  hold  a  small  tube  of  solution  which  it  may  be  desired 
to  test  or  which  may  be  used  to  give  a  comparison  spectrum. 
The  spectroscope  J  revolves  on  the  pivot  K,  so  that  it  can  be 
brought  into  position  over  the  eye -piece  or  moved  away  to  per- 
mit focussing  the  object.  At  the  side  is  a  tube  (JV)  which  con- 
tains a  scale,  the  divisions  of  which  represent  wave-lengths,  ex- 
pressed in  one  hundred  thousandths  of  a  millimetre.  By  means 
of  the  mirror  O  the  scale  is  thrown  upon  the  spectrum  of  the  ob- 
ject, and  it  is  f  ocussed  by  the  sliding  tube  N.  It  should  be  ad- 
justed by  the  sliding  screw  P  so  that  Fraunhofer's  line  D,  the 
sodium  line,  coincides  with  the  division  line  58.9,  the  wave-length 
of  the  sodium  line  being  589  millionths  of  a  millimetre. 

PREPARATIpN   OF   SPECIMENS. 

Considerable  amounts  of  solution,  1  c.c.  or  less,  may  be  ex- 
amined by  placing  the  fluid  in  a  small  tube  or  flat-sided  cell  and 
clamping  before  the  aperture  at  the  side  of  the  drum.  Very 
minute  quantities  of  solution  or  minute  fragments  of  blood  must 
be  examined  on  a  glass  slide  from  the  stage  of  the  microscope,  in 
which  case  the  drum  prism  furnishes  a  comparison  spectrum. 
If  the  blood  is  comparatively  recent,  distilled  water  or  salt  solu- 
tion may  be  used  as  a  solvent. 

Minute  fragments  of  blood-stain  require  very  careful  handling. 
The  material  should  be  scraped  by  a  knife  upon  a  glass  slide  lying 
upon  white  paper,  and  carefully  immersed  and  dissolved  in  a  mi- 
nute drop  of  water  or  salt  solution.  Hanging-drop  slides  with  a 
shallow  concavity  may  be  employed,  as  they  secure  a  desirable 
depth  of  very  weak  solutions.  The  specimen  is  then  transferred 
to  the  stage  of  the  microscope,  and  its  point  of  deepest  color  fo- 
cussed  by  a  low-power  (  J-inch)  lens.  Sorby  '  claims  that  a  good 
spectrum  may  be  obtained  from  a  blood-stain  TL  inch  in  diameter 

1  Sorby,  Quarter.  Jour.  Science,  1865,  ii.,  205. 


PREPARATION   OP   SPECIMENS.  861 

and  weighing  not  more  than  T,TJVJ7  grain,  and  that  by  careful  man- 
ipulation a  faint  spectrum  may  be  obtained  from  a  single  blood 
corpuscle. 

From  soap-suds  from  cloths  containing  blood-stains,  haematin 
may  be  extracted  by  repeatedly  shaking  up  with  ether.  The 
decanted  ether  may  then  be  concentrated  by  evaporation.  Blood 
in  earth  is  usually  extracted  best  by  digestion  with  ammonia. 

If  the  specimen  is  old  and  altered,  the  more  active  solvents 
of  haematin  must  be  used,  as  sodium  hydrate  or  warm  acidified 
alcohol.  Old  blood  decomposed  or  dissociated  by  chemicals  or 
high  heat,  or  mixed  with  much  foreign  matter,  sometimes  requires 
the  demonstration  of1  hsernatoporphyrin,  which  may  be  accom- 
plished either  in  acid  or  alkaline  solutions.  Kratter l  recom- 
mends the  acid  solution,  and  prepares  the  specimen  on  a  glass 
slide,  adding  a  drop  of  concentrated  sulphuric  acid  and  crushing 
down  the  material  to  a  suitable  layer  by  pressure  on  the  cover- 
glass. 

Many  such  specimens,  especially  if  containing  much  animal 
or  vegetable  material,  are  dark  yellowish  in  color  and  do  not 
yield  satisfactory  spectra.  In  such  cases  Zieuike 2  recommends 
the  alkaline  haeinatoporphyrin  test  and  the  following  method: 
The  pulverized  material  is  treated  for  twenty-four  hours  with 
concentrated  sulphuric  acid,  filtered  slowly  through  asbestos  or 
glass  wool,  the  filtrate  diluted  with  several  volumes  of  distilled 
water,  and  the  pigment  precipitated  by  neutralization  with  am- 
monia. The  brownish  precipitate  is  thoroughly  washed  in  dis- 
tilled water,  dried  and  dissolved  in  a  mortar  rubbing  up  with 
equal  parts  of  absolute  alcohol  and  strong  ammonia.  The  solu- 
tion, if  too  concentrated,  must  be  diluted  until  the  bauds  in  the 
violet  end  of  the  spectrum  become  visible. 

Grigorjew3  has  had  successful  results  by  the  following 
method,  by  which  the  spectrum  of  haeniochromogen  is  secured: 
The  material  is  macerated  from  twelve  to  twenty-four  hours  in : 
Caustic  potash,  12;  sodium  potassium  tartrate,  40;  water,  100; 
and  then  for  six  hours  in  caustic  potash,  15;  sodium  potassium 
tartrate,  10 ;  water,  20.  From  this  fluid  it  is  transferred  to  a 
glass  slide,  the  opaque  particles  removed,  and  the  solution  ex- 

1  Kratter,  Vierteljahrsschr.  f.  ger.          3  Grigorjew,  ibid.,  1902,  Bd.  xxiv., 
Med.,  1892,  Bd.  iv.,  p.  62.  p.  82. 

•  Ziemke,  ibid.,  1901,  Bd.  xxii.,  p. 
231. 


862  BLOOD   AND   OTHER   STAINS— EWING. 

amined  under  a  cover-glass  for  alkaline  hsemochromogeu.  This 
procedure  obviates  the  opaque  yellowish  color  often  encountered 
in  acid  solutions  of  hsematoporphyrin. 

Ipseu 1  successfully  tested  a  large  number  of  much  altered 
or  even  charred  blood-stains  by  the  following  method:  To  a 
flask  containing  the  material  he  added  absolute  alcohol  and 
roasted  copper  sulphate,  and  also  one  or  two  drops  of  strong 
sulphuric  acid.  After  a  few  days  at  37°  C.  the  alcohol  became 
tinged  with  blood  pigment,  and  when  placed  in  long  tubes  the 
spectrum  of  acid  hsematin  was  obtained.  Later,  he  employed 
ten  per  cent  potassium  acetate  in  alcohol,  digesting  some  days 
at  38°-40°  C.,  and  secured  the  spectrum  of  alkaline  hsematin. 

THE  PBECIPITIN  SEBUM   TEST. 

Although  only  a  few  years  have  elapsed  since  the  first  appli- 
cation of  the  bio-chemical  method  to  the  medico-legal  study 
of  blood,  numerous  extensive  contributions  appearing  in  rapid 
succession  have  so  fully  established  the  value  of  this  test  and  so 
clearly  defined  its  limitations,  that  the  method  has  been  univer- 
sally endorsed  for  the  medico-legal  detection  of  the  origin  of 
blood.  Although  future  investigations  will  doubtless  extend  our 
knowledge  of  technical  details,  they  cannot  invalidate  the  prin- 
ciples on  which  the  method  is  based  and  cannot  seriously  alter 
the  conditions  under  which  its  results  may  now  be  pronounced 
specific. 

The  original  observations  on  which  the  precipitin  test  is  based 
were  those  of  Kraus,  in  1897, 2  who  obtained  albuminous  precipi- 
tates in  certain  bacterial  cultures  by  the  addition  of  homologous 
immune  sera,  and  of  Tschistovitsch,  1899, 3  who  obtained  a  pre- 
cipitate in  eel  serum  by  means  of  anti-eel  serum  from  the  rabbit. 
Very  soon  contributions  byBordet,4  Uhlenhuth,5  Wassermau  and 
Schiitze,6  Stern,7  Nuttall,8  Griinbaum,9  and  many  others  demon - 

1  Ipsen,  Vierteljahr.   f.   ger.  Med.,          6  Wasserman,    Schiitze,    Berl.     kl. 
1898,  Bd.  xv.,  p.    Ill;  ibid.,  1900,      Woch.,  1901,  p.  187. 

Bd.  xix.,  p.  1.  7  Stern,    Deutsche    med.    Woch., 

2  Kraus,  Wien.  kl.  Woch.,  1897,  p.      1901,  p.  135. 

736.  "Nuttall,    "Blood   Immunity  and 

3  Tschistovitsch,  Annales  de  1'In-      Blood     Relationship,"     Cambridge, 
stit.  Pasteur,  1899,  p.  406.  1904. 

4Bordet,  ibid.,  1898,  p.  886;  1899,          9  Griinbaum,  Lancet,  1902,  i.,  p. 
p.  225.  143. 

4  Uhlenhuth,  Deutsche  med.  Woch., 
1900,  p.  734. 


THE   PRECIPITIN   SERUM   TEST.  863 

strated  that  most,  but  not  all,  animals  develop  precipitiii  sera 
against  alien  bloods.  The  rabbit  has  been  chiefly  used  in  these 
experiments,  and  specific  anti-sera  have  been  developed  in  this 
animal  for  the  blood  of  man,  monkey,  beef,  goat,  sheep,  horse, 
dog,  guinea-pig,  hog,  and  many  ovipara  and  cold-blooded  animals, 
as  the  chicken,  alligator,  turtle,  frog,  lobster,  eel,  and  crab.  The 
writer1  found  that  the  chicken  develops  an  active  and  highly  spe- 
cific serum  for  man  and  rabbit.  In  cold-blooded  animals  Mesnil,2 
v.  Duiigern,3  and  Noguchi4  found  normal  precipitins  for  some 
alien  bloods,  but  failed  to  increase  them  by  immunization.  Pre- 
cipitins for  the  albumens  of  milk  have  been  studied  extensively 
by  Boi'det,5  Fisch,8  Wasserman  and  Schiitze,7  and  Meyer  and 
Aschoff,8  who  found  the  anti-sera  more  or  less  specific  for  these 
albumins,  but  affecting  to  some  extent  the  blood  and  tissue  albu 
mens  as  well. 

Schiitze 9  produced  precipitiu  sera  for  muscle  and  bone  which 
were  also  hsemolytic,  and  applied  them  to  the  differentiation  of 
bones,  and,  with  Jess  and  Uhlenhuth,10  in  the  detection  of  meats. 

Albuminous  exudates  from  the  pleural  or  peritoneal  cavity 
and  albuminous  urine  have  been  found  to  yield  anti-sera  affect- 
ing the  albumens  of  these  exudates  and  of  the  blood  (Mertens,11 
Zuelzer  ").  That  obtained  by  Leclainche  and  Valle'e, 13  however, 
was  inert  on  blood  albumens.  Injections  of  albumen-free  urine 
yield  haemolytic  and  agglutinating  sera,  but  no  precipitiu. 

Several  observers  have  separated  the  different  proteids  of 
blood,  exudates,  and  eggs,  and  tested  their  action  apart  from  the 
mixtures  in  which  they  naturally  occur. 

Nolf  "  obtained  precipitins  by  injections  of  plasma,  but  none 
with  the  blood  cells  of  the  chicken  and  dog.  Nolf  u  and  Biondi l5 
failed  to  secure  precipitins  from  injections  of  pure  serum  albu- 

1  Ewing,  Proc.  N.  Y.  Path.  Soc.,          •  Schutze,  Zeit.  f.  Hyg.,  Bd.  xxxvi., 
1903,  vol.  iii.,  p.  14.  p.  5;   ibid.,  Bd.  xxxviii.,  p.  437. 

2  Mesnil,   Annal.   de  1'Instit.   Pas-  I0  Jess,  Berl.  tieriirztl.  Woch.,  1901, 
.teur,  1901,  p.  1.  p.  633. 

3  v.     Dungern,  "  Die  AntikSrper,"  "  Mertens,  Deutsche  med.  Woch., 
Jena,  1903.  1901,  p.  161. 

4  Noguchi,  Univ.  of  Penna.  Bulle-  12  Zuelzer,  ibid.,  p.  219. 

tin,  1902,  vol.  xv.,  p.  295.  IJ  Leclainche,  Vall6e,  Semainem6d., 

'See  note  4,  p.  862.  1901,  p.  28. 

"  Fisch,  St.  Louis  Courier  of  Med.,          "  Nolf,  Annal.  de  1'Instit.  Pasteur, 

1900,  xxii..  p.  90.  1900,  p.  297. 

'See  note  6,  p.  862.  l5  Biondi,  Vierteljahrsschr.  f.  ger. 

'Meyer,  Aschoff,  Berl.  kl.  Woch.,  Med.,  1902,  Bd.  xxiii.,  Suppl.,  p.  1. 
1902,  p.  638. 


864:  BLOOD   AND   OTHER   STAINS — EWING. 

ineii,  but  Obermayer  and  Pick,1  Umber,  Michaelis,2  and  others 
secured  precipitius  for  both  globulins  and  albumens.  Yet  the 
globulins  have  always  proved  so  much  more  active  as  to  lead  to 
the  conclusion  that  they  are  the  chief  protein  which  causes  the 
development  of  precipitin. 

Peptones  have  so  far  failed  to  develop  precipitins,  but 
Schiitze3  and  Kowarski4  produced  non-specific  precipitins  with 
the  albumens  of  wheat. 

The  observations  of  Obermayer  and  Pick 5  indicate  that  ap- 
parently slight  alterations  produced  in  proteins  may  affect  in  a 
demonstrable  and  specific  manner  the  corresponding  anti-sera, 
and  illustrate  the  peculiar  delicacy  of  precipitius. 

They  found  that  beef  serum  heated  to  60°  to  70°  C.,  which  de- 
stroys its  reaction  to  anti-serum,  produces  in  rabbits  a  modified 
precipitin  serum  affecting  both  fresh  and  heated  beef  blood, 
while  beef  globulin  oxidized  by  potassium  permanganate  and 
thus  deprived  of  its  capacity  to  react  to  normal  anti-serum  de- 
velops in  rabbits  a  serum  which  precipitates  oxidized  globulins 
and  very  slightly  the  fresh  globulins. 

This  brief  review  of  the  scope  of  demonstrated  precipitins  is 
sufficient  to  emphasize  from  the  medico-legal  standpoint  that  the 
existence  of  a  specific  agent  precipitating  human-blood  albumens 
is  not  an  isolated  observation,  but  represents  a  comprehensive 
principle  in  biology. 

By  virtue  of  their  complex  molecular  constitution  the  various 
animal  and  vegetable  proteins  are  found  to  differ  not  merely  in 
some  of  their  grosser  chemical  reactions,  but  by  a  new  series  of 
very  delicate  properties  which  are  no  more  surprising  and  no  less 
definite  than  those  recognized  in  meats  by  the  sense  of  taste. 
Moreover,  in  Ehrlich's  conception  of  the  mode  of  origin  of  pre- 
cipitins and  other  specific  anti-bodies  we  have  a  logical  explana- 
tion of  the  phenomena  which  has  removed  much  of  the  obscurity 
surrounding  them.  For  the  full  discussion  of  Ehrlich's  views 
the  reader  may  consult  the  summaries  of  Eitchie 6  in  English  and 
Aschoff 7  in  German. 

1  Obermayer,     Pick,    Wien.     klin.  5  Obermayer,     Pick,    Wien.     klin. 

Rundschau,  1902,  p.  277.  Woch.,  1903,  p.  659. 

1  Michaelis,  Deutsche  med.  Woch.,  8  Ritchie,  Jour   of    Hygiene,  1902, 

1902,  p.  733.  vol.  ii.,  pp.  215,  251,  452. 

s  See  note  9,  page  863.  '  Aschoff,     Zeitschr.     f.     Physiol., 

4  Kowarski,  Deutsche  med.  Woch.,  Bd.  L,  1902,  p.  69. 
1901,  p.  422. 


CHANGES  IN   PRECIPITIN   SERUM.  865 

NATURE   OF  THE  PRECIPITIN  REACTION. 

It  has  already  been  shown  that  the  substances  exciting  the 
development  of  precipitins  are  chiefly  the  globulins,  the  albu- 
mens being  less  active,  while  peptones  have  so  far  failed  to  de- 
velop precipitins  and  mucins  have  not  been  separated  in  sufficient 
purity  to  permit  their  study  in  this  field.  Likewise  the  active 
agent  in  precipitin  serum  is  chiefly  or  exclusively  the  globulin. 

The  globulins  precipitated  from  the  serum  by  magnesium  or 
ammonium  sulphate  contain  most  or  all  of  the  active  agents, 
while  the  remaining  albumens  are  practically  inert  (Corin,1 
Michaelis,  Ziemke,2  Pick3). 

The  precipitated  substance  (precipitum)  is  also  a  globulin,  as 
first  shown  by  Nolf.  In  milk  Miiller 4  found  the  precipitum  to 
consist  of  casein,  but  it  also  contained  the  precipitin  itself,  which 
he  succeeded  in  isolating  in  active  form  by  strong  acetic  acid. 

The  general  properties  of  a  precipitum  are  those  of  an  alkali- 
albumen,  as  it  is  insoluble  in  water  or  alkaline  carbonates  or 
neutral  salts,  but  soluble  in  dilute  acids  or  alkalies.  The  sub- 
stance attacked  by  the  precipitin,  however,  is  not  necessarily  a 
protein,  but  may  be  merely  associated  with,  or  derived  from,  the 
proteins.  Thus,  egg  albumen  may  be  digested  with  pepsin  till  it 
no  longer  yields  the  biuret  reaction,  but  still  precipitates  with 
anti-serum  (Obermayer,  Pick).  The  precipitable  substance  may, 
therefore,  suffer  considerable  alteration  without  losing  its  affinity 
for  precipitin,  a  fact  of  importance  in  testing  decomposed  blood. 
The  precipitin  is  usually  in  much  smaller  proportion  than  the 
precipitable  substance  (Lenoissier,  Lemoine5). 

ARTIFICIAL    AND    SPONTANEOUS   CHANGES    IN    PRECIPI- 
TIN SERUM. 

All  observers  have  found  that  precipitin  serum  rather  rapidly 
deteriorates  with  age,  and  recommend  its  careful  preservation  in 
sealed  tubes  on  ice  and  in  the  dark.  Bacterial  growth  may  be 
prevented  by  the  addition  of  .5-per-ceut  carbolic  acid  or  .5-per- 
cent chloroform,  but  while  these  antiseptics  do  not  directly  alter 

1  Corin,    Vierteljahrsschr.    f.    ger.          4  Miillcr,  Miinchener  med.  Woch., 
Med.,  1902,  Bd.  xxiii.,  p.  61.  1902,  p.  272. 

•  Ziemke,    Deutsche   med.   Woch.,          5  Lenoissier,     Lemoine,      Semaine 
1901,  pp.  424,  731.  meU,  1902,  No.  13,  p.  104. 

3  Pick.  Hoffmeister's  Beitrage,  Bd. 
i.,  pp.  351,  448. 
III.— 55 


866  BLOOD   AND   OTHER  STAINS — EWING. 

the  action  of  the  serum  they  do  not  prevent  its  gradual  deterio- 
ration. Sera  may  be  safely  kept  on  ice  without  preservatives  for 
at  least  ten  days,  and  do  not  greatly  diminish  in  strength  in  three 
mouths,  after  which  they  may  become  relatively  inactive. 
Strauss  and  the  writer,  *  however,  obtained  a  pronounced  reaction 
from  a  humanized  serum  kept  with  a  trace  of  chloroform  on  ice 
for  ten  mouths.  The  precipitable  globulins  also  deteriorate  with 
equal  rapidity.  No  method  of  preservation  can  replace  the  ad- 
vantage of  working  with  fresh  serum. 

Heat  destroys  the  activity  of  precipitin  sera,  but  at  different 
degrees  for  different  sera.  Strauss  and  the  writer  destroyed  a 
beef-rabbit  precipitin  by  exposure  to  55°  C.  for  fifteen  minutes, 
and  a  human  precipitin  at  65°  C.,  but  most  observers  find  a  trace 
of  reaction  after  heating  to  60°  C.  or  70°  C.,  while  Michaelis' 
experiments  indicate  that  moderate  heating  merely  retards  the 
action  of,  but  does  not  destroy,  the  precipitin.  The  dry  globulins 
resist  heating  to  100°  C.,  but  are  completely  destroyed  at  130°  C. 

Many  salts,  as  NaCl,  ammonium  and  magnesium  sulphate, 
have  no  deleterious  action  on  precipitius  and  are  employed  in 
their  separation.  Michaelis  (I.e. )  destroyed  blood  precipitin 
by  digestion  for  one  hour  with  pepsin  and  HC1,  and  removed  the 
calcium  from  fresh  serum  by  oxalic  acid,  without  affecting  its 
activity. 

PRECIPITOIDS. 

Serum  which  has  lost  its  precipitating  capacity,  either  spon- 
taneously or  by  heat,  is  still  capable  of  uniting  with  precipitable 
substances  and  preventing  the  subsequent  action  of  fresh  serum. 
It  thus  acts  as  an  auti-precipitin.  Such  a  serum  is  said  to  con- 
tain precipitoids.  According  to  Ehrlich's  theory,  precipitoids  are 
complex  precipitin  molecules  which  have  lost  the  zymophore 
(precipitating)  groups  while  retaining  the  haptophore  groups  by 
which  they  unite  with  the  precipitable  substance. 

CHANGES   IN   THE   PRECIPITABLE   SUBSTANCE. 

It  is  of  great  importance  in  the  medico-legal  use  of  the  serum 
test  that  the  precipitable  substance  may  be  exposed  to  a  great 
variety  of  influences  without  losing  its  susceptibility  to  the  pre- 
cipitin, which  is  lost  only  when  the  albuminous  molecule  is  dis- 
1  Ewing,  Strauss,  Medical  News,  1903,  vol.  Ixxxiii.,  pp.  871,  925. 


CHANGES  IN  THE   PRECIPITABLE   SUBSTANCE.  867 

sociated  and  loses  its  receptor  for  the  precipitin.  Heat  affects 
anti-serum  and  fluid  precipitable  substance  about  equally,  the 
reaction  beginning  to  fail  after  short  exposure  above  55°  C.  Such 
heated  fluids  then  act  as  anti-precipitius  and  neutralize  fresh  pre- 
cipitin serum. 

Ferrai1  reports  partial  or  complete  loss  of  reaction  from 
blood-stains  heated  to  130°  C.  for  1  hour;  140°  for  20  minutes; 
150°  for  10  minutes ;  160°  for  5  minutes.  Biondi  (7.c.)  places 
the  limit  of  resistance  of  dry  blood  at  above  130°  C.,  finding  some 
specimens  to  react  after  exposure  to  this  temperature.  Oka- 
moto2  obtained  distinct  coagula  from  blood-stains  heated  1 
hour  at  50°  and  100°  C.,  but  negative  results  with  stains  heated 
1  hour  at  150°  C.  Obermayer  and  Pick,  by  injections  of  heated 
serum,  claim  to  have  produced  a  precipitin  serum  which  is  active 
with  heated  blood. 

Drying  seems  to  preserve  indefinitely  the  properties  of  the 
precipitable  albumens  of  blood,  but  not  without  some  loss. 
Ziemke  (I.e. )  secured  a  definite  reaction  from  an  extract  of  the 
stomach  of  a  10 -year-old  mummified  cadaver,  from  dry  stains  2, 
9,  15,  and  25  years  old,  from  5-year-old  stains  on  rusty  knives, 
from  an  8-year-old  washed  stain,  and  from  blood  1  and  3  years 
in  earth.  Yet  most  of  the  old  stains  did  not  react  strongly, 
yielding  only  turbidity  without  flocculent  precipitates,  and  one 
10  years  old  on  a  shirt  did  not  react  at  all.  Uhleuhuth 3  obtained 
turbidities  in  1  minute  with  stains  6  to  12  years  old,  but  Bioudi 
failed  with  one  20  years  old.  Graham-Smith  and  Sanger 4  ob- 
tained slight  or  marked  turbidities  in  5  to  60  minutes  with  nearly 
all  of  29  stains  3  to  30  years  old  from  the  Scotland  Yard  Museum, 
17  of  which  came  from  knives  which  had  been  smeared  with  oil 
to  prevent  rusting.  They  found  that  fluid  sera  and  egg  albumen 
9  and  14  months  old  had  lost  respectively  7  and  12  per  cent  in 
the  bulk  of  precipitiu,  while  one  specimen  of  egg  albumen  9 
months  old  had  lost  33  per  cent. 

Okamoto  (1903)  obtained  very  feeble  reactions  from  blood  on 
wood  and  limestone  dating  from  1867  and  1874,  but  abundant 
precipitate  from  a  dry  blood  clot  preserved  from  venesection  in 
1874.  Some  observers  report  good  reactions  from  decomposing 

1  Ferrai,  Bollet.  d.  r.  Accad.  di  3  Uhlenhuth,  Deutsche  raed.  Woch., 

Geneva,  1901,  an.  xvi.,  p.  272.  1901,  p.  260. 

7  Okamoto,  Vierteliahrsschr.  f.  ger.  4  Graham-Smith,  Sanger,  Jour,  of 

Med.,  1903,  Bd.  xxiii.,  p.  207.  Hygiene,  1903,  vol.  iii.,  pp.  258,  35-1 


868  BLOOD   AND   OTHER  STAINS— E WING. 

blood  and  from  mixtures  of  several  bloods,  and  Graham-Smith 
and  Sauger  found  a  decrease  of  precipitin,  20  to  30  per  cent,  in 
albuminous  fluids  in  which  various  putrefactive  bacteria  \vere 
grown  for  36  to  50  days.  The  presence  of  ammonia  in  old  or 
decomposed  blood  may  prevent  precipitation  (Okamoto). 

ACTION  OF  ACIDS. 

As  the  precipitum  is  soluble  in  dilute  acids  and  alkalies,  any 
great  variation  from  a  neutral  reaction  of  the  tested  solution 
must  be  avoided.  The  precipitum  thus  dissolved  is  reprecipi- 
tated  by  neutralization.  Graham-Smith  and  Sanger  (I.e.)  tested 
the  action,  in  .6-per-ceut  salt  solution,  of  various  acids — sul- 
phuric, nitric,  hydrochloric,  acetic,  oxalic,  tartaric,  carbolic, 
picric,  citric,  and  salicylic.  All  these  in  dilutions  up  to  1  in 
10,000  caused  turbidities  on  addition  of  test-serum,  except  car- 
bolic and  salicylic,  which  were  inert  in  dilutions  of  1  in  1,000 
or  above.  Strong  alkalies  were  less  uniform  in  action,  caustic 
potash  and  soda  causing  turbidities  up  to  1  in  1,000  dilution, 
while  sodium  carbonate  and  ammonia  were  inert  at  1  in  10  and 
above  and  were  therefore  available  for  neutralization  of  acid 
fluids.  Small  quantities  of  acid  or  alkali,  especially  of  acid, 
diminished  the  quantity  of  precipitum.  In  testing  old  blood- 
stains from  leather  they  found  the  solutions  acid  and  requiring 
neutralization  by  sodium  carbonate  before  adding  the  serum.  A 
thick  polished  yellow  leather  gave  a  highly  acid  reaction,  and 
no  method  of  neutralization  could  be  found  which  permitted  the 
application  of  the  test.  Okamoto  and  the  writer  encountered 
spontaneous  precipitates  in  solutions  of  blood-stains  on  leather. 
In  the  writer's  case  the  solutions  were  neutral,  and  after  filtra- 
tion of  the  spontaneous  precipitate  the  fluid  continued  to  precipi- 
tate various  non-specific  anti-sera  subsequently  added,  appar- 
ently from  the  presence  of  tannin. 

THE  ACTION  OF  NEUTRAL  SALTS  on  the  precipitable  sub- 
stance has  been  studied  by  several  observers  with  conflicting 
results.  A  certain  proportion  of  salt,  preferably  .6  to  .8  per 
cent,  must  be  present  to  prevent  spontaneous  precipitation  of 
albumins,  and  the  majority  of  writers  agree  that  normal  salt 
solution  is  the  best  solvent  for  dried  blood-stains.  Turbidities 
arise  on  addition  to  tested  fluids  of  sodium  and  potassium  tar- 


BLOOD -STAINS   ON  MISCELLANEOUS   MATERIALS.  869 

trate,  10  per  cent ;  sodium  acetate,  potassium  cyanide,  and  borax, 
1  per  cent ;  while  sodium  citrate,  potassium  nitrate  and  chlorate 
are  inert. 

ACTION  OF  EARTH  ON  BLOOD. 

Graham-Smith  and  Sanger  mixed  equal  parts  of  human  serum 
with  detritus  of  chalk,  red  brick,  Pasteur  filter,  Berkefeld  filter, 
ordinary  earth,  white  brick,  mortar,  and  lime,  one  specimen  of 
each  being  kept  dry  and  one  wet  for  four  days,  with  the  result 
that  there  was  in  all  well-marked  diminution  of  precipitum,  aver- 
age 20  to  30  per  cent,  while  mortar  and  lime  completely  destroyed 
the  precipitin  reaction.  They  found  that  the  lime  in  ordinary 
earth  precipitates  test  serum  and  must  be  removed  by  a  current 
of  CO,,  which  does  not  interfere  with  the  precipitin  reaction, 
but  that  the  quantity  of  lime  in  ordinary  earth  does  not  seriously 
affect  the  precipitable  substance  of  blood  mixed  with  it.  The 
writer  failed  to  obtain  a  precipitate  from  human  blood  exposed 
to  the  weather  and  mixed  three  months  with  earth  containing 
much  vegetable  matter.  Ziemke's  results  with  certain  specimens 
of  blood  one  to  three  years  in  earth  must  be  regarded  as  negative, 
and  Okamoto  obtained  spontaneous  precipitates  in  solutions  of 
blood  in  sand  and  mortar. 

EFFECT  OF  ANTISEPTICS. 

Carbolic  acid  and  chloroform,  if  present  in  1-per-cent  strength, 
cloud  blood  solutions;  mercuric  bichloride  and  silver  nitrate 
atl  in  10,000,  copper  sulphate  at  1  in  100,000,  formalin,  thymol, 
benzol,  toluol,  xylol,  and  ether,  at  1  in  1,000. 

RESULTS  OBTAINED  FROM  BLOOD-STAINS  ON  MISCELLANEOUS 

MATERIALS. 

The  writer  obtained  a  spurious  reaction  from  blood-stains  on 
wall-paper.  A  neutral  solution  from  the  unstained  paper  gave 
the  same  reaction. 

Graham-Smith  and  Sanger  report  spurious  reactions  from  ten 
samples  of  wall -paper.  They  secured  good  reaction  from  a  large 
stain  on  oak  wood,  but  failed  with  small  stains  on  cedar  and  pine. 
Most  observers  have  had  no  difficulty  with  stains  on  wood.  I 
have  found  the  presence  of  starch  to  interfere  with  the  reaction. 


870  BLOOD   AND    OTHER   STAINS— EWING. 

SPECIFICITY   OF  PRECIPITIN   REACTIONS. 

The  reactions  of  precipitiu  sera  are  not,  in  one  sense,  strictly 
specific,  since  there  are  only  quantitative  differences  in  the  reac- 
tions produced  by  a  given  anti-serum  in  its  homologous  blood 
and  in  those  of  closely  related  animals.  Nevertheless,  these 
quantitative  differences  are  so  great  as  to  constitute  a  virtual 
difference  in  quality.  A  powerful  anti-beef  serum  used  in  con- 
centrated form  precipitates  not  only  beef  blood  but  also  the  blood 
of  the  sheep  and  the  goat,  although  to  a  much  less  extent.  Nut- 
tall  (I.e. )  has  shown  that  the  action  of  a  powerful  precipitin 
serum  extends  in  diminishing  intensity,  and  with  some  striking 
exceptions,  over  classes  or  subclasses  in  the  animal  kingdom, 
and  he  describes  a  mammalian,  an  aviau,  and  a  reptilian  reaction, 
on  evidence  that  a  serum  prepared  against  a  mammal  affects 
slightly  the  blood  of  all  mammals,  while  one  prepared  against 
the  fowl  is  more  or  less  active  with  many  birds.  Much  finer 
subdivisions  of  these  reactions,  however,  are  possible,  since  a 
humanized  serum  has  little  effect  on  any  but  human  and  mon- 
key blood,  and  an  anti-beef  serum  is  comparatively  inert  on  all 
but  beef,  sheep,  and  goat  bloods.  In  order  to  define  a  reaction 
which  can  occur  only  with  homologous  blood  it  has  been  found 
necessary  to  consider : 

(1)  THE  DILUTION  OF  THE  TEST  SERUM. 

(2)  THE  POTENCY  OF  THE  TEST  SERUM. 

(3)  THE  CHARACTER  OF  THE  PRECIPITATE. 

(4)  THE  TIME  LIMIT. 

(1)  THE  DILUTION  OF  THE  TEST  SERUM. 

The  serum  must  be  added  to  the  tested  blood  in  such  dilution 
1  hat  the  reaction  in  heterologous  bloods  shall  be  very  faint  01 
absent. 

A  powerful  humanized  serum  will  cause  a  flocculent  precipi 
tate  in  human  blood  solutions  1  in  100  in  3  hours  or  less, 
when  the  test  serum  is  added  in  dilution  of  1  in  200.  Such  a 
serum  added  in  dilution  1  in  10  may  cause  marked  turbidities  or 
flocculent  precipitates  in  the  blood  of  several  domestic  animals, 
but  if  diluted  as  much  as  1  in  30  it  will  not  cause  more  than  a 
slight  turbidity  in  any  but  human  or  monkey  bloods.  Kister 


THE   CHARACTER  OF  THE  PRECIPITATE.  871 

and  Wolf, l  and  Strauss  and  the  writer,  have  shown  that  this  dilu- 
tion is  sufficient  to  rule  out  most  reactions  of  precipitin  sera  on 
heterologous  bloods.  A  dilution  of  1  in  50  may  therefore  be  de- 
scribed as  a  safe  limit  at  which  the  occurrence  of  a  flocculent 
precipitate  in  3  hours  indicates  positively  the  presence  of  hu- 
man or  monkey  blood. 

(2)  THE  POTENCY  OF  THE  SERUM. 

The  test  serum  should  be  of  sufficient  strength  to  cause  a 
flocculent  precipitate  in  3  hours  in  human  serum  diluted  1  in  100 
when  the  test  serum  is  added  in  proportion  of  1  of  test  serum  to 
100  of  blood  solution. 

Most  humanized  test  sera  secured  after  eight  to  ten  injections 
are  much  more  active.  The  potent  sera  so  far  observed  have 
shown  far  greater  increase  in  activity  over  homologous  than 
over  related  bloods.  A  potent  serum,  moreover,  permits  a  dilu- 
tion far  beyond  the  point  where  heterologous  blood  reacts  and  is 
needed  to  demonstrate  the  character  of  very  old  or  very  small 
stains. 

(3)  THE  CHARACTER  OF  THE  PRECIPITATE. 

It  is  a  very  striking  distinction  between  reactions  in  homol- 
ogous and  those  in  heterologous  bloods,  that  the  turbidities  in 
the  former  rapidly  become  flocculent. 

Moreover,  the  development  of  a  flocculent  precipitate  in 
about  three  hours  visible  to  the  naked  eye  is  a  criterion  which 
effectually  escapes  the  influence  of  the  personal  equation.  This 
phenomenon  has  therefore  been  widely  recognized  as  a  most  reli- 
able indication  of  a  specific  reaction.  Strube 2  has  insisted  that  it 
is  the  only  result  which  can  warrant  a  positive  opinion,  but  it 
cannot  always  be  secured  in  very  dilute  solutions  or  with  very 
old  specimens  of  blood.  Nevertheless,  observations  on  old  speci- 
mens of  known  human  blood  have  shown  that  the  reactions  may 
not  pass  beyond  the  point  of  pronounced  turbidity  in  three  or 
four  hours,  and  there  seems  to  be  no  sufficient  reason  why  such 
turbidities,  under  proper  control  tests,  should  not  be  accepted  as 
specific. 

Nuttall  judges  the  reactions  by  measuring  the  bulk  of  precip- 

1  Kister,  Wolf,    Zeitschr.  f.  Hyg.,          2  Strube,    Deutsche    med.    Woch., 
Bd.  xli.,  p.  410.  1902,  p.  425. 


8T2  BLOOD  AND  OTHER  STAINS— EWING. 

itum  after  twenty-four  hours,  but  this  method  is  not  fortunately 
adapted  to  medico-legal  work  as  it  offers  opportunity  for  the  en- 
trance of  several  disturbing  factors.  Nevertheless,  the  bulk  of 
precipitum  produced  in  human  blood  by  specific  serum  is  so 
much  greater  than  that  forming  in  any  other  than  human  or 
monkey  blood  that  this  evidence  is  often  very  convincing. 

(4)  THE  TIME  LIMIT. 

The  great  majority  of  observers  have  found  that  when  a  pre- 
cipitiu  serum  of  ordinary  strength  is  added  to  a  solution  of 
homologous  blood  a  flocculent  precipitate  forms  in  at  least  three 
hours  at  37°  C.  After  this  time  the  result  is  apt  to  be  obscured 
by  bacterial  growth  and  the  appearance  of  reactions  in  heterolo- 
gous  bloods.  Hence  by  very  general  consent  the  requirement  of 
a  flocculent  precipitate  in  about  three  hours  has  come  to  be  ac- 
cepted as  an  essential  requirement  of  a  specific  reaction.  This 
arbitrary  requirement  errs  on  the  side  of  extreme  caution,  since 
even  with  dilutions  of  serum  1  in  20  turbidities  in  heterologous 
blood  seldom  become  flocculent  in  less  than  12  hours,  while  in 
dilutions  of  humanized  serum  of  the  prescribed  1  in  50  one 
will  obtain  no  flocculent  precipitate  in  any  but  human  and  mon- 
key bloods  within  12  hours.  When  dealing  with  old  speci- 
mens of  blood  which  gradually  lose  their  reaction  to  precipitin 
serum  this  time  limit  may  safely  be  increased,  or  a  pronounced 
turbidity  may  be  accepted,  or  it  may  be  permissible  to  judge  of 
the  extent  of  the  reaction  from  the  bulk  of  precipitum  found 
after  24  hours.  In  such  cases  also  the  strength  of  the  serum 
may  be  increased  to  1  in  30  or  1  in  20,  with  the  control  tests 
mentioned  later.  Yet  with  each  concession  of  this  sort  the  re- 
sults become  less  positive  and  the  conclusions  to  be  drawn  remain 
a  matter  of  opinion  on  the  part  of  the  examiner,  who  must  con- 
sider all  the  circumstances  of  the  case.  It  is  under  these  con- 
ditions that  the  behavior  of  control  tests  becomes  of  decisive  im- 
portance. 

THE  DIAGNOSIS  BETWEEN  MONKEY  AND  HUMAN  BLOOD. 

Five  methods  have  been  employed  for  this  purpose : 

(1)  The  progressive  dilution  of  the  test  serum. 

(2)  The  progressive  dilution  of  the  tested  blood. 


DIAGNOSIS  BETWEEN   HUMAN   AND   MONKEY   BLOOD.      873 

(3)  The  absorption  of  the  monkey  receptors  in  the  serum  by 
monkey  blood. 

(4)  The  use  of  a  humanized  serum  prepared  in  the  monkey. 

(5)  The  method  of  complement  fixation. 

(1)  The  writer  has  found  that  fresh  blood  serum  of  the  lower 
monkeys  fails  to  react  to  certain  powerful  humanized  rabbit  sera 
when  these  test  sera  were  diluted  1  in  100,  but  the  blood  of  the 
higher  monkeys  (orang,  chimpanzee)  still  reacted  faintly  at  1  in 
200  dilution  of  test  serum,  indicating  that   humanized  rabbit 
serum  is  incapable  of  positively  distinguishing  between  dried 
specimens  of  human  and  higher  monkey  blood. 

Precipitin  sera  vary  not  only  in  strength,  but  in  specificity  of 
action.  The  writer  found  that  the  chicken  produces  a  much 
more  specific  humanized  serum  than  the  rabbit,  two  such  sera 
failing  to  precipitate  lower-monkey  blood  in  any  dilutions,  while 
at  dilution  of  1  in  200,  although  still  actively  affecting  human 
blood,  they  failed  to  yield  a  flocculent  precipitate  in  the  fresh 
blood  of  the  orang  or  chimpanzee  in  three  hours ;  in  fact,  caused 
only  a  moderate  turbidity  in  these  monkey  bloods.  While, 
therefore,  it  is  possible  by  careful  calibration  of  the  test  serum 
to  distinguish  higher-monkey  blood  from  human  by  the  precipitin 
test,  it  is  clearly  a  delicate  undertaking,  and  until  further  obser- 
vations are  at  hand  it  would  be  unwise  for  the  medico-legal  ex- 
pert to  claim  that  a  given  specimen  yielding  the  reactions  of 
human  blood  may  not  be  that  of  an  anthropoid  monkey. 

(2)  The  differentiation  of  related  bloods  may  be  facilitated, 
as  shown  byLayton,1  by  varying  the  dilution  of  the  tested  blood, 
but  the  results  are  much  less  striking  than  those  which  follow 
successive  dilutions  of  the  test  serum.      Moreover,  it  is  impossi- 
ble to  estimate  the  dilution  of  dried  blood.     It  has  been  found 
that  the  dilution  of  blood  albumens  most  favorable  for  the  rapid 
formation  of  flocculi  is  about  1  in  50  or  1  in  100. 

(3)  It  may  prove  possible  to  render  a  humanized  rabbit  serum 
more  specific  against  human  blood  by  absorbing  it  with  the  blood 
of  monkeys.       The  remaining  receptors  of  the  filtered  serum 
should  be  active  only  against  human-blood  proteid. 

Weichardt2  claims  to  have  succeeded  by  this  method  in  dis- 

1  Layton,  American  Medicine,  1903,       1903,  Bd.  xiii.,  p.  7;>6;    Vierteljahr. 
vol.  v.,  p.  913.  f.  ger.  Med.,  1905,  Bd.  xxix.,  p.  19. 

•Weichardt,  Hygien.  Rundschau, 


874  BLOOD   AND   OTHER   STAINS — EWING. 

tinguishing  not  only  between  Immaii  and  monkey  blood,  but  even 
between  the  blood  of  different  human  beings.  For  this  purpose 
he  prepared  a  serum  of  moderate  potency  secured  by  five  daily 
injections  of  1  c.c.  each  of  blood  in  a  rabbit.  This  serum  he 
twice  precipitated  with  one-tenth  its  volume  of  monkey  serum, 
passing  it  rapidly  through  a  clay  filter,  after  fifteen  hours'  con- 
tact in  the  ice-chest.  Of  this  absorbed  serum  0.5  c.c.  added  to 
0.1  c.c.  of  human  blood,  the  mixture  being  brought  up  to  10  c.c. 
bulk,  gave  turbidity  in  fifteen  minutes,  and  a  flocculent  precipi- 
tate in  five  hours,  while  with  two  monkey  sera  (not  named)  nine 
hours  elapsed  before  a  fine  precipitate  formed.  These  results 
showed  that  the  serum  was  not  completely  absorbed,  and  they 
are  not  more  definite  than  those  secured  by  high  dilutions  of 
potent  sera,  while  the  technique  is  more  uncertain. 

(4)  Uhlenhuth '  has  been  able  to  distinguish  between  human 
and  lower-monkey  blood  by  using  the  serum  of  lower  monkeys 
(Macacus  rhcesus  and  Cercopithecus  fuliginosus')  immunized  against 
human  blood.     He  was  unable  to  test  this  serum  against  the 
blood  of  higher  monkeys. 

(5)  For  this  method  see  section  on  Complement  Fixation. 

TECHNiaUE. 

THE  PRODUCTION  AND  USE  OF  PRECIPITIN  SERUM. 

Animals. — The  rabbit  is  usually  chosen  for  the  production 
of  the  serum.  Large  healthy  field-rabbits  or  hares  should  be 
selected,  and  they  must  be  housed  under  good  hygienic  condi- 
tions. The  writer  has  obtained  more  specific  serum  from  the 
chicken,  which  is  a  hardier  animal  than  the  rabbit. 

PREPARATION  OF  INJECTED  MATERIAL. 

Fresh  human  blood  expressed  from  the  placenta  or  cord,  and 
defibriuated  by  shaking  in  a  sterile  flask  containing  beads,  is 
much  superior  to  any  albuminous  exudate.  In  its  absence  one 
may  employ  pleuritic  exudate  or  ascitic  fluid,  but  albuminous 
urine  is  uncertain  in  its  action  and  often  poisonous.  Uhlenhuth 
and  Grigorjew  employed  a  solution  of  dried  blood. 

1  Uhlenhuth,  Deutsche  med.  Woch.,  1905,  p.  1673. 


DRAWING  AND  PRESERVATION  OP  SERUM.          875 

METHODS  OF  INJECTION. 

The  intraperitoneal  is  the  preferable  route.  Subcutaneous 
injections  frequently  cause  abscesses,  but  the  intravenous 
injections  may  give  more  rapid  results.  Ten  c.c.  of  blood 
may  be  used  from  the  first,  but  the  initial  injections  may  well 
be  limited  to  5  c.c.  A  10-c.c.  syringe  with  rather  large 
needle  is  required.  The  animal  is  held  by  the  ears,  an  area  of 
skin  over  the  lower  abdomen  shaved  and  sterilized,  and  the  needle 
inserted  carefully  to  avoid  puncture  of  the  intestine.  The  inter- 
val between  injections  should  be  uniform,  but  must  be  determined 
by  the  health  of  the  animal.  If  it  loses  weight  or  appears  sick 
treatment  must  be  omitted.  A  four-day  interval  is  usually 
adopted. 

From  six  to  ten  injections  are  required  to  develop  a  serum  of 
proper  strength,  but  animals  vary  greatly  in  their  capacity  to 
develop  precipitins,  some  failing  entirely  to  yield  a  good  serum, 
while  others  show  pronounced  activity  after  three  or  four  injec- 
tions. There  is  sometimes  an  advantage  gained  by  increasing 
the  amount  and  the  rate  of  injections. 

DRAWING  AND  PRESERVATION  OF  SERUM. 

As  each  injection  causes  a  temporary  diminution  in  the 
amount  of  free  precipitin  in  the  blood,  an  interval  of  at  least  six 
or  seven  days  should  elapse  between  the  last  injection  and  the 
drawing  of  blood.  Sufficient  blood  may  be  obtained  from  a 
transverse  incision  of  the  sterilized  lateral  ear  vein  from  an  ani- 
mal suspended  head  downward  or  wrapped  in  a  blanket  with  a 
warm  water- bag.  The  serum  exudes  promptly  from  clots  form- 
ing in  the  test  tubes  laid  nearly  horizontal. 

If  the  work  has  been  clean  bacteria  seldom  develop  in  serum 
preserved  on  ice  without  the  addition  of  any  antiseptic,  but 
chloroform  or  carbolic  acid,  not  more  than  .5  per  cent,  may 
safely  be  added  to  prevent  decomposition.  The  drawn  serum 
should  be  used  as  soon  as  possible,  but  it  usually  remains  of  un- 
diminished  activity  for  two  to  three  weeks,  and  may  still  be 
active  after  several  months. 


876  BLOOD  AND  OTHER  STAINS — EWING. 

PREPARATION  OF  THE  STAIN  FOR  TESTING. 

The  best  solvent  for  dried  blood  is  .6  to  .8  per  cent  solution 
of  .Nad  c.p.  Very  old  stains  may  require  maceration  for  some 
hours,  and  the  presence  of  albumens  in  solution  may  be  deter- 
mined by  NuttalPs  foam  test  developed  by  shaking  the  fluid. 
One-teuth-per-cent  soda  solution  has  been  recommended  as  a 
more  active  solvent,  but  this  amount  of  soda  may  cause  sponta- 
neous precipitation  in  any  blood  serum. 

The  use  of  potassium  cyanide  with  subsequent  neutralization 
by  tartaric  acid  in  substance  has  not  been  proved  a  reliable 
solvent.  The  solution  need  not  be  colored,  as  Ziemke  obtained 
a  reaction  from  a  solution  too  weak  to  give  spectroscopic  bands. 
It  must  be  perfectly  clear,  and  after  extraction  in  a  clean  watch 
glass  the  fluid  may  be  filtered  through  Schleicher's  filter  paper, 
blue  label,  which  clears  the  great  majority  of  fluids.  An  asbestos 
filter  or  the  centrifuge,  or  a  small  Berkefeld  or  Chamberlain 
filter,  may  be  required.  The  solution  should  not  be  very  con- 
centrated. 

Small  test  tubes,  diameter  not  less  than  .5  cm.,  are  required 
in  the  work,  and  these  should  be  cleaned  without  alkali,  steril- 
ized, and  polished.  The  fluids  may  be  handled  with  small  sterile 
pipettes.  Ten  drops  of  the  solution  or  its  multiple  should  be 
placed  in  a  tube  and  the  serum,  properly  diluted,  should  be  added 
in  such  quantity  that  the  final  dilution  shall  be  at  the  limit  de- 
sired, which  is  usually  1  in  50.  For  ten  drops  of  solution  this 
requires  therefore  the  addition  of  one  drop  of  test  serum  diluted 
by  adding  four  drops  of  salt  solution  to  one  of  pure  serum.  All 
test  solutions  should  be  placed  in  the  thermostat  and  observed  at 
frequent  intervals,  but  after  three  hours  they  should  be  trans- 
ferred to  the  ice-box  to  prevent  bacterial  growth. 

CONTROLS. 

Without  the  rigid  employment  of  certain  control  tests  the 
results  of  the  serum  method  are  valueless  for  medico-legal  pur- 
poses. 

(a)  One  must  demonstrate  that  a  precipitate  obtained  in  a 
solution  of  suspected  human  blood  is  not  of  spontaneous  origin, 
for  which  purpose  it  is  necessary  to  carry  through  a  solution  of 


CONTROLS.  877 

the  stain  which  received  no  other  treatment  than  that  required 
in  its  preparation. 

(f)  Since  the  solution  may  contain  some  agent  which  slowly 
precipitates  foreign  albumens,  it  is  necessary  to  carry  through  a 
specimen  which  receives  the  same  quantity  of  some  other  anti- 
serum.  In  testing  for  human  blood  the  writer  has  used  for  this 
control  a  potent  beef-rabbit  serum,  but  normal  rabbit  serum  may 
perhaps  suffice. 

(c)  A  third  control  giving  very  welcome  corroborative  evi- 
dence is  secured  where  one  carries  through  a  known  specimen  of 
human  blood  of  appropriate  dilution  to  which  is  added  the  usual 
quantity  of  test  serum. 

(d)  As  there  is  considerable  variation  in  the  specificity  of 
different  sera,  it  is  desirable  to  test  each  serum  on  human  blood 
and  on  that  of  several  domestic  animals,  to  determine  not  only 
the  strength  of  the  serum,  but  also  its  effects  on  heterologous 
bloods.     This  control  is  the  more  necessary  with  the  very  potent 
sera. 

(e)  If  the  observation  extends  over  three  hours  the  precipi- 
tum  must  be  examined  for  the  presence  of  multiplying  bacteria 
which  may  of  themselves  precipitate  albumens  or  simulate  an 
albuminous  coaguluui. 

(/)  Since  any  albumen  from  the  human  body  may  respond 
to  humanized  serum,  it  must  first  be  determined  by  the  hsemin 
or  spectroscopic  tests  that  the  material  is  blood. 

While  it  is  possible  that  the  blood  of  a  domestic  animal  may 
be  mixed  with  human  albuminous  exudates,  as  sputum,  pus, 
urine,  or  faeces,  such  a  combination  must  be  exceedingly  rare. 
A  microscopical  examination  will  determine  the  presence  of 
mucus  in  sputum,  excess  of  leucocytes  in  pus,  and  fecal  detritus. 
In  the  writer's  tests  highly  purulent  or  albuminous  sputum,  or 
diarrhoaal  faeces,  were  required  to  yield  definite  reactions  with 
humanized  sera.  The  gross  appearance  of  the  stain  will  usually 
determine  the  possibility  of  mixture  with  albuminous  urine,  or 
the  demonstration  of  characteristic  crystals  of  nitrate  of  urea 
may  be  undertaken. 


878  BLOOD   AND   OTHER  STAINS— EWING. 

THE  FORENSIC  SIGNIFICANCE  OF   THE  BORDET-GENGOU- 
MORESCHI  PHENOMENON  (COMPLEMENT  FIXATION). 

In  1901  Bordet  and  Gengou l  observed  that  when  a  precipit- 
able  protein  is  added  to  its  homologous  auti -serum  the  resulting 
union  of  precipitin  and  precipitable  substance  carries  down  with 
it  any  complement  present  in  the  fluids,  although  no  complement 
is  necessary  to  bring  about  the  precipitation.  This  phenomenon 
has  been  called  " complement  fixation,"  and  it  is  to  be  distin- 
guished from  the  phenomenon  of  Neisser  and  "Wechsberg, 
"complement  deviation,"  in  which  the  complement  is  present 
but  is  rendered  inactive  for  of her  reasons.  Moreschi 2  has  shown 
that  complement  fixation  occurs  when  very  slight  and  entirely 
invisible  reactions  occur  between  precipitable  proteins  and  their 
anti-sera.  The  delicacy  of  the  reaction  suggested  to  Neisser  and 
Sachs 3  that  the  phenomenon  might  be  of  forensic  value  in  the 
identification  of  blood-stains,  and  they  claim  to  have  distin- 
guished in  this  way  very  minute  quantities  of  human  blood  from 
that  of  monkeys  and  other  lower  animals. 

The  method  employed  to  demonstrate  the  mechanism  of  com- 
plement fixation  is  as  follows:  Two  mixtures  are  prepared :  (1) 
Washed  sheep  red  cells  (freed  from  complement),  plus  heated 
inactivated  hsemolytic  serum  prepared  in  the  rabbit  against  sheep 
red  cells  (amboceptor,  no  complement).  This  mixture  provides 
sensitized  red  cells  ready  to  be  hsemolyzed  by  the  addition  of  any 
complement.  (2)  Fluid  containing  bacterial  protein,  plus  spe- 
cific precipitin  anti-serum  for  the  bacterial  protein,  and  comple- 
ment. In  this  mixture  the  precipitin  unites  with  the  precipit- 
able protein,  and  at  the  same  time  fixes  the  complement  present, 
so  that  on  adding  No.  2  to  No.  1  haemolysis  does  not  take  place. 

If  in  mixture  No.  2  either  bacterial  protein  or  precipitin  is 
lacking  the  complement  is  not  fixed,  and  on  addition  of  No.  1  to 
No.  2  the  active  complement  unites  with  the  amboceptor  already 
attached  to  the  red  cells,  and  haemolysis  follows. 

In  applying  the  test  to  blood-stains  four  solutions  are  em- 
ployed :  (1 )  A  solution  of  the  stain  in  normal  salt.  (2)  Normal 
rabbit  serum,  which  hsemolyzes  sheep  red  cells.  (3)  Humanized 

1  Bordet,  Gengou,  Annal.  de  Tin-          3  Neisser,  Sachs,  Berl.  kl.  Woch., 
stit.  Pasteur,  1901,  p.  283.  1906,  p.  1388. 

"  Moreschi,  Berl.  kl.  Woch.,  1905, 
p.  1181. 


THE  BORDET-GENGOU-MORESCHI   PHENOMENON. 


879 


rabbit  precipitin  serum.  (4)  A  5-per-ceut  suspension  of  fresh 
sheep  blood  in  normal  salt  solution. 

.Neisser  and  Sachs 1  have  determined  that  the  minimal  amount 
of  normal  rabbit  serum  completely  dissolving  1  c.c.  of  5-per- 
ceut  suspension  of  sheep  blood  is  .25  c.c.,  and  in  all  tests  they 
employ  this  constant  quantity.  They  have  also  found  that  .02 
c.c.  of  precipitin  serum  is  the  optimum  proportion,  and  this 
amount  is  employed  in  each  test. 

In  performing  the  test  .25  c.c.  of  normal  rabbit  serum  is 
mixed  with  .02  c.c.  of  precipitin  serum,  and  to  several  such 
tubes  are  added  varying  amounts  of  the  suspected  solution,  and 
the  mixtures  are  placed  in  the  thermostat  at  37°  C.  for  1  hour. 
Then  follows  the  addition  of  1  c.c.  of  sheep-cell  suspension,  and 
the  tubes  are  now  placed  in  the  thermostat  for  2  hours.  The 
failure  of  haemolysis  indicates  the  presence  of  human  blood  in  the 
suspected  material. 

The  results  obtained  by  Neisser  and  Sachs  with  known  quan- 
tities of  fresh  human  serum  are  indicated  in  the  accompanying 
table : 


Human  Serum. 

Normal  Rabbit 
Haemolytic  Serum. 

Precipitiu 
Serum. 

Haemolysis  of  1  C.P.  of 
5-per-cent  Sheep  Blood. 

1/1,000  

0.25 

0.01 

0 

1/10,000  

0.25 

0.01 

0 

1/100,000  

0.25 

0.01 

0 

1/1,000,000  

0.25 

001 

Slight 

1/10,000,000     .    . 

0.25 

0.01 

Strong 

1/100,000,000  
0  . 

0.25 
0.25 

0.01 
0,01 

Complete 
Complete 

While  the  method  of  Neisser  and  Sachs  may  prove  to  be  suf- 
ficiently exact  for  medico-legal  purposes,  it  would  seem  desirable 
to  employ  the  more  delicately  balanced  haemolytic  mixtures  used 
in  bacterial  research.  In  this  field  it  has  been  found  necessary 
to  control  the  amounts  of  the  several  agents  entering  into  the 
reaction.  This  is  necessary  because  the  precipitin  reaction  does 
not  fix  an  unlimited  amount  of  all  complements  present  in  serum, 
but  only  limited  amounts  of  some  complements  (Muir  and 
Martin2).  According  to  Gay,3  there  is  a  quantitative  relation 

'Neisser,  Sachs,  Berl.  kl.  Woch.,          3  Gay,  Annal.  de  I1  Instit.  Pasteur, 
1906,  p.  67.  1905,  p.  593. 

2  Muir,  Martin,    Jour,  of  Hygiene, 
1906,  vol.  vi.,  p.  265. 


880  BLOOD   AND   OTHER   STAINS — EWING. 

between  the  amount  of  precipitate  and  complement  fixation. 
Hence  if  complements  are  in  excess  a  delicate  precipitin  reaction 
may  fail  to  fix  enough  of  them  to  influence  the  final  haemolysis, 
and  a  misleading  negative  result  is  obtained.  In  order  to  se- 
cure a  delicately  balanced  hseinolytic  mixture  it  is  necessary  to 
work  with  the  following  factors: 

(1)  An  immune  hsemolytic  serum  prepared  in  the  rabbit  by 
4  or  5  injections  of  3  to  5  c.c.  of  sheep  blood.     This  serum 
should  be  heated  ^hour  at  55°  C.,  and  thus  inactivated  it  con- 
tains only  immune  ainboceptor,  but  no  complement.     It  should 
be  kept  on  ice. 

(2)  A  5-per-cent  suspension  of  sheep  red  cells  washed    3 
times  in  .8-per-cent  salt  solution,  at  a  low  temperature. 

Torrey  and  Teague,1  in  the  Loomis  Laboratory,  find  that  .5 
c.c.  of  a  l-to-50  dilution  of  this  hsemolytic  serum  added  to  .5  c.c. 
of  the  suspension  of  washed  sheep  cells  is  usually  the  minimum 
amount  required  completely  to  hsemolyze  the  cells  in  2  hours  at 
37°  C.  when  the  proper  amount  of  complement  (described  later) 
is  added.  As  an  excess  of  free  amboceptor  in  the  haemolytic  in- 
dicator may  interfere  with  the  complement  action  it  is  better, 
after  the  addition  of  haemolytic  serum,  to  wash  the  red  cells  twice 
in  cold  salt  solution  and  bring  the  suspension  of  cells  up  to  the 
original  bulk,  1  c.c.,  with  salt  solution.  Eeageuts  (1)  and  (2) 
may  thus  be  combined  and  designated  as  5-per-cent  suspension 
of  sensitized  red  cells. 

(3)  Normal  rabbit  serum  containing  complement. 

The  amount  of  complement  required  must  be  determined  by 
experiment  with  the  sensitized  red  cells.  For  this  purpose  take 
10  tubes,  each  with  .5  c.c.  of  sensitized  cell  suspension,  and  add 
.5  c.c.  of  complement  serum  in  several  dilutions  from  1  in  10  up 
to  1  in  100,  and  incubate  2  hours.  The  greatest  dilution  of 
complement  serum  which  suffices  to  bring  about  distinct  haemo- 
lysis in  the  trials  should  be  employed  in  the  final  tests. 

(4)  Humanized  rabbit  precipitiu  serum  heated  one-half  hour 
at  55°  C. 

It  has  been  abundantly  shown,  among  others  by  Friedberger 2 
and  Liefmann,3  that  this  treatment  does  not  interfere  with  the 

1  Torrey  and    Teague,    communi-          a  Liefmann,  Berl.  kl.  Woch.,  1906, 
cated.  p.  448. 

2  Friedberger,      Deutsche        med. 
Woch.,  1906,  p.  578. 


THE  BORDET-GENGOU-MOEBSCHI  PHENOMENON.  881 

complement-fixing  power.  The  optimum  amount  of  this  serum 
to  be  used  must  also  be  determined  by  experiment.  Using  a  1- 
in-10,000  solution  of  known  human  serum  one  should  make  fix- 
ation tests  with  sensitized  red  cells  and  conip lenient  serum  in  the 
dilution  chosen  above  and  with  precipitin  serum  in  several  dilu- 
tions from  1  in  10  to  1  in  100,  using  .5  c.c.  of  each  reagent.  The 
greatest  dilution  which  fixes  the  complement  and  prevents  haemo- 
lysis in  the  system  should  be  used  in  the  final  tests.  This  deter- 
mination is  necessary  because  in  excess  of  precipitin  serum  the 
pre-zone  phenomenon  of  Neisser  and  Wechsberg  may  appear  and 
prevent  fixation  of  complement  (cf.  Morgenroth,  Stertz1). 

(5)  A  solution  of  the  stain  in  .8-per-cent  salt. 

The  strength  of  this  solution  must  always  remain  more  or 
less  indeterminate,  since  the  solubility  of  blood-stains  and  their 
capacity  to  react  with  precipitin  serum  vary.  The  chief  danger 
is  that  the  solution  will  be  too  strong.  Friedberger 2  found  that 
human  sweat  in  the  dilution  of  1  in  10,000  deviates  complement, 
hence  the  entire  system  must  be  adjusted  to  a  dilution  of  human 
blood  serum  of  at  least  1  in  10,000.  As  human  sweat  can  never 
enter  into  the  suspected  stain  in  the  concentration  found  in  Fried  - 
berger's2  test  specimen,  a  dilution  beyond  1  in  10,000  is  not 
necessary.  At  present  such  a  dilution  from  a  dried  stain  can 
only  be  determined  approximately. 

With  these  preliminary  tests  accomplished,  the  final  test  may 
be  carried  out  as  follows: 

To  .5  c.c.  of  the  stain  solution  add  .5  c.c.  of  the  precipitiu 
serum  in  the  chosen  dilution,  and  .5  c.c.  of  the  complement 
serum  in  the  chosen  dilution,  and  incubate  2  hours  at  37°  C. 
Then  add  .5  c.c.  of  the  sensitized  red-cell  suspension  and  incu- 
bate again  2  hours.  Readings  should  be  taken  at  once  and 
after  24  hours  in  the  ice-chest.  Failure  of  any  trace  of  haemo- 
lysis at  either  of  these  readings  indicates  a  positive  reaction  for 
human  blood. 

Various  controls  must  Ije  carried  through  to  eliminate  errors. 

(1)  As  the  fixation  of  complement  may  be  due  to  non-specific 
substances,  one  control  should  substitute  normal  rabbit  serum  for 
precipitin  serum. 

(2)  A  known  specimen  of  human  serum,  dilution  1  in  10,000, 

1  Morgenroth,     Stertz,     Virchow'a          '  Friedberger,       Deutsche       med. 
Archiv,  1906,   Bd.  clxxxviii.,  p.  166.      Woch.,  1906,  p.  578. 
III.-66 


882  BLOOD   AND   OTHER   STAINS — EWING. 

should  be  used  to  demonstrate  that  the  system  is  properly  ad- 
justed. 

(3)  If  the  quantity  of  the  stain  will  permit,  other  higher  di- 
lutions of  the  original  solution  should  be  employed. 

It  is  too  early  to  predict  the  final  position  of  the  complement- 
fixation  test  in  forensic  blood  diagnosis.  The  extraordinary 
delicacy  of  the  reaction  is  both  its  strong  and  its  weak  feature. 
Friedberger  finds  that  the  reaction  occurs  with  dilutions  of  blood 
fifty  million  times  greater  than  is  required  to  give  the  precipitiu 
reaction,  and  Bruck '  claims  to  have  demonstrated  by  this  method 
marked  distinctions  between  the  blood  of  Europeans  and  of 
Chinese,  and,  still  further,  of  Malayans.  The  technical  difficul- 
ties are  so  great  that  the  test  can  be  satisfactorily  performed  only 
in  a  laboratory  where  serum  work  is  being  pursued,  but  for  one 
accustomed  to  this  work  the  difficulties  are  not  extreme.  Uhlen- 
huth 2  would  limit  the  method  to  corroboration  of  the  precipitin 
test,  and  claims  to  have  gotten  complement  fixation  with  a  vari- 
ety of  non-specific  substances,  but  his  controls  were  not  ade- 
quate. There  appears  to  be  no  real  necessity  for  performing  the 
complement-fixation  test  when  the  precipitin  test  is  positive  and 
satisfactory. 

When  the  precipitin  test  is  negative  because  the  stain  is  old, 
altered,  or  scanty,  the  complement-fixation  test  should  be  used, 
but  the  influence  of  changes  in  the  blood  which  prevent  the  pre- 
cipitin reaction  remains  to  be  determined. 

Since  the  principles  of  the  test  are  well  founded,  the  certainty 
of  its  results  must  depend  on  the  skill  and  experience  of  the 
operator.  At  present  the  technical  details  and  the  sources  of 
error  have  not  been  sufficiently  studied  to  warrant  exclusive  re- 
liance on  this  test,  or  the  recommendation  of  its  use  outside  the 
experimental  laboratory. 

MISCELLANEOUS  METHODS  IN  DIFFERENTIATION  OF 

BLOODS. 

BY  THE  FORM  OF  HAEMOGLOBIN  CRYSTALS. 

It  has  long  been  known  that  haemoglobin  crystals  vary  in 
form,  color,  and  rapidity  of  formation  in  different  animals,  and 
attempts  have  been  made  to  distinguish  human  from  other  bloods 

'Bruck,  Berl.  kl.  Woch.,  1907,  p.          2  Uhlenhuth,  Deutsche  med.Woch., 
793.  1906,  pp.  1244,  2072. 


DIFFERENTIATION  OF  BLOODS.  883 

on  this  basis.  Dvornitscheuko '  concluded  from  a  comparative 
study  of  haemoglobin  crystals  that  flat  rectangular  plates  are 
characteristic  of  human  haemoglobin.  Moser2  believes  it  possi- 
ble to  distinguish  human  blood  with  certainty  by  the  character  of 
the  haemoglobin  crystals,  and  finds  that  their  form  is  but  slightly 
affected  by  moderate  degrees  of  putrefaction  of  the  blood. 

The  test  is  applicable  only  to  fresh  blood  or  comparatively 
recent  stains  in  which  the  Hb  has  not  been  reduced  to  haematin. 
Both  the  above  observers  attempt  to  secure  crystals  by  allowing 
a  drop  of  solution  of  the  stain  in  distilled  water  to  fall  on  a  glass 
slide,  and  after  drying  around  the  edges  it  is  covered  with  a 
cover-glass  to  prevent  evaporation  before  the  crystals  form.  If 
no  crj^stals  form,  the  solution  should  be  exposed  to  air  for  some 
days  to  transform  the  oxy-Hb  to  reduced  Hb  which  crystallizes 
more  readily.  Moser  obtained  the  best  crystals  by  allowing 
solutions  of  blood  to  stand  in  open  vessels  for  2  to  10  days. 
Human  Hb  crystallizes  usually  in  24  to  48  hours. 

BY  THE  ODOR  OF  BLOOD. 

Barruel 3  has  claimed  that  the  odor  of  dry  blood  treated  with 
sulphuric  acid  is  characteristic  of  each  species  of  animal. 

BY  THE  RESISTANCE  OF  OXY-HB  TO  ACIDS  AND  ALKALIES. 

It  was  first  shown  by  K6rber,4and  fully  demonstrated  by 
Kriiger,5  that  oxy-Hb  of  different  animals  shows  very  different 
degrees  of  resistance  to  acids  and  alkalies  before  it  is  transformed 
to  reduced  Hb,  as  indicated  by  the  fading  of  the  spectroscopic 
bauds  of  oxy-Hb.  Using  25  c.c.  of  y^  sodium-hydrate  solu- 
tion to  .005  gram  oxy-Hb,  Miugauimi8  found  that  human 
haemoglobin  lost  its  spectrum  in  31  minutes.  He  tested  stains 
2  months  old  successfully,  using  the  spectrophotometer  to  de- 
termine the  quantity  of  Hb  in  solution.  Ziemke 7  had  no  difli- 

1  Dvornitschenko,         Vierteljahrs-  4  KSrber,   "  Ueber    Differenzen   d. 
schr.  f.    ger.    Med.,  1901,  Bd.  xxii.,  Blutfarbstoff.,"  Inaug.  Diss.,  Dorpat, 
p.  12.  1886. 

2  Moser,  ibul.,  1901,  Bd.   xxii.,  p.  8  Kriiger,  Zeitschr.  f.  Biol.,  1888, 
44.  Bd.  xxiv.,  p.  312. 

3  Barruel,  Annal.  d'Hygiene  publ.,  8  Minganimi,  cit.  by  Ziemke. 
1829,  p.  267.     See  Fleming,  Amer.  7  Ziemke,  Vierteljahrsschr.  f.  ger. 
Jour.  Med.  Sci.,  1859,  vol.  xxxv.,  p.  Med.,  1901,  Bd.  xxii.,  p.  77. 

98. 


884  BLOOD   AND   OTHER   STAINS — EWING. 

culty  iii  distinguishing  by  this  method  known  quantities  of  fresh 
human  blood  taken  from  healthy  and  diseased  subjects  and 
that  of  many  domestic  animals,  the  haemoglobin  of  the  cat 
furnishing  the  nearest  approach  to  human,  but  requiring  28.8 
minutes  for  decomposition  by  ^  KOH  to  5. 6  minutes  for  human 
blood.  To  determine  the  quantity  of  fresh  Hb  in  solution 
he  used  Gowers'  hsemoglobinometer.  Solutions  in  .1-per  cent 
soda  of  old  blood-stains  containing  methaenioglobin  were  treated 
with  a  few  drops  of  Stokes's  reagent,  and  then  shaken  in  the 
air  until  oxy-Hb  was  secured  and  the  usual  test  performed  on 
this  solution.  A  human  stain  thus  treated  required  forty  minutes 
for  the  transformation  of  oxy-Hb,  while  dog  blood  two  months 
old  required  two  hours.  The  method  is  applicable  only  to  stains 
which  have  not  been  reduced  to  haematin,  and  the  approximate 
age  of  the  stain  and  the  strength  of  the  solution  must  be 
determined. 

Marx  and  Ehrenrooth1  claim  that  if  one  adds  dissolved  human 
blood-stain  to  a  thick  suspension  of  human  red  cells  in  .8-per 
cent  NaCl  and  no  agglutination  of  the  cells  follows,  the  diagnosis 
of  human  blood  is  justified.  If  the  agglutination  is  prompt  and 
is  followed  by  haemolysis,  the  serum  is  certainly  from  a  lower 
animal,  while  slow  agglutination  without  haemolysis  suggests 
human  serum.  Southerland2  has  shown  that  this  method  is  un- 
reliable. 

'Marx,     Ehrenrooth,     Miinchener          2  Southerland,      "Blood     Stains," 
med.  Woch.,  1904,  p.  696;    Cent.  f.       1907,  p.  72. 
Bacteriol.,  1906,  Bd.  xli.,  p.  140. 


SEMINAL  STAINS. 


THE  detection  of  seminal  stains  becomes  of  medico-legal  in- 
terest in  cases  of  rape  or  sodomy,  and  sometimes  in  connection 
with  homicide. 

THE  SEMEN  is  a  thick  albuminous  fluid  of  pale  whitish  or 
yellowish  color  referable   to  spermatozoa  and  epithelial  cells. 
It  has  a  peculiar  odor  contributed  by  mixture  with  prostatic 
secretions  and  residing  in  certain  characteristic  phosphatic  crys- 
tals of  spermin  (Boettcher's l  crystals) 
(  Fiirbringer 2 ) .  These  crystals  are  f  ou  r- 
sided  monoclinic    prisms    of   variable 
size,  but  usually  large,  40  to  60/*,  and 
resembling  triple  phosphate,  but  others 
are  very  minute  spindles  or  needles. 
They  differ  from  Charcot-Leyden  crys- 
tals in  being  soluble  in  foruiol,  and  they 
dissolve  slowly  in  water,  acids,  and  al- 
kalies, but  not  in  salt  solution,  alco- 
hol, ether,  or  chloroform.     With  Flor- 
ence's3 reagent  they  turn  bluish-black. 
On  chemical  analysis  semen  yields 
90  per  cent  of  water,  and  10  per  cent  of 

solids,  of  which  6  per  cent  are  organic  and  4  per  cent  inorganic. 
The  inorganic  salts  are  chiefly  calcium  phosphates  and  sodium 
chloride. 

The  spermatozoa  are  motile  filamentous  bodies  consisting  of 
a  head  and  tail.  The  head,  in  man,  is  pyriform  when  viewed  on 
the  side,  oval  when  seen  from  the  surface,  with  a  length  of  3  to 
5/z  (5  ATT  t°  i.^nr  inch),  and  a  breadth  of  2  to  3/j.  (r^mr  to  ^.Air 
inch).  Its  pointed  end  is  homogeneous  and  highly  refractive. 
The  tail  is  a  filament  composed  of  delicate  fibrils  about  which, 
in  birds  and  tailed  amphibia  and  rarely  in  man,  is  a  spirally 

1  Boettcher,      Virchow's      Archiv,          a  Florence,      Arch.      d'Anthropol. 
1865,  Bd.  xxxii.,  p.  525. 

1  Fiirbringer,  Virchow's  Jahresber., 
1881,  i.,  p.  240. 


FIG.  34.— Spermatozoa.  1,  2, 
3,  Human  ;  4,  bull,  o,  Head  ;  b, 
connecting  piece,  and  c,  chief 
piece  of  the  tail.  1,  3,  and  4,  Sur- 
face views ;  2,  side  view.  X  360. 
( After  St6hr.) 


4  Florence,      Arch. 
Crim.,  1896,  p.  146. 


885 


886 


SEMINAL   STAINS — EWING. 


wound  filamentous  hyaline  membrane.  The  thickest  portion  of 
the  tail  is  nearest  the  head  where  it  measures  l/>,  gradually 
diminishing  toward  the  extremity.  The  length  varies  from  45 
to  75/x  (T>1FVTr  to  ^  inch). 

Boston l  gives  the  following  table  of  measurements  in  micra 
of  spermatozoa  of  various  animals : 


Source. 

Total  Length. 

HEADS. 

Tail  Length. 

Length. 

Width. 

Man  

51-  58 
67-  74 
51-  66 
64-  67 
87-  93 
83 
58-  74 
120-158 
225-238 
113-138 

4-  6 
4-  8 
6-  9 
6-  8 
9 
9 
7 
8-  9 
12-16 
6-12 

3-  4 
3-  4 
3-  4 
6 
6 
3-  3 
3-  4 

7-ii 

41-  53 
59-  67 
45-  58 
54-  60 
77-  83 
74 
53-  66 
112-138 
209-222 
102-132 

Dog  

Rabbit          

Horse  

Bull  

Sheep      

Cat  

Mouse  

White  rat  

Guinea-pig  

The  movements  of  the  spermatozoon  are  executed  by  the 
cilium  alone,  which  propels  the  head,  and  beginning  first  in  the 
seminal  vesicles  and  prostate  they  continue  twenty-four  to  forty- 
eight  hours  after  death  and  for  a  week  or  longer  periods  in  the 
alkaline  mucus  of  the  cervix  and  uterus.  Water,  acids,  and 
metallic  salts  inhibit  the  movements. 

The  spermatozoa  are  nuclear  structures,  motile  chromosomes, 
the  head  being  rich  in  nucleinic  acid,  and  the  tail  containing 
albumen,  lecithin,  cholesterin,  and  fat,  while  both  contain  much 
mineral  matter.  They  are  therefore  remarkably  resistant  to 
chemical  agents,  being  incompletely  soluble  in  concentrated  sul- 
phuric, nitric,  and  acetic  acids,  or  hot  soda  solution,  and  resisting 
decomposition  and  drying. 

Seminal  stains  may  be  pure  or  mixed  with  mucus,  pus,  faeces, 
urine,  or  other  foreign  organic  or  inorganic  material,  and  the 
gross  appearance  of  the  stain  will  vary  accordingly.  Owing  to 
its  tenacious  physical  properties,  semen  clings  firmly  to  the  cloth- 
ing, penetrates  cloth  much  more  readil}7  than  blood  or  mucus, 
and  on  drying  gives  a  glazed  opaque  appearance  to  transmitted 
light  and  a  starched  consistence  to  the  fabric.  The  color  is  gray 
1  Boston,  Journal  of  Applied  Microscopy,  1901,  vol.  iv.,  p.  1360. 


METHOD  OF  EXAMINATION.  887 

or  yellowish,  the  outline  irregular,  and  on  softening  with  water 
a  muciuous  quality  is  recognized,  and  a  faint  characteristic  odor 
may  be  detected.  Orfila  states  that  if  held  near  a  flame  seminal 
stains  become  pale  yellow,  while  other  dry  albuminous  stains  do 
not  change  their  color. 

The  detection  of  semen  may  also  be  required  in  fluid  mucous 
discharges,  urine,  solid  concretions  from  the  genitals,  or  on  the 
genital  hairs,  when  the  gross  examination  is  of  slight  moment. 

METHOD   OF   EXAMINATION. 

The  positive  identification  of  semen  can  be  accomplished  only 
by  the  detection  of  spermatozoa  under  the  microscope.  If  the 
material  is  fluid  it  is  diluted  in  salt  solution,  examined  in  a  thin 
layer  under  a  cover-glass  and  by  a  moderately  high-power  lens. 
Dried  smears  of  the  fluid  stained  by  eosin  and  methylene  blue 
greatly  assist  in  their  identification,  especially  when  the  sperma- 
tozoa are  fragmented. 

Whitney  recommends  staining  dried  specimens  successively 
with  watery  eosin  and  watery  methyl  green  in  order  to  bring 
out  the  rather  specific  structure  of  the  head. 

From  dry  stains  the  restoration  of  spermatozoa  is  accom- 
plished by  softening  fluids,  as  in  the  case  of  blood-stains,  but  the 
manipulation  must  be  more  delicate  than  with  blood  because  the 
dried  spermatozoa  are  brittle  and  may  be  badly  comminuted  by 
careless  teasing  of  the  fabric.  Some  recommend  that  the  stained 
material  be  softened  by  water,  or  dilute  glycerin,  or  sodiuin-hy- 
drate  solution  tinged  with  eosin  or  iodine,  and  an  impression  of 
the  stain  taken  by  pressing  a  glass  slide  upon  it.  On  withdraw- 
ing the  slide  intact  spermatozoa  usually  adhere  to  the  surface  and 
are  readily  identified  either  fresh  or  after  staining.  Usually  it 
is  necessary  carefully  to  tease  apart  the  suspected  material  in 
softening  fluid  and  examine  it  under  a  cover-glass,  when  some 
intact  and  some  fragmented  spermatozoa  are  commonly  detected. 

Grigorjew  1  finds  that  semen  on  cloth  or  mixed  with  fseoes  or 
organic  material  is  best  examined  after  treatment  with  concen- 
trated sulphuric  acid  for  four  to  seventy-two  hours,  which  dis- 
solves the  organic  matter  while  leaving  the  resistant  spermatozoa 
nearly  intact  and  plainly  visible  in  the  transparent  fluid.  For 

1  Grigorjew,  Vierteljahrsschr.  f.  ger.  Med.,  Bd.  xxiv.,  p.  82. 


888 


SEMINAL   STAINS — EWING. 


stains  011  insoluble  material  which  cannot  be  treated  in  this  way 
he  uses  glacial  acetic  acid,  which  renders  the  heads  more  distinct 
while  clearing  up  much  detritus. 

In  the  microscopical  examination,  especially  of  stained  prep- 
arations, one  may  detect  besides  spermatozoa  many   epithelial 


FIG.  35.— Different  Crystals  Forming  In  Semen  some  Time  after  Ejaculation.  X  500.  1,  Crys- 
tals of  phosphate  of  spermln ;  2,  needles  of  fatty  acids ;  3,  crystals  of  ammonio-magnesium 
phosphate.  After  Deguy  and  Guillaumin,  "  Tralte"  de  Microscopic  Clinique,"  Paris,  1906. 

cells,  pigmented  if  from  the  seminal  vesicles,  prostatic  concre- 
tions, albuminous  granules,  red  cells,  and  leucocytes.  The  sper- 
min  crystals  are  frequently  found  in  dry  semen,  but  should  be 
cautiously  differentiated  from  triple  phosphate. 

The  recognition  of  spermatozoa  presents  no  difficulties  if  com- 
plete individuals  are  encountered,  while  no  reliance  whatever  can 
l>e  placed  upon  the  discovery  of  probable  fragments  of  the  tail. 
A  distinct  head  and  considerable  portion  of  the  tail  cannot, 
however,  be  mistaken  for  any  other  object  in  nature.  The  Tri- 


FLORENCE'S  TEST  FOR  SEMEN.  889 

chomonas  vaginae  often  mentioned  as  resembling  spermatozoa  has 
a  globular  head  several  times  larger,  several  cilia,  and  a  short 
tail.  Besides  the  spermatozoa  one  should  carefully  note  all  other 
elements  which  appear  under  the  microscope,  such  as  fragments 
of  cloth,  hairs,  red  and  white  blood  cells,  etc.,  all  of  which  may 
later  prove  of  significance  in  the  case. 

RESULTS  OF  EXAMINATION. 

While  the  detection  of  spermatozoa  is  a  positive  indication  of 
the  presence  of  semen,  a  negative  result  does  not  exclude  its  pres- 
ence. Spermatozoa  are  absent  from  the  semen  of  young  boys 
and  old  men,  and  their  absence  from  the  semen  of  apparently 
healthy  men  is  so  frequent  that,  according  to  Kehrer, l  sterility 
is  in  forty  per  cent  of  cases  referable  to  azoospermia  in  the  male, 
usually  from  epididymitis.  Yet  the  great  resistance  of  sperma- 
tozoa to  chemical  agents  and  decomposition  makes  it  possible  to 
identify  them  after  many  years  of  drying,  Bayard 2  having  de- 
tected them  after  six  years,  and  Eoussiu 3  after  eighteen  years. 

If  a  prolonged  search  for  spermatozoa  proves  to  be  negative 
and  the  other  features  of  the  stain  warrant  a  strong  suspicion 
that  it  contains  semen,  corroborative  evidence  may  be  obtained 
by  Florence's  test. 

FLORENCE'S  TEST  FOR  SEMEN. 

This  test  is  based  on  the  formation  of  characteristic  crystals 
of  iodo-spermin  when  spermatic  fluid  is  treated  with  an  ice-cold 
iodine  solution  of  the  following  composition : 

Iodine,  1.65  gm. ;  potassium  iodide,  2.54  gm. 
Aqua  dest.,  30  c.c. 

When  a  portion  of  a  suspected  stain  is  placed  in  the  solution 
at  low  temperature,  dark-brown  crystals  of  idiospermin  readily 
form  which  may  be  seen  by  the  naked  eye.  Under  the  micro- 
scope the  crystals  first  appear  as  fine  needles,  single  or  grouped 
in  rosettes  or  pairs,  but  soon  they  grow  to  larger  rhombic  prisms 

1  Kehrer,  Beitr.  zur  klin.  Gynae-          3  Roussin,    Annal.    d'Hyg.    publ., 
kol.,  1879,  Bd.  ii.  1867,  i.,  p.  152. 

-  Bayard,  "  Manuel   Prat,  de  M6d. 
16-rale/'  T.  ii.,  p.  6. 


890 


SEMINAL   STAINS — EWING. 


resembling  hsemin  crystals,  which  are  soluble  in  water,  alcohol, 
acids,  and  alkalies.  Being  soluble  also  in  iodide  of  potassium, 
they  may  disappear  from  the  specimen  in  a  few  hours. 

Takayama l  recommended  the  following  reagent,  with  which 
he  secured  excellent  crystals  that  remained  intact  for  two  weeks: 


FIG.  36.— Florence  Crystals  from  Human  Semen.  Prepared  by  adding  to  the  extract  from 
the  seminal  stain  in  60-per-cent  alcohol  an  equal  part  of  a  solution  containing  2  per  cent  each 
of  potassium  iodate  and  iodide,  acidulated  with  5  per  cent  phosphoric  acid,  and  cementing  on 
the  cover-glass  with  Japan  varnish.  Photographed  the  third  day  after  preparation.  X  175. 
(After  Takayama). 

Potassium  iodate,  2  gm. ;  potassium  iodide,  2  gm. ;  phosphoric 
acid,  5  gm. ;  aqua  dest.,  100  gm. 

Florence  regarded  this  test  as  specific  of  human  semen,  hav- 
ing failed  to  obtain  it  from  other  genito- urinary  secretions  or 
from  other  animal  semen,  but  his  claims  have  not  been  sustained. 

Posuer 2  obtained  the  crystals  from  a  solution  of  pure  sper- 
min  phosphate  (Poehl),  but  not  from  piperazin,  the  isomere  of 
spermin.  Whitney 3  found  the  test  always  successful  with  semi- 

1  Takayama,  Beitr.  z.  Tox.  u.  d.          3  Whitney,  Boston  Med.  and  Surg. 
ger.  Med.,  Stuttgart,  1905,  p.  169.          Jour.,  1897,  vol.  cxxxvi.,  p.  329. 

2  Posner,  Berl.  kl.  Woch.,  1897,  p. 
62. 


FLORENCE'S  TEST  FOB  SEMEN.  891 

nal  stains  and  negative  with  various  secretions,  and  with  the 
tissue  of  a  leukseinic  spleen  containing  Charcot-Leyden  crystals, 
but  he  also  obtained  a  reaction  from  rabbit  semen.  Eichter  * 
obtained  the  reaction  from  semen  which  contained  no  sperma- 
tozoa, but  also  from  prostatic  and  vaginal  secretions  and  other 
organic  fluids  containing  lecithin,  and  concluded  that  the  test  is 
chiefly  of  value  as  excluding  the  presence  of  senien  when  the  re- 
sult is  negative.  Cruz,2  however,  as  well  as  Eichter,  had  nega- 
tive results  with  some  specimens  of  semen,  and  the  former  states 
that  crystallization  may  be  prevented  by  the  presence  of  much 
urine,  blood,  or  pus. 

Florence's  test  must  therefore  be  reserved  for  the  prelimi- 
nary examination  of  suspected  stains,  and  a  negative  result  held 
to  indicate  a  strong  probability  that  no  semen  is  present. 

1  Richter,  Wien.  klin.  Woch.,  1897,          2  Cruz,  Annal.  d'Hyg.  Publ.,  1898, 
p.  569.  T.  39,  p.  158. 


THE 

EXAMINATION  OF  HAIR 


BY 

JAMES  EWING,  A.M.,  M.D., 

Professor  of  Pathology  in  Cornell  University  Medical  College. 


THE  EXAMINATION  OF  HAIE. 

GREAT  importance  attaches  to  the  examination  of  hairs  and 
fibres  found  upon  weapons,  in  blood  and  other  stains,  upon  the 
clothing  or  person  of  the  victim  or  assailant  in  violent  encoun- 
ters, or  upon  objects  in  the  vicinity  of  a  criminal  act,  and  the 
collection  of  evidence  should  never  fail  to  include  all  the  material 
of  this  sort  that  can  be  discovered.  The  peculiar  importance  of 
this  class  of  evidence  consists  in  the  facts  that  human  hair  can 
usually  be  distinguished  from  that  of  all  lower  animals,  that 
among  the  lower  animals  the  hair  is  often  extremely  characteris- 
tic of  the  species,  that  the  location  of  hairs  can  be  fixed  often 
with  great  accuracy,  that  their  manner  of  extraction  can  be  de- 
termined, that  from  the  hairs  the  age  of  the  individual  may  be 
estimated  with  some  accuracy,  and  that  animal  hairs  and  vege- 
table fibres  may  be  distinguished  with  certainty. 

Numerous  recorded  cases  collected  by  Taylor,1  Tidy,2  and 
Oesterlen3  illustrate  the  great  medico-legal  importance  of  hairs. 
In  many  cases  the  discovery  of  hairs  on  weapons  found  far  away 
from  the  locality  and  long  after  the  date  of  a  crime  has  demon- 
strated that  these  weapons  were  the  ones  employed  in  the  acts. 
Robin4  demonstrated  that  a  man  was  not  killed  in  the  field  where 
his  body  was  found  but  in  his  house,  by  finding  on  the  doorsill 
a  few  bloody  hairs  corresponding  to  those  of  the  victim's  head. 
Kolisko 5  found  some  bloody  hairs  of  the  scalp  with  attached  epi- 
dermis in  the  handkerchief  from  the  pocket  of  the  assailant. 
Gallard8  claimed  a  foetal  origin  of  hairs  found  on  a  linen  cloth 
in  which  the  victim  had  been  strangled.  Babcock7  mentions 
that  in  the  trial  of  Eubenstein  for  the  murder  of  Sarah  Alexau- 

1  Taylor.  "  Medical  Jurisprudence,"  5  Kolisko, Hoffmann's  "  Ger.  Med.," 
Philadelphia,  1892.  1902,  p.  447. 

2  Tidy,  "Legal  Medicine,"   Phila-  *Gallard;    Annal.    d'Hyg.    Publ., 
delphia,  1882.  Third  series,  T.  x.,  p.  371. 

3  Oesterlen,  Maschka,    "  Gerichtl.  7  Babcock,  Hamilton's  "System  of 
Med.,"  1881,  Bd.  i.,  p.  511.  Legal  Med.,"  vol.  i.,  p.  511. 

4  Robin,     Annal.     d'Hyg.     Publ., 
1858,  x.,  p.  434. 

895 


896  THE   EXAMINATION   OF    HAIR — EWING. 

der  a  fragment  of  cornhusk  and  a  fibre  of  wool  from  a  shawl 
worn  by  the  girl  found  attached  to  a  blood-spot  on  the  boat  of 
the  defendant  proved  to  be  very  important  evidence. 

In  many  cases  false  claims  or  probable  but  erroneous  con- 
clusions were  set  aside  by  the  discovery  that  the  hairs  in  ques- 
tion came  from  a  lower  animal,  or  were  probably  cut  off  and 
not  torn  out.  The  writer  once  found  several  human  hairs  torn 
from  the  scalp  and  mixed  with  blood  upon  the  shoes  of  an  assail- 
ant. The  precipitin  test  not  being  applicable  to  this  blood  on 
account  of  the  presence  of  tannin,  these  hairs  served  as  evidence 
that  the  blood  and  the  hairs  came  from  the  same  source. 


STRUCTURE   AND   GROWTH  OF   HAIR. 

The  hairs  are  flexible,  elastic,  horny  threads  corresponding 
anatomically  with  the  horny  layer  of  the  epidermis.  They  con- 
sist of  a  shaft  pro  jesting  beyond  the  skin,  a  root  lying  within 
the  skin,  a  bulb  which  is  the  expanded  end  and  is  occupied  by  a 
structure  of  the  corium  called  the  hair  papilla. 

The  root  of  the  hair  is  enclosed  in  the  hair/oZ^cte,  consisting 
of  the  epithelial  root  sheaths  and  the  connective -tissue  sheaths, 
while  sebaceous  glands  open  into  the  upper  part  of  the  follicle, 
and  a  smooth  muscle  bundle,  erector  pili,  is  attached  to  the 
sheath  beneath  a  sebaceous  gland  and  near  the  bulb.  Portions 
of  any  of  these  structures  and  even  of  contiguous  fat  adhere  to 
the  hair  when  forcibly  extracted. 

The  shaft  of  the  fully  developed  hair  shows  three  strata:  (1) 
cuticle,  (2)  cortex,  (3)  medulla.  The  cuticle  consists  of  the  im- 
bricated scales  which  are  non-nucleated  horny  epithelia.  The 
size  and  character  of  these  scales  vary  in  different  animals  and 
in  different  regions  of  the  same  animal.  Their  free  ends  point 
to  the  tip  of  the  hair,  and  each  scale  in  the  human  hair  covers 
about  four-fifths  of  the  underlying  scale. 

The  cortex  consists  of  densely  packed  fibres  which  are  elon- 
gated horny  epithelia  with  attenuated  nuclei.  Nearer  the  bulb 
the  fibres  become  softer  and  rounder  and  the  nuclei  more  volu- 
minous. The  medulla  is  absent  in  many  fine  human  hairs,  and 
when  present  does  not  extend  throughout  the  entire  hair  shaft. 
It  consists  of  a  double  row  of  granular  cuboidal  epithelial  cells. 
Colored  hairs  contain  pigment  grains  in  the  medulla  and  cortex 


STRUCTURE   AND   GROWTH   OF   HAIR. 


897 


elaborated  by  the  epithelial  cells,  arid  adult  hairs  contain  numer- 
ous air  vesicles  in  medulla  and  cortex  which  contribute  to  the 
opacity  and  affect  the  color. 


Fio.  37.— Longitudinal  Section  of  the  Lowest  Divisiou  of  the  Root  of  the  Hair. 

tical  section  of  the  human  scalp.     (After  stohr.) 
III.— 57 


From  a  ver- 


898  THE  EXAMINATION  OF   HAIR— EWING. 

The  number  of  hairs  in  a  given  area  of  the  scalp  varies  in 
different  races  and  individuals  and  at  different  ages  in  the  same 
individual.  Hilgendorf1  counted  in  1  sq.  cm.  272  hairs  in  a 
German,  252  to  286  in  a  Japanese.  Withof 2  found  the  hairs 
more  numerous  in  blond  than  in  dark  subjects,  and,  in  areas  of  J 
square  inch,  counted  147  black,  162  brown,  and  182  blond  hairs. 
The  grouping  of  the  hairs  in  twos,  threes,  or  fours  is  sometimes 
an  individual  characteristic  and  depends  on  the  anatomical  ar- 
rangement of  the  follicles. 

The  hairs  are  constantly  being  thrown  off  and  replaced  by 
new  ones,  those  present  at  birth  being  rapidly  replaced,  while 
the  life  of  the  hair  of  the  adult  scalp  is  placed  at  1,600  days 
(Stohr3).  In  this  shedding  process  the  bulb  becomes  horny  and 
rounded  or  frayed  and  displaced  from  the  papilla,  while  the 
empty  root  sheath  collapses.  After  a  considerable  period  the 
epithelial  cells  of  the  root  sheath  begin  to  proliferate  and  form 
a  new  hair  alongside  of  the  old,  which  after  a  time  falls  out. 
Pincus4  states  that  the  rate  of  growth  of  the  hair  of  the  head 
during  the  first  two  years  is  from  2  to  5  mm.  (^  to  -^  inch)  in 
ten  days.  In  authentic  instances  the  hair  has  been  known  to 
grow  long  after  death. 

THE  DISTINCTION  BETWEEN  LOWER  ANIMAL  AND 
HUMAN  HAIRS. 

In  nearly  all  cases  microscopical  examination  shows  definite 
features  of  the  cuticle,  medulla,  and  cortex,  which  permit  the 
certain  differentiation  of  human  hairs  from  those  of  the  lower 
animals.  The  cuticle  of  human  hairs  is  composed  of  very  fine 
scales  which  project  very  slightly  and  can  be  detected  only  by 
careful  focussing  with  a  moderately  high-power  lens  and  often 
only  after  the  edge  of  the  hair  has  been  cleared  in  strong  sul- 
phuric acid. 

The  cuticle  of  most  animal  hairs  is  composed  of  much  larger 
scales  which  project  prominently  in  step-like  or  wavy  succession, 
yielding  a  very  characteristic  appearance,  especially  evident 
when  any  excess  of  pigment  is  dissolved  in  strong  nitric  acid. 
Even  in  very  fine  animal  hairs  these  cuticular  markings  serve  for 

1  Hilgendorf,    cit.    by    Hamilton,  3  Stohr,  "  Text-book  of  Histology," 

"System  of  Legal  Med.,"  1900,  vol.  1906,  p.  322. 

L,  p.  196.  4  Pincus,  Virchow's    Archiv,  1866, 

a  Withof,  ibid.  Bd.  xxxvii.,  p.  18. 


MEDICAL   JURISPRUDENCE-PLATE   X. 


2. 


3. 


4. 


EXPLANATION   OF   PLATE   X. 


HAIHS. — 1,  Human;  2,  cat;  3,  dog;  4,  calf;  5,  sheep;  6,  rabbit;  7, 
guinea-pig;  8,  white  rat;  9,  white  mouse.  No.  1  is  X  300,  the  others  are 
X  150. 

Photographed  by  Dr.  Leopold  Jaches. 


DISTINCTION  BETWEEN  HUMAN  AND  ANIMAL  HAIRS.    901 

identification.  This  character  suffices  for  the  identification  of 
human  hairs  from  the  hair  of  the  sheep,  goat,  horse,  dog,  cat, 
and  cow.  The  tips  of  hairs  from  the  hare,  field-mouse,  and  mole 
show  feathery  projections  of  the  cuticle. 

The  cortex  and  medulla  of  lower-animal  hair  differ  even  more 
strikingly  from  the  human.  The  cortex  of  the  human  hair  forms 
the  bulk  of  the  shaft  while  the  medulla  is  always  relatively  nar- 
row, and  in  the  downy  hairs  and  often  in  the  fine  hairs  of  the 
scalp  the  medulla  is  absent.  In  animal  hairs  the  round  or  oval 
medullary  cells  are  much  more  prominent  and  may  usually  be 
detected  by  a  low  magnification,  and  in  most  animals  these  cells 
occupy  a  wider  zone  than  the  cortex.  Oesterlen's1  table  shows 
that  in  human  hairs  the  cortex  is  usually  four  to  ten  times  as 
broad  as  the  medulla,  while  in  the  lower  animals  the  cortex  is 
seldom  more  than  twice  as  broad  as  the  medulla  and  is  often  re- 
duced to  a  thin  shell  enclosing  the  medullary  cells.  The  arrange- 
ment of  the  medullary  cells  is  also  characteristic.  In  the  dog 
and  cat  the  tips  of  the  hairs  show  a  single  row  of  polygonal  cells 
which  increase  in  width  as  the  hair  broadens.  In  the  hare  and 
occasionally  in  the  dog  this  row  of  cells  may  become  double, 
while  in  the  hare  multiple  spirally  twisted  rows  yield  a  very 
peculiar  appearance  in  the  broader  hairs.  Even  those  hairs 
which  most  resemble  human  may  still  be  recognized  by  the 
greater  breadth  of  the  medulla.  Nevertheless,  the  medulla  is 
entirely  missing  in  some  hairs  or  more  often  from  some  portion 
of  the  shaft  in  lower  animals.  Sharply  marked  areas  of  different 
color  are  found  only  in  the  hair-shafts  of  lower  animals,  and  in 
dyed  human  hair. 

When  several  hairs  can  be  obtained  for  examination  the 
above  criteria  are  usually  sufficient  to  warrant  a  positive  opinion 
regarding  their  origin. 

The  exact  measurements  of  the  diametem  of  the  hairs  and 
their  strata  is  often  required  and  may  be  accomplished  by  the 
micrometer  eye-piece.  The  following  table  of  Oesterlen's  gives 
the  average  diameters  of  the  broadest  portions  of  many  hairs 
from  different  animals,  and  in  different  ages,  sexes,  and  regions 
in  man: 

1  Oesterlen,Ma8chka,  "  Ger.Med.,"  1881,  Bd.  i.,  p.  511. 


902 


THE  EXAMINATION  OF  HAIR — EWING. 


Medulla. 

MEN. 
Top  of  head  

0.006  mm.  =  1-4233  in. 

Crown           

0.010  mm.  =  1-2540  in. 

Temple.           

0.014  mm.  =  1-1814  in. 

Forehead       

0.012  mm.  =  1-2117  in. 

Eyelashes       

0.004  mm.  =  1-6350  in. 

Eyebrows  

0.010  mm.  =  1-2540  in. 

Mustache  .  .        

0.  032  mm.  =  1-794    in. 

Axilla                   

0.  008  mm.  =  1-3175  in. 

Pubes  

0.015  mm.  =  1-1693  in. 

WOMEN. 
Top  of  head  

0.007  mm.  —  1-3629  in. 

Crown  

0.012  mm.  =  1-2117  in. 

Temple  

0.013  mm.  =  1-1953  in. 

Forehead              

0.008  mm.  —  1-3175  in. 

Eyelashes 

0.011  mm.  —  1-2309  in. 

Eyebrows  

0.014mm.  =  1-1814  in. 

Axilla  

0.015  mm.  =  1-1693  in. 

Pubes  

0.012mm.—  1-2117  in. 

OLD  MAN. 
Top  of  Head  

0.012mm.—  1-2117  in. 

Crown  

0.012mm.—  1-2117  in. 

Temple. 

0.014mm.—  1-1814  in. 

Forehead  

0.011  mm.—  1-2309  in. 

BOY  —  Aged  15  years. 
Top  of  head  

0.012mm.—  1-2117  in. 

Nape  of  neck  

0.010  mm.  —  1-2540  in. 

Crown  

0.011  mm.  —  1-2309  in. 

Eyebrow  

0.011  mm.—  1-2309  in. 

BOY  —  Aged  1-i  years. 
Forehead  

0.009mm.—  1-2822  in. 

BOY—  Aged  6  months. 
Crown  

0.010  mm.  —  1-2540  in. 

ANIMALS. 
Dog  —  belly  

0.  040  mm.  —  1-635    in. 

'  '     back  

0.  048  mm.  —  1-529    in. 

White  poodle  

0.008mm.—  1-3175  in. 

White  horse  —  back  .  . 
belly.... 
Black  horse  —  back  .  .  . 
belly... 

0.  069  mm.  =  1-368    in. 
0.036mm.  =  1-706    in. 
0.040  mm.  =  1-635    in. 
0.034mm.—  1-747    in 

Goat  

0.  045  mm.  —  1-564    in. 

Cow  —  belly  

0.  026  mm.  —  1-976    in 

4  '       back  

0.026  mm.  —  1-976    in 

Cat—  back.  .. 

0.  057  mm.  —  1-446    in 

'  '      belly.  .  .  . 

0  010  mm.  —  1-2540  in 

Hare  —  back  .  .  . 

0.  048  mm.  —  1-529    in. 

'  '      belly  .  .  . 

0  046  mm  —  1-552    in 

Mole  —  fine  

0  006  mm.  —  1-4233  in 

'  '       coarse  

0.018  mm.  —  1-1411  in 

Shaft 


0.052mm. 
0.053mm. 
0.096mm. 
0. 091  mm. 
0.043  mm. 
0.042mm. 
0.123mm. 
0.079mm. 
0.099mm. 


0.043mm. 
0.081  mm. 
0.066mm. 
0. 054  mm. 
0.076mm. 
0.060mm. 
0.086mm. 
0. 105  mm. 


0.059mm. 
0.067mm. 
0.063mm. 
0.048mm. 


0.059mm. 
0.061  mm. 
0.055mm. 
0.053mm. 


1^488  in. 
1-479  in. 
1-264  in. 
1-279  in. 
1-591  in. 
1-604  in. 
1-206  in. 
1-321  in. 
1-256  in. 


1-591  in. 
1-313  in. 
1-385  in. 
1-470  in. 
1-334  in. 
1-423  in. 
1-295  in. 
1-241  in. 


1-430  in. 
1-379  in. 
1-403  in. 
1-591  in. 


1-430  in. 
1-416  in. 
1-462  in. 
1-479  in. 


0.039  mm.  =  1-651  in. 
0.046  mm.  =  1-552  in. 


0.074mm.: 
0.069mm.: 
0.025mm.; 
0.114  mm. 
0. 083  mm. : 
0. 088  mm. : 
0.057  mm.: 
0.065mm.: 
0.057mm.: 
0.038mm.: 
0.075mm.: 
0.015mm.: 
0. 053  mm. : 
0.055mm.: 
0.008mm.: 
0. 024  mm. : 


1-343  in. 
1-368  in. 
1-1016  in. 
1-223  in. 
1-306  in. 
1-288  in. 
1-446  in. 
1-391  in. 
1-446  in. 
1-668  in. 
1-338  in. 
1-1693  in. 
1-479  in. 
1-462  in. 
1-3175  in. 
1-1058  in. 


CHARACTER  OP  HAIRS   IN  DIFFERENT  BODY   REGIONS.     903 

CHARACTERS  OF  HAIRS  IN  DIFFERENT  BODY   REGIONS. 

Variations  in  length,  thickness,  and  form  of  human  hairs  are 
usually  sufficient  to  indicate  the  location  from  which  they  have 
been  derived ;  but  when  only  a  single  specimen  or  a  very  few 
are  at  hand  the  conclusion  will  often  remain  uncertain. 

The  fine  downy  hairs  of  the  general  body  surface  can  be 
readily  identified  by  their  fineness,  shortness,  and  absence  of 
medulla  and  pigment. 

The  length  of  the  hair  is  alone  sufficient  to  indicate  the  origin 
in  the  case  of  the  head  hair  of  females.  Hairs  of  the  beard  and 
head  may  attain  great  length  in  males,  but  are  seldom  longer 
than  12  inches.  The  hairs  of  the  pubes,  axillae,  and  chest  are 
1  to  3  inches  in  length;  shorter  hairs  suggest  an  origin  from  the 
arms  or  legs;  while  the  eyebrows,  lashes,  and  nostrils  present 
hairs  J  to  ^  inch  in  length. 

The  diameter  of  the  hair  varies  in  different  portions  of  the 
shaft,  in  different  localities,  and  with  the  age  and  type  of  the  in- 
dividual. The  thickest  hairs  are  those  of  the  beard. 

Oesterlen  found  the  average  diameter  of  many  hairs  of  the 
beard  and  other  regions  as  follows:  Chin,  .125mm.  (3-^  inch); 
genitals,  .121  mm.  (-g\-g  inch) ;  mustache,  .115mm.  (F|T  inch)  ; 
cheek,  .104  mm.  (j^y  inch);  scrotum,  .082  mm.  (7J7  inch); 
eyebrow,  .080  mm.  ( j{T  inch) ;  eyelid,  .076  mm.  (^T  inch) ; 
axilla,  .077  mm.  (3^  inch);  head  hairs,  .07  mm.  (-$}-$  inch). 

Yet  it  is  commonly  observed  that  in  each  region  the  diameters 
of  the  hairs  vary  greatly  in  different  individuals,  and  even  in  the 
same  individual.  Oesterlen  measured  head  hairs  varying  in 
thickness  between  .030  mm.  and  .117  mm.  (xlr  an<^  TIT  incn)» 
pubic  hairs  from  .064  to  .153  mm.  (7|T  to  ^^  inch)  ;  and  of  the 
beard  from  .062  to  .159  mm.  (rj^  to  y^  inch). 

The  form  of  the  hair  shaft  is  circular  in  section  if  the  hair  is 
straight,  as  from  the  scalp  and  eyelashes,  while  the  twisted  curly 
hair  of  the  pubes,  beard,  chest,  axilla,  and  nares  is  oval  or  tri- 
angular or  irregular  on  section. 

The  roots  of  hairs  cleansed  in  strong  alkali  appear  short  and 
thick  in  the  case  of  long  body  hairs ;  the  short  body  hairs  have 
a  long  thin  root;  while  the  roots  of  the  beard  and  the  head  hairs 
lie  between  these  extremes,  being  a  little  longer  than  broad. 
The  ends  of  the  hairs  deserve  attention. 


904 


THE   EXAMINATION   OP   HAIR — EWING. 


The  short  hairs  of  the  eyelashes  and  nares  rapidly  come  to  a 
point,  while  the  larger  hairs  slowly  diminish  in  diameter  toward 
their  tips,  often  becoming  extremely  minute  for  some  distance. 
The  short  body  hairs  have 
rounded  ends,  sometimes  split 
or  thickened,  owing  to  con- 
stant trauma  and  moisture. 

Hairs  from  the  scrotum, 
vulva,  and  axilla  are  con- 
stantly subjected  to  moisture 
and  rubbing,  they  lose  their 
cuticle,  and  their  macerated 
shafts  often  show  the  split- 
ting of  fibres,  giving  the  ends 
a  brush-like  appearance,  or 


FIG.  38. 


FIG.  39. 


FIG.  38.— Hair  from  Lower  Part  of  Thigh,  with  Rounded  Ends.     X  7.    (After  Hofmann.) 
FIG. 39.— Ends  of  Hair  from  Woman's  Head.    X  70.    (After  Hofmann.) 

the  rounded  ends  may  become  thickened  and  club-shaped  from 
adherent  detritus.  Prolonged  combing  and  brushing  often  split 
the  ends  of  the  hairs  of  women,  and  give  them  a  characteristic 
appearance. 

Freshly  cut  hairs  exhibit  a  sharply  cut  edge  with  projecting 
cuticle  and  possibly  some  loosened  fibres,  but  after  one  week  the 
end  becomes  square,  smooth,  and  rounded,  but  blunt.  After 
twelve  to  fifteen  weeks  the  end  becomes  elongated,  but  never  to 


IDENTITY   OF   THE  INDIVIDUAL.  005 

the  same  extent  as  the  original  uncut  end,  and  the  medulla  is 
always  absent  from  such  ends. 

IDENTITY  OF  THE  INDIVIDUAL   FROM  WHOM  THE  HAIRS 

ORIGINATE. 

The  attempt  to  demonstrate  that  certain  hairs  belong  to  a 
particular  individual  can  seldom  be  successful,  but  in  some  cases 
a  strong  probability  can  be  established  regarding  the  age  and  sex 
of  the  subject,  or  a  direct  comparison  may  show  that  the  hairs 
under  examination  are  identical  in  appearance  with  those  of  a 
certain  individual,  although  not  necessarily  belonging  to  him. 
In  such  an  undertaking  it  is,  of  course,  necessary  that  a  con- 
siderable number  of  hairs  be  submitted  for  examination. 

AGE. 

The  head  hair  of  the  foetus  is  more  or  less  characteristic. 
Gallard  was  able  to  show  that  certain  hairs  probably  came  from 
a  fo3tus  of  5  to  7  months.  The  average  diameter  was  .024  mm. 
(T7J3T  iuch)  with  variations  between  .012  and  .040  mm.  (2,TV? 
and  ^3  inch).  He  found  that  five  new-born  infants  and  four 
foetuses  of  7  to  9  mouths  had  hairs  of  about  the  same  thickness 
(.028  to  .0376  mm.)  (^  to  T^  inch),  5-inonth  foetus  .024 
mm.  ( jvaVs  inch),  and  a  3-month  foetus  .018  mm.  (T,TVT  inch). 
The  hairs  in  question  were  therefore  thinner  than  those  of  a 
new-born  infant,  and  thicker  than  those  of  a  3-month  foetus. 
The  presence  of  downy  body  hairs  may  be  of  value  in  determin- 
ing the  age  of  the  foetus,  since  these  hairs  do  not  develop  before 
the  fifth  month,  while  during  the  ninth  and  tenth  mouth  they 
fall  out,  except  over  the  shoulders  and  thighs,  and  are  found 
free  in  the  amuiotic  fluid. 

The  head  hair  of  children  has  usually  no  medulla.  Oesterlen 
found  the  largest  average  diameter  of  the  head  hair  of  a  12-day 
infant  was. 024  mm.  (T,jjY^  inch)  ;  of  one  at  G  months,  .037  mm. 
(tfa  iuch) ;  at  18  months,  .038mm.  (^^  inch);  and  at  15 years, 
.053  mm.  (^^  inch)  ;  while  the  average  diameter  in  the  adult  is 
.071  mm.  (g^  inch). 

The  very  limited  value  of  such  measurements  is  apparent, 
however,  when  one  remembers  that  many  infants  are  born  with- 
out any  but  downy  hairs  on  the  head,  and  that  the  coarseness  of 


906  THE  EXAMINATION  OP   HAIR — EWING. 

the  hair  at  all  periods  of  life  is  a  very  prominent  individual  and 
racial  characteristic. 

SEX. 

The  sole  indication  bearing  upon  sex  to  be  derived  from  the 
hair  is  its  great  length  in  the  female.  Short  hairs  with  fine 
natural  points  are  constantly  growing  on  the  head  in  both  sexes. 

EACE. 

Certain  distinct  racial  characteristics  may  be  plainly  visible 
in  a  small  tuft  of  hair.  The  black  curly  hair  of  the  negro  is 
most  distinctive,  while  the  black  stiff  hair  of  the  American 
Indian  or  the  Mongolian  is  more  difficult  to  distinguish  from 
that  of  the  Caucasian. 

COLOR. 

The  color  of  the  hair  is  one  of  the  first  features  that  attracts 
the  attention  in  an  individual,  and  may  naturally  prove  of  value 
in  the  identification  of  single  hairs.  The  demonstration  that  the 
hair  has  been  artificially  altered  in  color  by  dyeing  or  bleach- 
ing may  likewise  be  found  very  significant  and  may  be  accom- 
plished by  microscopical  and  chemical  tests.  Under  the  micro- 
scope the  dyestuff  is  found  uniformly  distributed  over  the  shaft, 
but  not  extending  through  it.  The  dye  seldom  affects  every  por- 
tion of  the  shaft,  so  that  areas  which  have  not  been  reached  and 
still  reflect  the  normal  color  are  much  more  sharply  marked  than 
the  natural  gradation  of  color  in  normal  hair.  When  some  days 
have  elapsed  since  the  dyeing  the  new  growth  at  the  roots  of  the 
hair  will  be  found  unaltered  in  color. 

The  chief  chemicals  used  in  dyeing  the  hair  contain  salts  of 
lead,  bismuth,  silver,  or,  rarely,  nickel.  The  sulphides  of  these 
metals  are  produced  by  sulphur  washes  and  may  be  removed  by 
washing  in  dilute  nitric  acid  and  the  solutions  tested  for  the 
presence  of  metals.  The  hair  is  sometimes  hastily  blackened  by 
a  mixture  of  lampblack  in  oils,  which  may  be  removed  by  wash- 
ing in  xylol  or  ether.  Eed  and  brown  tints  are  sometimes  ob- 
tained by  means  of  saffron  and  permanganate  of  potash. 

Bleaching  by  peroxide  of  hydrogen  is  a  trade-mark  readily 
suspected  in  the  gross,  and  leaves  the  hair  unnaturally  brittle, 


DETERMINATION  OP  THE   MANNER  OF  EXTRACTION.      DO? 

while  the  pigment  granules  of  bright  yellow  color  are  still  visible 
under  the  microscope. 

DETERMINATION   OF  THE  MANNER,  OF   EXTRACTION. 

Hairs  separated  from  the  body  may  have  fallen  out  naturally, ' 
or  been  torn  out  forcibly,  or  been  cut  off,  and  the  microscopical 
study  will  often  enable  one  to  determine  which  event  has  oc- 
curred. 

HAIRS  THAT  HAVE  BEEN  CUT  OFF  will  show  an  absence  of 
the  roots,  while  the  severed  ends  exhibit  a  more  or  less  regular 
section.  A  sharp  knife  severs  the  hairs  evenly  and  without 
splintering  the  ends,  but  Oesterlen  found  that  a  sharp  knife  used 
with  a  sawing  motion  in  order  to  sever  loose  hair  left  many  ends 
somewhat  splintered. 

A  dull  knife  fractures  some  hairs,  splinters  the  ends  of  many, 
produces  several  planes  of  section,  and  may  pull  out  hairs  which 
fail  to  yield  promptly.  The  use  of  scissors  may  at  times  be  de- 
tected in  step-like  planes  of  section. 

HAIRS  PULLED  OUT  FORCIBLY  possess  roots  exhibiting  hol- 
lov.-^d  ends  in  which  lay  the  papillae  of  the  corium. 

THE  DISTINCTION  BETWEEN  FALLEN  AND  FORCIBLY 
EXTRACTED  HAIRS. 

In  order  to  determine  whether  hairs  have  fallen  out  or  have 
been  pulled  out  one  must  have  a  considerable  number  for  exam- 
ination. In  either  case  the  hairs  possess  roots,  but  the  appear- 
ance of  the  roots  varies,  in  living  hairs  which  could  not,  and  in 
dead  hairs  which  might,  have  fallen  out. 

If  a  firmly  fastened  living  hair  is  extracted  and  cleared  of 
the  adherent  scales,  its  root  will  be  found  hollowed  out  where  it 
covered  the  papilla  of  the  corium.  If  many  such  hairs  in  a 
group  show  such  hollowed  roots  it  is  impossible  that  they  could 
have  fallen  out.  Old  hairs  still  attached  to  the  skin,  but  which 
have  reached  their  full  development,  are  gradually  displaced  from 
the  papilla  and  sooner  or  later  will  fall  out  spontaneously.  The 
ends  of  such  hairs  are  rounded  and  solid.  If  a  group  of  hairs 
all  show  such  rounded  ends  they  could  not  possibly  have  been 
pulled  out  since  some  living  hairs  must  have  been  included  with 
the  others,  but  of  a  single  such  hair  with  rounded  end  it  can 


908 


THE  EXAMINATION   OP   HAlR — EWING. 


only  be  said  that  it  may  either  have  fallen  out,  or  have  "been 
brushed  out,  or  been  pulled  out  forcibly.  Eecently  extracted 
hairs,  especially  if  living,  very  often  show  adherent  red-cell  de- 
tritus and  large  scales  of  epithelium. 

EFFECTS   OF   HEAT. 

Minakow1  exposed  hair  to  dry  heat  120°  to  150°  C.  for  one 
hour  without  finding  any  gross  or  microscopical  changes.     At 


A  BCD 

FIG.  40.— A,  Thickened  End  of  Hair  Shaft  Burned  by  Flame.  JJ,  Distended  air  spaces  in 
nair  shaft  at  some  distance  from  burned  area.  C  and  D,  Air  spaces  in  medulla  of  hair 
shaft  scorched  by  curling  iron.  (After  Minakow.) 

180°  C.  the  hair  became  reddened  in  10  to  15  minutes,  and  curled 
owing  to  shrinkage  of  the  outer  layers  of  fibres.  At  240°  to  250° 
C.  the  hair  became  reddish  or  black  and  the  medulla  was  dis- 
tended with  large  vacuoles.  Curling  the  hair  with  hot  irons  pro- 
1  Minakow,  Vierteljahr.  f.  ger.  Med.,  1896,  Bd.  xii.,  Suppl.  Heft,  p.  105. 


EFFECTS   OF   HEAT.  909 

duced  characteristic  changes.  The  scorched  areas  of  the  shaft 
became  reddish  and  opaque,  while  the  medulla  aud  sometimes 
the  cortex  exhibited  groups  of  distended  air  spaces,  and  many 
fibres  were  split  off  from  the  shaft.  The  flame  from  pistol  shots 
began  to  scorch  the  hair  with  characteristic  changes  at  a  distance 
of  20  cm.,  the  effects  rapidly  increasing  with  closer  proximity  of 
the  weapon. 


GENERAL  INDEX 

TO 
VOLUMES  L,  II.,  AND  111. 


(For  Index  of  Laws  Regulating  the  Practice  of  Medicine,  see  also  Vol.  I ., 
pages  709-774.) 

PAGE 

ABDOMEN,  contusions  of, II.,  127 

post-mortem  examination  of,  .         -         .         .         .         .1.,  852 

wounds  of II.,  126 

ABDOMINAL  CAVITY,  post-mortem  examination  of,    .         .         .         .      I.,  846 

ABDOMINAL  VISCERA,  rupture  of, II.,  128 

wounds  of,         .         .         ...         .         .         .         .         .         .     II.,  128 

ABDOMINAL  WALL,  contusions  of,  II.,  126,  127 

wounds  of,         ..........     II.,  126 

ABORTIFACIENTS,  drugs  used  as,  .         .         .         .         .         .     II.,  372 

ABORTION II.,  355,  357,  369 

and  hypnotism,          .         . II.,  385 

at  common  law,         .         .         .         .         .         .         .         .1.,  74,  75,  76 

cases  illustrative  of, II.,  401 

criminal,  II.,  355,  369 

duties  of  medical  experts  in  cases  of,  ....     II.,  394 

diagnosis  of, II.,  357 

examination  of  discharged  matters, II.,  359 

clots, II.,  396,  399 

drugs,  instruments,  etc., II.,  397,  399 

foatus,          .         .         .         » II.,  396,  399 

ovum, II.,  396,  399 

woman  during  life, II.,  358,  394,  398 

after  death,          .         .         .  '      .         .         .         .     II.,  396,  398 

hemorrhage  after II.,  386 

ill  effects  of II.,  387 

induced,     .         .         .     -   .        .         .         .         .         .         .         .     II.,  357 

injuries  produced  by, II.,  389 

measures  used  to  produce, II.,  371 

i  general  methods,         .         .         .         .         .         .         .         .II.,  380 

internal  remedies, II.,  372 

local  measures,    .  II. ,381 

911 


912        GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

ABORTION, 

natural, II.,  364 

causes  of,  .         .         .         .         .         .         .         .         .II.,  364 

foetal  causes, II.,  367 

habit  of, II.,  365 

maternal  causes,          .         .         .         .         .         .         .         .II.,  366 

self-induced,  case  of, II.,  359 

sepsis  after, .         .         .         .II.,  386 

sequelae  of,         ..........     II.,  386 

hemorrhage, II.,  386 

sepsis, .     II.,  386 

subin volution,     .         .         .         .         .         .         .         .         .II.,  387 

tetanus,      ..........     II.,  393 

signs  of, II.,  395 

size  of  embryo,  .........     II.,  361 

spontaneous, 11.,  357,  364 

subinvolution  after, II.,  387 

tetanus  after, II.,  393 

was  it  caused  by  a  given  drug? II.,  379 

was  it  spontaneous  or  induced?          .         .         .         .         .         .II.,  364 

was  its  induction  justifiable?      .         .         .         .         .         .         .II.,  368 

weight  of  foetus,         .         .         .         .         .         .         .         .         .II.,  363 

ABSCESS  OF  BRAIN, II.,  109 

ACCIDENT  INSURANCE,  see  Insurance. 

ACCIDENT,  medico-legal  significance  of  term,  ....    III.,  1^6 

ACTION  FOR  MEDICAL  SERVICES  (and  see  Privileged  Communications). 

amount  of  recovery  in,       .         .         .         .         .         .         .         .         I.,  45 

common  law  rule  as  to  maintenance  of,  .         .         .         .         I.,  11 

elements  to  be  proved  in,  .         .         .         .         .         .         .         I.,  47 

evidence  in,        .         .         .         .         .         .         .         .         .         .  I.,  25-48 

license  prerequisite  to,  .         .         .         .         .         .         .         I.,  18 

measure  of  recovery,  the  reasonable  worth,        .         .         .         .         I.,  45 

value,  how  proved,     .........         I.,  46 

ACTION     FOR     PRACTISING     MEDICINE     WITHOUT     A     LICENSE,       .  I.,   18-23 

(See  also  Synopsis  of  Subjects,  I.,  709-774.) 
ADIPOCERE,      ...........        I.,  933 

ADOPTION,  sexual  incapacity  and,  .         .         .         .         .         .II.,  634 

ADVERTISING,  .         .         .    •     .         .         .         .         .         .  I.,  709 

AFFECTION,  medico-legal  significance  of  term,  ....    III.,  138 

AGE,  as  indicated  by  hair, .    III.,  905 

determination  of,       .         .         .         .         .         .         .         .         .1.,  882 

of  consent II.,  660,  664 

AGENESIA,   .  II.,  628,  739 

ALABAMA,  legal  status  of  dead  body  in, I.,  785 

statutes  regulating  the  practice  of  medicine  in,         .         .         .   *    I.,  180 

statutes  relating  to  incompetent  persons  in,       ....     III.,  607 

ALASKA,  legal  status  of  dead  body  in I.,  785 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.         913 

PAGE 

ALASKA, 

statutes  regulating  the  practice  of  medicine  in,         .         .         .        I.,  182 

statutes  relating  to  incompetent  persons  in,  .         .     III.,  615,  721 

ALBERTA,  statutes  regulating  the  practice  of  medicine  in,     .         I.,  619,  707 

ALCOHOLISM, II.,  110 

chronic,  ..........    III.,  330 

ALLOPATHIC  SCHOOL  OF  MEDICINE,          .        .        ,        .        .        .        I.,  709 

AMAUROsfs III.,  19 

AMBLYOPIA ,.,,..      III.,  19 

AMOR  LESBICUS, =  II.,  731 

ANAPHRODISIA,        ...  II.,  628, 642 

ANIMALS,  sexual  criminality  in,       .......      II.,  743 

unnatural  relations  with, „         .II.,  744 

ANTHROPOMETRY, I.,  914 

APHASIA,          ...........     III.,  190 

APNCEA ...,.„        II.,  225, 318 

APOPLEXY,      ...  ,  III.,  336 

APOTHECARY, I.,  709 

APPEAL I.,  710 

ARIZONA,  legal  status  of  dead  body  in,  .         .         ,         .         .        I.,  785 

statutes  regulating  the  practice  of  medicine  in,  .  .  .  I.,  184 
statutes  relating  to  incompetent  persons  in,  .  .  .  .  III.,  616 
ARKANSAS,  legal  status  of  dead  body  in,  .....  I.,  786 
statutes  regulating  the  practice  of  medicine  in,  .  ,  I.,  187,  679 
statutes  relating  to  incompetent  persons  in,  ....  III.,  617 

ARTERIES,  wounds  of II.,  124 

ASPHYXIA ,         .      II.,  225 

by  submersion, ,         .II.,  318,  319 

external  appearances  due  to,  .......       II. ,231 

internal  appearances  due  to,  .         .         .         .         .         .II.,  235 

survivorship  in  cases  of  death  by, II.,  346 

ASSAULT,  indecent II.,  662,  664,  706 

ASTIGMATISM,         ..........         III.,  7 

ATAVISM, II.,  645 

AUDITION,  see  Ear 

AUTOHYPNOSIS II.,  775 

AUTOPSIES,  MEDICO-LEGAL, .1.,  831-864 

after  death  from  electricity, .       II.,  218 

by  whom  ordered,    ......  .         I.,  783 

in  cases  of  poisoning,       ....  I.,  838,  853 

late I.,  860 

of  fragments, .  I.,  862 

of  infants, ,11.,  474 

order  of,  ....  .         .  I.,  838 

reports,  I.,  863 

rights  of  relatives  and  accused  persons,    ...  I.,  783 

AZOOPHILIA, II.,  739 

III.— 58 


914  GENERAL   INDEX    TO    VOLS.    I.,    II.,    AND    III. 


PAGE 


BACK,  INJURIES  TO, JI.,  816,  818,  819,  820,  823 

BALLOTTEMENT, II.,  565 

BANKRUPTCY  OF  INSANE  PERSONS, III.,  598 

BASTARDY,  impotence  and, II. ,  634 

BESTIALITY, II.,  737,  743,  744 

examination  in  alleged  cases  of,        .         ,         .         ,         .         .II.,  758 

BILLS  FOR  SERVICES,' effect  of,         .  I.,    43 

BIRTHS,  see  Labor. 

coffin, .         .       II.,  613 

post-mortem,   .........       II.,  366,  613 

precocious,       ..„,,.....       II.,  521 

BlUTEHINE  MARRIAGES,     .........         II.,  755 

BLADDER,  rupture  of,  .         .         .         .         .         .         .         .II.,  131 

wounds  of,        ....  .....       II.,  131 

BLANK  CHARGES,  wounds  by,  .         .         .         .         .         .         .II.,  166 

BLINDNESS,  simulated,  ........       III.,  19 

BLOOD  AND  BLOODSTAINS,  MEDICO-LEGAL  EXAMINATION   OF,  III.,  807-884 

age  of  blood,             .         .         .         .         .         .         .         .         .  III.,  815 

appearance  of  red  cells  in  washed  stains,          ....  III.,  832 

blood  spots,  location  of,            .......  III.,  810 

number  of, III.,  809 

Bordet-Gengou-Moreschi  phenomenon,  forensic  significance  of,  III.,  878 

coagulation  of,          .........  III.,  813 

color  of, III.,  815 

comparative  morphology  of  red  cells,       .         .         .         .         .  III.,  817 

complement  fixation,  forensic  significance  of,            ...  III.,  878 
conclusions  warranted  by  microscopical  examination  of  blood 

cells, III.,  834 

corpuscles,  red,  appearance  of,  in  washed  stains,             .         ,  III.,  832 

comparative  morphology  of,               ,  III.,  817 

method  of  measuring,        .......  III.,  833 

objects  simulating,             .         ,         .         .         .         .         .  III.,  832 

osmotic  relations  of,          ....                   .  III.,  819 

size  of, ...  III.,  821 

staining  properties  of,        ....                  .         .  III.,  820 

corpuscles,  white,             .         .         .         .         ...         .  III.,  827 

diagnosis  between  monkey  and  human  blood,          .         .         .  III.,  872 

differentiation  of  bloods,  miscellaneous  methods  of,          .         .  III.,  882 

by  form  of  Hb.  crystals,            ......  III.,  882 

by  odor  of  blood, III.,  883 

by  resistance  of  Oxy-Hb.  to  acids  and  alkalies,         .         .  III.,  883 

dry  blood, III.,  829 

evidence  and  material  gathered  by  the  examiner,             .         ,  III.,  809 

evidence  officially  handed  to  the  examiner,       ....  III.,  812 

examination  of,  gross  examination,           .....  III.,  812 

guaiacum  test,           ........  III.,  844 

hsemin  test,                III.,  848 


GENERAL   INDEX   TO   VOLS.    I.,    II.,    AND    III.  915 

PAGE 
BLOOD     AND     BLOODSTAINS,     MEDICO-LEGAL     EXAMINATION     OF, 

microscopic  examination, III.,  817,  828 

precipitin  serum  test, III.,  862 

spectroscopic  examination, III.,  854 

fresh  blood,  miscroscopical  examination  of,     .         .         .        .  III.,  828 

gross  examination, III.,  812 

guaiacum  test, III.,  844 

haemin  test III.,  848 

haemoglobin  crystals,  differentiation  of  bloods  by  form  of,     .  III.,  882 

leucocytes, III.,  827 

lochial  stains,            .........  III.,  843 

menstrual  blood, III.,  842 

menstrual  stains, III.,  842 

method  of  measuring  restored  red  cells,            ....  III.,  833 

microscopical  examination  of,           ......  III.,  817 

technic  of,                III.,  828 

miscellaneous  microscopical  objects  in  blood-stains,          .         .  III.,  828 

objects  simulating  red  cells,              .         .         .     '    .         .         .  III.,  832 

odor,  differentiation  of  bloods  by,             .....  III.,  883 

osmotic  relations  of  red  cells,            ......  III.,  819 

oxy haemoglobin,  resistance  of  to  acids  and  alkalies,  a  method  of 

differentiating  bloods, III.,  883 

precipitin  reaction,  nature  of, III.,  865 

specificity  of,              III.,  870 

precipitin  serum,  artificial  and  spontaneous  changes  in,            .  III.,  865 

production  and  use  of, III.,  874 

test   for,            III.,  862 

scheme  of  examination,             .......  III.,  812 

size  of  red  cells III.,  821 

specificity  of  precipitin  reactions,              III.,  870 

spectroscopic  examination,       ......  III.,  854 

staining,  methods  of,       ........  III.,  829 

staining  properties  of  red  cells, III.,  820 

stains  of  nasal,  buccal,  pulmonary,  and  gastro-intestinal  origin,  III.,  843 

substances  resembling  dried  blood, III.,  816 

BLOOD,  coagulation  of,  II.,  34,  218;  III.,  813 

after  electrical  injuries, II.,  218 

in  wounds II.,  34 

condition  of,  after  burns,          .         .         .  .         .         .1.,  966 

examination  of, III.,  812 

extravasation  of,  in  brain, II.,  Ill 

spatters  of, III.,  811 

stains I.,  833;   III.,  807-884 

on  weapons, II.,  81 

BLOOD-SPOTS,  location  of, III.,  810 

number  of III.,  809 

BLOWS  ON  ABPOMEN  CAUSING  DEATH, II.,  17 


91(5  GENERAL   INDEX   TO    VOLS.    I.,    II.,    AND   HI. 

PAGE 

BOARDS  OF  HEALTH,  physicians  to  report  contagious  diseases  to,  .  I.,  23 
state  and  local,  powers  governed  by  special  statutes,  .  .  I.,  23 

BOARDS  OF  MEDICAL  EXAMINERS,  I.,  711 

BODY,  see  Dead  Body. 

examination  of,         .         .         .         .         .         .         .         .         .        II.,  83 

temperature  of, I.,  941 

BONES,  identification  of  human,  I.,  873 

old  or  recent? I.,  874 

BOOKS,  medical,  when  and  where  used  in  court,  .  .  .  .  I.,  64 
of  original  entry,  when  admissible  in  evidence,  ...  I.,  48 
of  physician,  see  Privileged  Communications. 

BoRDET-GENGOu-MoRESCHi  PHENOMENON,  forensic  significance  of,      III.,  878 
BRAIN,  abscess  of,  .        .         .         .         .         .         .         .         .         .II.,  109 

compression  of,  II.,  847 

concussion  of, II.,  107, 843 

congestion  of,  in  drowning,       .......       II.,  318 

extravasation  of  blood  in,         .......       II.,  Ill 

post-mortem  examination  of,  ......        I.,  844 

wounds  of, II.,  115 

BREAKING  OF  LIMB,  medico-legal  significance  of  term,  .         .     III.,  138 

BREASTS,  see  Mammae. 

BRITISH  COLUMBIA,  statutes  regulating  the  practice  of  medicine  in,  I.,  579,  707 
BRITISH  POSSESSIONS,  statutes  regulating  the  practice  of  medicine  in,  542,  706 

BUCCAL  COITUS,  II.,  750 

BULLETS, II.,  141 

experiments  with,  II.,  169 

infected,  wounds  by, II.,  169 

loss  of  weight  of,      .         .         .  .         .         .         .         .       II.,  147 

track  of, II.,  141 

BURDEN  OF  PROOF, I.,  713 

BURIAL  OF  DEAD  BODY,  duration  of, I.,  887 

law  of, I.,  780-783 

BURKING II.,  297 

BURNS, I.,  842,  951 

by  acids, I.,  953 

by  boiling  water,      .         .         .         .         .         .         .         .         .1.,  952 

by  burning  oil, I.,  952 

by  corrosives, I.,  953 

by  electrical  currents,  • II.,  180,  192 

by  flame I.,  952 

by  fused  metals, I.,  952 

by  lightning II.,  211 

by  petroleum, I.,  953 

cases  of, I.,  970 

causes  of  death  by, I.,  957 

classification  of, .         .1.,  954 

constitutional  effects  of,  .        I.,  956 


GENERAL    IXDEX   TO    VOLS.    I.,    II.,    AND    III.  917 

PAGE 

BUHNB, 

local  effects  of, I.,  955 

of  the  eye,  .........       III.,  56 

period  of  death  from,  .         .         .         .         .         .         .        I.,  961 

post-mortem  appearances  of,  ......        I.,  960 

whether  ante-mortem  or  post-mortem,     .        .         .         .         I.,  961,  965 

CADAVERIC  CHANGES  (and  see  Post-mortem),  ....  I.,  924 

lividity, I.,  840 

rigidity, I.,  924 

saponifi cation, I.,  933 

CALIFORNIA,  legal  status  of  dead  body  in,  ....  I.,  786 

statutes  regulating  the  practice  of  medicine  in,  .  .  I.,  194,  680 
statutes  relating  to  incompetent  persons  in,  .  .  .  .  III.,  621 

CANADA,  statutes  regulating  the  practice  of  medicine  in,    .          I.,  589,  707,  714 

CARBON-MONOXIDE  HEMOGLOBIN,  III.,  856 

CARE  OF  INSANE,  see  Incompetent  Persons. 

CA»KS  ILLUSTRATIVE  OF: 

abortion,  ..........       II.,  401 

self-induced, II.,  359 

burns I.,  970 

coffin-birth, II.,  614,  616 

corpora  lutea II.,  595 

delusional  insanity, III.,  357-361 

diagnosis  of  delivery,        ........       II.,  595 

of  pregnancy,  ........       II.,  576 

early  viability,          .........       II.,  541 

exposure  to  heat  and  cold, I.,  970 

feigned  labor, II.,  580 

lying-in-state,    .  .         .         .         .         .         .         .II.,  580 

pregnancy,         .........       II.,  580 

hanging II.,  282 

accidental, II.,  296 

homicidal, II.,  289 

judicial,  . II.,  292 

suicidal,  II.,  282 

infanticide,  II.,  478 

melancholia, II I., 207,  223 

mothers'  marks,       .         .         .         .         .         .         .         .         .II.,  544 

partial  or  moral  insanity, III.,  447,  457 

post-mortem  parturition,          ......       II.,  614,  616 

prolonged  pregnancy,  .         .         .         .         .         .  II.,  515 

resemblances  between  parent  and  child,  .         .         .         .II.,  544 

strangulation, II.,  243 

accidental II.,  251 

homicidal,          .         .         .         .         „         .         .         .         .      II.,  243 
suicidal,  .  .         .      II.,  249 


918         GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

CASES  ILLUSTRATIVE  OF: 

substitution  of  children,  .         .         .         .....       II.,  551 

suffocation,      ....  .....       II.,  309 

accidental,         .         .         .         .    '     .         .         ...         .       II.,  309 

homicidal,          .         .         .         .         .         .         .         .  II.,  312 

suicidal, II.,  312 

superfoetation, II.,  600 

undue  influence, III.,  418,  521 

unconscious  delivery,        ........       II.,  610 

impregnation,  :        .         .         .         .         .         .         .II.,  604 

pregnancy,         .         .         .         ,         .         .         .         .         .II.,  606 

CATALEPSY,  I.,  984 

CAUSE  OF  DEATH: — 

from  severe  mechanical  injury,         ......         II.,  45 

from  submersion,     .         .         .         .         .         .         .         .         .II.,  319 

from  wounds,  .         .         .         .         .         .         .         .II.,  42,  43,  55 

hemorrhage  as,         .         .         .         .         .         .         .         .         .         II.,  43 

latent  disease  as,      .         .         .         .         .         .         .         .         .         II.,  49 

shock  as,  .........         II.,  45 

was  it  natural? II.,  49 

wounds  as  secondary, II.,  55 

CEMETERIES,  law  of, I.,  782,  783 

CERTIFICATE, I.,  714 

CHANCROID,  ..........       II.,  687 

CHARGES,  I.,  715 

CHARITY  PATIENTS,  experiments  not  to  be  tried  on,         .         ,...!.,  36,  83 

CHEMIST, .1.,  715 

CHILD  (and  see  Infant,  Foetus), II.,  355 

CHRISTIAN  SCIENCE,  . I.,  715 

CLAIRVOYANT, I.,  716 

CLITORIDISM, II.,  755 

CLOTHING,  action  of  lightning  on,  II.,  209 

examination  of,  ...  .      I.,  834;  II.,  25, 83 

COAGULATION  OF  BLOOD,          ....  II.,  34. 218-    III.,  813 

after  death  from  electricity,      .....  II.,  218 

in  wounds,  .......  II    34 

CODE  OF  ETHICS,  I.,  716 

COFFIN  BIRTH, II.,  613 

case  of,  II.,  614,  616 

COITUS,  buccal,  II.,  750 

rectal  (and  see  Pederasty),      .         .         .         .         .         .         .II.,  749 

COLD,  cases  of  exposure  to,  .......        I.,  970 

effects  of  extreme,  I.,  942 

survivorship  in  cases  of  death  by,  II.,  347 

COLLEGE I.,  716 

of  physicians, I.,  716,  717 

of  physicians  and  surgeons,  I.,  717 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.         919 

PAGE 

COLLEGE  of  surgeons, I.,  717 

COLORADO,  legal  status  of  dead  body  in, I.,  787 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  203,  680 

statutes  relating  to  incompetent  persons  in,              ...  III.,  626 

COMA,              II.,  225 

COMBUSTION,  SPONTANEOUS, I.,  959 

COMMITTEE,  definition  of,                          III.,  352 

COMMOTIO  CEREBRI,  .  .  .  ' II.,  843 

COMMUNICATIONS,  PRIVILEGED  (and  see  Privileged  communications),       I.,  33 
COMPENSATION  (and  see  Physician  and  Patient,  Expert  Witness, 

Coroners,  Medical  Examiners), I.,  717 

of  physicians  and  surgeons,  .         .         .         .         .1.,  25,  37,  717 

recovery  of,       .....        ~         ...        I.,  764 

COMPLAINT, I.,  718 

COMPLEMENT  FIXATION,  forensic  significance  of,  .         .         .     III.,  878 

COMPRESSION  OF  BRAIN. II.,  847 

CONCUSSION, II.,  18 

of  brain,  .         .         . II.,  107 

of  spinal  cord, II.,  119,  825 

of  spine, II.,  870 

CONGENITAL  PECULIARITIES,  identity  from, I.,  886 

CONNECTICUT,  legal  status  of  dead  body  in,        ....        I.,  788 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  205,  685 
statutes  relating  to  incompetent  persons  in.  ...     III.,  628 

CONSENT,  age  of,     .........       II.,  660,  664 

CONSTITUTIONALITY  OF  MEDICAL  LAWS,  ...        I.,  7-11,  719-728 

CONSTRUCTION  OF  STATUTES, I.,  728 

CONTINUOUS  PRACTICE, I.,  731 

CONTRACT, .        .        I.,  731 

with  patients  (and  see  Physicians  and  Surgeons),        .         .     I.,  25-36 

CONTRACTURES, II.,  910 

CONTRECOUP, II.,  105,  159 

CONTUSIONS I  ,  840;  II.,  13,  16,  69 

by  lightning,   . II.,  212 

of  abdomen, II.,  126,  127 

of  head, H-,  104 

of  neck, II.,  116 

CONVICTION,  I-,  732 

COPROLALIA, HI-.  257 

CORONER,  an  ancient  office, I.,  811 

authority,  delegation  of, I-,  813 

to  hold  inquest, !••  814 

county  officer, !••  812 

court, I.,  812 

duties,  both  judicial  and  ministerial, 

is  virtute  electionia  in  America, I.,  812 

judicial  authority  relates  to  inquiries  into  cases  of  sudden  death,        I.,  812 


920        GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 


CORONER, 

jurisdiction  of, I., 

jury  and  inquest,      .........         I., 

kinds  of,  at  common  law,         .......        I., 

Massachusetts  (see  Medical  Examiners). 

office  abolished  in, I.,  815 

statutory  provisions, I.,  818 

who  may  hold  inquest  in, I.,  818 

New  York,  movement  toward  abolition  of  office  in,          .         .        I.,  815 

statutory  provisions, I.,  819 

post-mortem  examination,        .......        I.,  817 

who  may  be  present  at,     .......        I.,  817 

powers  and  duties  of,          .......         I.,  809-83Q 

cannot  delegate  authority  or  appoint  deputy,  .         .        I.,  813 

contract  will  bind  county  for  payment  of  reasonable  com- 
pensation,      .........         I.,  816 

may  employ  professional  skill  to  aid  him,          ...        I.,  816 
may  have  body  disinterred,       ......        I.,  815 

may  issue  process  of  apprehension,  .         .         .         .        I.,  824 

power  to  hold  inquest,       ......         I.,  812,  814 

presumption  that  he  has  acted  in  good  faith,  ...        I.,  812 

prisoner,  privilege  of,  after  arrest,  .....        I.,  824 

process  of  apprehension,  power  to  issue  by,      ....        I.,  824 

professional  skill,  may  employ, I.,  816 

protected  under  same  principles  which  protect  judicial  officers,        I.,  813 
virtute  carlce  sive  commissionis ,          .         .         .         .         .         I. ,811,  812 

virtute  dectionis, I.,  811, 812 

virtute  offitii, I.,  811,  812 

CORONER'S  INQUEST,  all  evidence  must  be  presented  to  jury,  .         I.,  821 

authority  to  hold,     .........         I.,  814 

evidence  and  verdict,  effect  of,         ......        I.,  823 

evidence  taken  on,  of  a  party  charged  with  crime,  when  admissible 

in  evidence  upon  his  trial  subsequently,         ...         I.,  825-830 

jurors  must  be  sworn  by  coroner, I.,  820 

must  investigate  and  determine  the  facts,         .         .         .        I.,  820 
must  view  the  body,          .         .         .         .         .         .         .1.,  820 

not  challengeable,     .         .         .         .         .         .         .         .1.,  820 

jury  to  deliberate  and  return  inquisition,          ....        I.,  821 

must  be  held  upon  view  of  the  body, I.,  814 

New  York  statutory  provisions,       .         .         .         .         .         .        I.,  822 

one  only, I.,  814 

rights  of  accused  party, I.,  821,  824 

separate,  over  each  of  several  bodies, ' I.,  813 

super  visum  carporis,        ........        I.,  814 

witnesses,  attendance  of,  may  be  compelled,  .         .         .        I.,  821 

must  be  sworn  by  coroner,        .         .         .         .         .         .1.,  821 

CORPORA  LUTEA, .II.,  592 


GENERAL   INDEX   TO    VOLS.    I.,    II.,    AND   III.  921 

PAGE 

CORPORA  LUTEA,  cases  of,  .         .         .         .         .         .         .II.,  595 

CORPORATION,         .        .        .        ., I.,  732 

COURTS,  .        .        . I.,  732 

CRANIOMETRY,  , I.,  877 

CREMATION, I.,  872 

CRIMES,  UNNATURAL,       .........      II.,  737 

CRUSHES,  by  fall  of  heavy  weights, II.,  99,  100 

CUSTOM  OF  PHYSICIANS  to  serve  each  other  gratuitously  is  enforceable,    I.,  47 

DEAD  BODY,  autopsies  (and  see  Autopsies), I.,  783 

burial  of,  law  of, I.,  780-783 

changes  in, .         .        L,  923 

cooling  of I.,  923 

coroners'  duties  concerning  (and  see  Statutes  relating  to  dead 

bodies) I.,  784 

crimes  against  (and  see  Statutes  relating  to  dead  bodies),         .        I.,  781 
disposal  of,  and  obligation  to  dispose  of  the,  ...        I.,  779 

dissection  of,  when  permitted  (and  see  Statutes  relating  to  dead 

bodies), I.,  784 

examination  of,  for  evidence  of  gunshot  wounds.     .         .         .       II.,  158 
external  examination  of,  .......        I.,  840 

flaccidity  of, I.,  924 

inquest  upon  (and  see  Coroner's  Inquest),        ....        I.,  814 

internal  examination  of,  .         .         .         .         .         .         .         I.,  842 

legal  status  of  (and  see  Statutes  relating  to  dead  bodies),     .     I.,  777-808 

lividity  of, I.,  925 

position  of,       ..........        I.,  833 

post-mortem  examination  of  (and  see  Autopsies),  .         .        I.,  783 

putrefaction  of,         .........        I.,  927 

removed  and  exhumed,  how  and  by  whom  it  may  be,      .         .        I.,  782 

rigidity  of I.,  924 

saponification  of, I.,  933 

seizure  of,  for  debt,  forbidden,          ......        I.,  781 

statutes  relating  to  (and  see  Statutes  relating  to  dead  bodies),   I.,  785-808 
temperature  of,         ...'.....         I.,  923,  935 

DEAD-BORN, II.,  416 

DEATH,  apparent,  .........        I.,  921 

by  heat  and  cold, I.,  939 

caused  by  accident  or  disease,  distinction,        ....     III.,  137 

certificate  of,  value  of,  in  insurance  claims,      .         .         .         .     III.,  135 

following  rape,         ........        1 1.,  677,  690 

from  abdominal  blows,    .         .         .         .         .         .         .  II.,  17,45 

anaesthetics, II.,  62 

blows  on  the  head,   ........         II.,  18 

burns,  causes  of, I.,  957 

period  of, I.,  961 

whether  accidental,  suicidal,  or  homicidal,         .         .         I.,  969 


922        GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 


DEATH, 

from  cold, I.,  945 

electrical  currents,  .         .         .         .         .         .         .II.,  200 

exhaustion,        .  '.        .         .         .         .         .         .         II.,  46 

hanging,  proof  of,  .         .         .         .         .         .       II.,  279 

intemperance,  . III.,  139 

intoxicating  liquors,  . III.,  139 

latent  disease,  ...         .         .         .         .         .         .         II.,  49 

narcotics,  .         .         .         .         .         .         .         .         .     III.,  139 

natural  causes, II.,  49;  III.,  140 

slight  injuries,  .         .         .         .         .         .         .         .         II.,  53 

starvation,       *.         .         .         .         .         .         .         .         .        I.,  975 

strangulation,  proof  of, II.,  238 

submersion,       / .       II.,  317,  319 

suffocation,        .         .         .         .         .         .         .  II.,  299,  458 

proof  of,     .         . II.,  306 

surgical  operations,  .         .         .         .         .         .         II.,  61,  173 

wounds,  causes  of, II.,  42,  43,  55 

proofs  of, III.,  135 

proximate  cause  of,  medico-legal  significance  of  term,         .     III.,  141 

signs  of,  .  "...        I.,  923 

time  of,  '    .-         I., 919,  934 

DEATHS  IN  A  COMMON  DISASTER,      .         .         .         .         .         .         .II.,  337 

expert  medical  testimony  in,   .         .         .         ...         .         .II.,  340 

DEFENCE,  : I.,  734 

DEFLORATION,  complete,  recent,      .         .         .         .         .         .         .II.,  676 

diseased  conditions  simulating,         .         .         .         ;  II.,  680 

errors  in  examination  for,         .         .          .         .         .         .         .       II.,  701 

genitals  after, II.,  676 

hemorrhage  from,    ...  ....       II.,  676,  678 

in  children, II.,  708 

incomplete,      .         .         .         .         .         .         .         .         .         .       II.,  710 

recent,       ...  ......       II.,  679 

lacerations  of  hymen  in,   .......        IT.,  677,  708 

non-recent,       .         .         .         .         .         .         .         .         .         .       II.,  679 

rules  for  examination,      .         .         .         .         .         .         .         .       II.,  701 

signs  of,  ..........       II.,  674 

simulated, II.,  701 

slight  signs  of,  in  prostitutes,  .         .         .         .         .         .II.,  680 

DEFORMITIES,  identity  from, I.,  886,  912 

DELAWARE,  legal  status  of  dead  body  in,         .         .  .         .        I.,  788 

statutes  regulating  the  practice  of  medicine  in,        .         .         .        I.,  211 
statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  630 

DELIRIUM, III.,  182 

DELIRIUM  TREMENS,        .         .         .         .         .         .         .         .         II.,  60,  173 

DELIVERY, 

date  of,  .         .        . II.,  590 


GENERAL   INDEX   TO    VOLS.    I.,    II.,    AND    III.  923 

PAGE 

DELIVERY, 

diagnosis  of,  cases  illustrative  of, II.,  595 

in  the  dead,       .  II.,  590 

in  the  living,     .         . II.,  586 

feigned, II.,  579 

how  long  after  can  diagnosis  be  made?     .         .         .         .         .II.,  590 
how  soon  after  can  woman  become  pregnant?          .         .         .II.,  600 

post-mortem, .         .         .       II.,  613 

signs  of  recent,         .         . -    • II.,  585 

in  the  dead, II.,  590 

in  the  living,     .         .         .         .         .         .         .         .         .       II.,  586 

positive,  .        .        .        .         .         .         .         .        .      II.,  589 

probable,  ......         .^  .  II.,  587 

uncertain,          .  .         .         .         .         .         .         .       II.,  586 

unconscious,     .         .         .         .      •   '. II.,  608 

cases  illustrative  of, II.,  610 

DELUSIONAL  INSANITY,  .         .         .         .         .         .         .         .     III.,  357 

cases  illustrative  of III.,  357-361 

DELUSIONS,  see  Insanity. 

DEMENTIA,  see  Insanity,  medical  aspect  of. 

adventitia III.,  350 

naturalis III.,  350 

DENTISTS, I.,  734 

not  physicians  in  law  of  privileged  communications,        .         .        I.,  115 
DEPECAGE  CRIMINEL,      ........  I.,  891 

DIAMETERS  OF  THE  F<ETAL  HEAD II.,  531 

DIAPHRAGM,  rupture  of,  . II.,  125 

wounds  of,        ..........       II.,  125 

DIPLOMA,         .  ...        I.,  735 

DIPLOMA  OR  LICENSE,  how  proved  in  court I.,  20 

DIPLOPIA ...          III.,  16,  44 

DIPSOMANIA,  III..  259,  498 

DISABILITY,  TOTAL,  medico-legal  significance  of  the  term.        .         .     III.,  143 
DISEASE,  as  a  ground  for  divorce,  ...         .         .         .         .     III.,  768 

legal  effects  of  on  marriage,     .......     III.,  766 

medico-legal  significance  of  term, III.,  138 

DISLOCATION  of  crystalline  lens,      .         .         .         .         .         .         .       III.,  68 

DISLOCATION  FRACTURE,  of  the  spine, II.,  830,  831 

DISLOCATIONS, II.,  22 

DISTRICT  OF  COLUMBIA, 

statutes- regulating  the  practice  of  medicine  in,         .         .         I.,  214,  685 
DIVORCE,  and  see  Marriage  and  Divorce,  medico-legal  aspects  of. 

for  habitual  intemperance, III.,  379 

for  habitual  use  of  drugs, III.,  379 

medico-legal  aspects  of, Ill,  758-776 

relation  of  insanity  to,     ........     III.,  377 

DOCTOR.  I..  730 


924        GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

DROWNING  (and  see  Submersion),  ......       II.,  317 

DRUG  CLERK,  not  a  physician  in  law  of  privileged  communications,       I.,  115 

DRUGGISTS,     .         .         . .        L,  736 

DRUGS  AND  MEDICINES,  ........        I.,  736 

habitual  use  of,  a  cause  for  divorce  or  separation,         .         .     III.,  379 

mental  incapacity  from, III.,  481,  500 

persons  stupefied  by,  as  witnesses, III.,  424 

DRUNKENNESS,  defined, III.,  481,  482 

DURATION  OF  BURIAL, I.,  887 

DUTIES  OF  PHYSICIANS  AND  SURGEONS,  see  Physicians  and  Surgeons. 

EAR,  injuries  to,      ..........  III.,  113 

to  external  auditory  canal,                ........  III.,  115 

to  external  ear, III.,  113 

to  drum, ....  III.,  123 

to  drum  head,           ...                                             ,         .  III.,  117 

EAR,  THE  INSANE, ,  III.,  184 

ECCHYMOSES, ,         ,         .  II.,  13 

ante-mortem,            ...                  ...                  .  I.,  927 

caused  by  lightning,         .......  II.,  212 

post-mortem .     I.,  926,  927;  II.,  31 

ELECTRIC  CARS, .II.,  184 

ELECTRIC  DRILL,  effect  of,  upon  the  eyes, II.,  193 

ELECTRIC  LIGHT,  effect  of,  upon  the  eyes, II.,  192 

ELECTRICAL  APPARATUS,  injuries  from,             .....  II.,  180 

ELECTRICAL  CURRENTS,  burns  from, II.,  180,  192 

death  from,      .........  II.,  200 

direct  injuries  from,          ........  II.,  187 

direct  symptoms  of  injury  from, II.,  192 

fatal, II.,  199 

high-tension,    ..........  II.,  182 

indirect  injuries  from,       ...,,.-..  II.,  186 

injury  from, II.,  180 

internal  symptoms  caused  by,          .         .         .         .         ,         .  II.,  195 

mechanical  effects  of,       ........  II.,  191 

mental  symptoms  from,            .......  II.,  206 

muscular  contraction  from, II.,  194 

resistance  of  human  body  to, II.,  189 

treatment  of  injuries  from,       .         .  .         .         .         .II.,  220 

ELECTRICAL  RESISTANCE, II.,  189 

ELECTRICITY, II.,  179 

autopsies  after  death  from,      .......  II.,  218 

faradic,             II.,  188 

medical, II.,  180 

static, II.,  189 

survivorship  in  cases  of  death  from, II.,  348 

ELECTROCUTION, II.,  200 

post-mortem  findings II.,  219 


GENERAL   INDEX   TO    VOLS.    I.,    II.,    AND    III.  925 

PAGE 

EMBRYO,  see  Fcetus. 

characters  of,  during  several  months  of  pregnancy,      .       II.,  361,  535 

signs  of  maturity  of, II.,  362 

size  of,     ...'........       II.,  361 

weight  of,         .         .         .         .         .         .         .         .         .         .II.,  363 

ENOPHTHALMUS,  traumatic, III.,  49 

EPIDEMICS,  medico-legal  significance  of  term,          ....     III.,  138 

EROSION, II.,  17 

EROTOMANIA, III.,  278 

ERYSIPELAS, II.,  57 

facial, II.,  58 

ESOPHORIA,     ....- III.,  16 

ESOTROPIA, ~  III.,   16 

EVIDENCE, I.,  737 

EVIDENCE  OF  COMMUNICATION  between  patients  and  physicians,  I.,  91,  737 

EXAMINATION, I.,  740 

of  body, II.,  83,  84 

of  clothes, II.,  25,  83,  84 

of  surroundings,       .........  II.,  87 

EXAMINERS,  see  Board  of  Medical  Examiners. 

EXCEPTIONS, I.,  740 

EXCORIATION, II.,  17 

EXHAUSTION,  death  due  to, II.,  46 

EXHIBITIONISM, II.,  742 

EXHUMATION  OF  DEAD  BODY, I.,  782 

EXOPHORIA, III.,  16 

EXOPHTHALMUS,  pulsating, III.,  50 

EXOTROPIA, III.,   16 

EXPERIMENTS,  not  to  be  tried  on  patients, I.,  36,  83 

testing  powder  marks, II.,  161 

with  cadavers,  . II.,  152,  153 

EXPERT  TESTIMONY,  how  given,       .......          I.,  59 

how  impeached,        .........          I.,  63 

in  cases  of  death  in  a  common  disaster,         .         .         .         .       II.,  340 

EXPERT  WITNESSES  (and  see  Privileged  communications,  and 

Insanity) I.,  49-72,  774 

classes  of  subjects  for  medical  testimony,         .         .         .         .          I.,  70 

compensation  of,  .  .  ; I..  60 

competence  of,  a  question  for  court  in  liminc,          .         .         .          I.,  62 

competency  presumed  from  license  to  practise  medicine,         .          I..  58 

sometimes  held  dependent  upon  license  to  practise  medicine.      I.,  62 

conclusions  stated  by  others  than,    .         .         .         .         .         .1.,  50,  53 

conduct  of,  in  court, I.,  65 

contingency  of  fee  upon  the  case  disqualifies I..  62 

definition  of.     .         .         .         .         .         .         .         .         .         .  I.,  53 

distinguished  from  other  witnesses,  .....     I..  49,  53 

duties  of,  in  cases  of  criminal  abortion,  .         .         .         .       II.,  394 


926  GENERAL    INDEX   TO    VOLS.    I.,    II.,    AND    III. 

PAGE 

EXPERT  WITNESSES 

examination  of,  practical  suggestions, I.,    70 

scope  and  intent  of,           .         .         .         .         .                  ,  I.,  66,  68 

functions  of,  judicial,        ...........  I.,  53 

general  rule  as  to  required  skill  and  experience,       .         .         .  I.,  64 
as  to  subjects  for  testimony  of,          .         .         .         .         .1.,  68,  69 

hypothetical  questions, I.,  59 

in  insanity  cases  (and  see  Insanity;    Expert  witnesses,  Non- 
Expert  witnesses), .         .III.,  529 

interested  persons  may  be, I.,  63 

medical  books,  how  may  be  used  in  examining,        .         .         .  I.,  64 
status  of,  in  France  and  Germany,  and  in  the  United  States  and 

-   England, ggj  I.,  54 

suggestions  and  admonitions  to,       .         .         .         .         .         .  I.,  70 

summoned,  how, .  I.,  60 

summons  must  be  obeyed,  but  opinions  need  not  be  given  with- 
out compensation,         .         .         .         .         .         .         .         .  I.,  60 

system  of,  in  America,  criticised,      .         .         .         .         .         .  I.,  55 

testimony,  how  given,      .         .         .         .         .         .         .         .  I.,  59 

how  impeached, I.,  63 

why  employed  in  railway  injuries,            .         .         .                  .  II.,  921 

EXPOSURE,  effects  of, ;  '       .         .  I.,  942 

indecent,          '.         '. II.,  742 

EXTREMITIES,  wounds  of,        ........  II.,  135 

EYE,  see  Eyeball,  Eyelids,  Orbit,  Vision. 

affections  of,  intentionally  produced III.,  28 

astigmatic,       ..........  III.,  7 

burns  of III.,  56 

dioptric  system  of,            ........  III.,  6 

emmetropic,     ..........  III.,  6 

foreign  bodies  in,      . III.,  77 

hypermetropic, .  III.,  7 

injuries  to, III.,  30 

to  the  eyeball, III.,  59 

to  the  lids III.,  53 

to  the  orbit,       .                   III.,  30 

injurious  effect  of  electric  drill  upon, II.,  193 

injurious  effect  of  electric  light  upon II.,  192 

irido-dialysis, III.,  64 

myopic,             ..........  III.,  10 

normal,    ...........  III.,  6 

refraction  of,     .  III.,  5,  12 

sympathetic  diseases  of,            .......  III.,  90 

inflammation,             .         .         .         .         .         .         .         .  III.,  92 

irritation, III.,  90 

EYEBALL,  see  Eye,  Eyelids,  Orbit,  Vision. 

burns  of.           ,,.,,,,,,.  III.,  57 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.         927 


EYEBALL, 

cataract,  traumatic,         .        . III.,  66 

chamber  of  vitreous,  penetrating  wounds  of,    .         .         .        .  III.,  76 

chambers,  foreign  bodies  in,     .  III.,  80 

choroid,  rupture  of, III.,  72 

ciliary  body,  foreign  bodies  in, III.,  80 

wounds  of,        .........  III.,  74 

conjunctiva,  contusions  of, III.,  60 

foreign  bodies  in,  III.,  78 

contusions  of,  .........  III.,  60 

cornea,  burns  of,  .         .         ...         .         .         .         .  III.,  57 

contusions  of,   .         .        .>, HI.,  62 

foreign  bodies  in,       ........  III.,  78 

rupture  of, III.,  64 

wounds  of, III.,  73 

crystalline  lens,  affections  of, III.,  66 

cataract,  traumatic,  .......  III.,  66 

congenital  dislocations  of,          ......  III.,  71 

dislocations  of,  .  III.,  68 

ectopia  lends,    . III.,  71 

foreign  bodies  in III.,  83 

luxation  of, III.,  68 

subluxation  of, III.,  69 

wounds  of, III.,  74 

dislocations  of, III.,  59 

enophthalmus,  traumatic,         .......  III.,  49 

evulsion  of, III.,  60 

exophthalmus,  pulsating, III.,  50 

injuries  to,        .         .         .         .         .         .  .         .         .  III.,  59 

iris,  affections  of,  .         .         .         .         .         .         .  III.,  64 

foreign  bodies  in, III.,  80 

wounds  of III.,  75 

protrusion  of,  ..........  III.,  50 

retina,  detachment  of,  .  .         .         .         .         .  III.,  72 

sclera,  burns  of, III.,  58 

rupture  of, III.,  60 

strabismus,       .         . '       .         .         .         .         .         .         .         .  III.,  44 

vitreous,  foreign  bodies  in, III.,  85 

wounds  of,       .         .         . III.,  72,  76 

EYELIDS,  see  Eyeball,  Orbit. 

burns  of,  ..........  III.,  56 

conjunctiva,  contusions  of.  .         .         .         .         .         III.,  60,  62 

foreign  bodies  in III.,  78 

contusions  of,  ..........  III.,  53 

foreign  bodies  in,     . III.,  77 

injuries  to, III..  53 

ptosis,  traumatic, III.,  55 

wounds  of,  III.,  54 


928  GENERAL   INDEX   TO    VOLS.    I.,    II.,    AND    III. 

PAGE 

FACE,  wounds  of, II.,  115 

FALLS,  II.,  95,  98 

FARADISM,       .         .  .        .         .         .         .         .      -  .         .      II.,  188 

FEES, I.,  741 

FELLATION, .      II.,  750 

FETICHISM, II.,  739 

FIREARMS,  evidence  from,       ......        ..         .       II.,  146 

examination  of, •  .         .         .         .II.,  159 

FLASH  OF  GUNPOWDER,  identification  by,        .         .         .        .         .      II.,  167 

FLORENCE'S  TEST  FOR  SEMEN, .     III.,  889 

FLORIDA,  legal  status  of  dead  body  in,  I.,  789 

statutes  regulating  the  practice  of  medicine  in,         .         .        I.,  220,  687 
statutes  relating  to  incompetent  persons  in,     .  .         .     III.,  632 

FCETICIDE, II.,  355 

FCETUS  (see  Embryo,  Infant), II.,  355 

can  it  live  after  death  of  mother? II.,  623 

characteristics  of,  during  several  months  of  pregnancy,       .       II. ,  361 ,  535 
death  of,  from  congenital  malformation,  .         .         .         .II.,  448 

from  debility, .       II.,  448 

from  disease,     .         .         .         .         .         .         .         .         .II.,  449 

from  hemorrhage, II.,  449 

from  injuries  to  the  head, II.,  464 

from  natural  causes, II.,  446 

from  prolapse  of  the  cord, II.,  454 

from  protracted  labor, II.,  447 

from  violent  causes, II.,  456 

fully  developed,        . II.,  540 

weight  of II.,  540 

heart  sounds  of,  in  pregnancy, II.,  573 

how  long  can  it  live  after  death  of  mother?      .         .         .         .II.,  453 

movements  of,  in  pregnancy, II.,  574 

natural  causes  of  death  of, •  .         .II.,  446 

palpation  of,  in  pregnancy, II.,  572 

signs  of  maturity  of,         .         .         .         .         .         .         .         .II.,  362 

size  of, II.,  361 

specific  gravity  of  lungs  of,      .         .         .         .         .         .         .       II.,  427 

time  when  life  begins  in,  .......       II.,  355 

violent  causes  of  death  of,  .         .         .         .         .         .II.,  456 

weight  of, II.,  363 

of  lungs  of, II.,  426 

in  relation  to  weight  of  body,     .         .         .         .         .II.,  427 

FOOTPRINTS I.,  910 

FOREIGN  BODIES  IN  THE  EYE, III.,  77 

FORENSIC  MEDICINE,        .         .         .         .         .         .         .         .         .       I.,  v,  vi 

FRACTURES, I..  841;   II..  20,  37,  99 

by  gunshot  wounds,          .         .         .         .         .         .         .         .II.,  158 

of  external  auditory  canal, III.,  116 


GENERAL   INDEX    TO    VOLS.    I.,    II.,    AND    III.  929 


FRACTURES,  of  ribs,        

PAGE 

.       II.,  120 

of  skull,    .         .         .         .         .         . 

.       II.,  105 

during  labor,     .         .         .         ." 

.       II.,  4G7 

of  spine,            ...... 

.       II.,  117 

of  sternum,      ........ 

.       II.,  120 

of  vertebrae,     

.       II.,  830 

Pott's,      .         .         .         

III.,  138 

spontaneous,    ........ 

II.,  21 

subcutaneous,  due  to  gunshot  wounds,     . 

.      II.,  144 

whether  ante-mortem  or  post-mortem,     . 

II.,  37 

FRACTURE-DISLOCATION  OF  SPINE,  .         .      •  . 

.      II.,  117 

FRAGILITAS  OSSIUM,         

II.,  20 

FRIGIDITY,      .        .        

.       II.,  628 

GALL  BLADDER,  wounds  and  ruptures  of.         ... 

.       II..  130 

GARROTING,     .         

II..  117,  223 

GENERAL  MEDICAL  COUNCIL  

I.,  742 

GENITAL  ABUSE,      ........ 

.      II.,  740 

GENITAL  ORGANS,  post-mortem  examination  of. 

I.,  858 

wounds  of,                 .         .         .         . 

.      II.,  134 

GENITALS,  FEMALE,  see  Hymen.  Uterus.  Vagina,  Vulra. 

after  defloration,      ....... 

.       II.,  676 

changes  in,  during  pregnancy,          .... 

II.,  558 

in  virgins,         .         . 

.       II.  ,666 

of  children,  after  rape,      .         .                   ... 

11.  .708,  721 

GEORGIA,  legal  status  of  dead  body  in. 

1.,  789 

statutes  regulating  the  practice  of  medicine  in, 

1.,  222 

statutes  relating  to  incompetent  persons  in,     . 

.     III.,  633 

GESTATION,  see  Labor,  Pregnancy. 

GLASS,  wounds  caused  by,       ........         II.,  68 

GONOCOCCUS, II.,  685 

GONORRHOSA .         .         II..  683,  705,  713.  729 

GRADUATE.      ...........        I.,  742 

GREAT  BRITAIN  AND  IRELAND,    statutes    regulating   the    practice   of 

medicine  in,          .         .         .         .         .         .         .         .  I  .  179,  542,  706 

GREEK  LOVE. II. ,739 

GUAIACUM  TEST  FOR   BLOOD,       ........       III.,  844 

method  of  performing.     ....  ...     III. .846 

precautions,     ..........     III. ,847 

GUNSHOT  WOUNDS  (and  see  Wounds,  gunshot).       ....       II..  139 

HABITS,  medico-legal  significance  of  term.       .         -  III..  139 

H^MATIN, III. .856 

reduced, HI-  857 

H^EMATOMATA .  .  II..   14 

H^EMATOMYELIA.  TRAUMATIC. 

ELmCATOPORPHYRIN,          ........  HI--  857 

III.— 59 


930        GENERAL  INDXE  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

H.EMATORRHACHIS, II.,  839 

H.EMIN  CRYSTALS,                III.,  848 

H^EMIN  TEST  FOR  BLOOD, .            .  III.,  848 

methods  of  performing,    ........  III.,  852 

precautions, III.,  852 

HJEMOCHROMOGEN, III.,  857 

H.EMOGLOBIN,             ..........  III.,  854 

HEMOGLOBIN  CRYSTALS,  differentiation  of  bloods  by  form  of,          .  III.,  882 

HAIRS,    ..........      II.,  758;  III.,  895 

as  indication  of  age,          .         .         .         .         .         .         .        . .  III.,  905 

of  race, III.,  906 

of  sex, ...  III.,  906 

color  of,                                                            ......  III.,  906 

determination  of  manner  of  extraction,    .         .         .         .  III.,  907 

diameter  of, III.,  901 

distinction  between  fallen  and  forcibly  extracted  hairs,         .  III.,  907 

hairs  from  different  regions  of  the  body,            .         .         .  III.,  903 

human  and  animal  hairs, III.,  898 

effects  of  heat  on,     .                  III.,  908 

examination  of, III.,  893 

growth  of,        ....                                             .         .  III.,  896 

identity  from,                                               .         .         . "      I.,  888;  III.,  905 

measurement  of,       .........  III.,  901 

on  weapons, II. ,81;  III.,  895 

structure  of III.,  896 

were  they  cut  off? III.,  907 

pulled  out? .         .         .  III.,  907 

HALLUCINATIONS,  see  Insanity,  medical  aspect  of. 

HANDWRITING, ....  I.,  916 

HANGING,        .....  ....        II.,  223,  252 

accidental,        ....                           ....  II.,  282 

cases  illustrative  of, II.,  296 

cases  illustrative  of,           ........  II.,  282 

cause  of  death  in,     .         .         .         .         .         .         .         .         .II.,  253 

homicidal, .  II.,  281 

cases  illustrative  of, II.,  289 

incomplete, II.,  261 

external  appearances  due  to, II.,  264 

internal  appearances  due  to,     .         .         .         .         .         .II..  273 

judicial,  cases  illustrative  of,             ......  II.,  292 

post-mortem  appearances,        .         .         .         .         .         .         .II.,  264 

external, .  II.,  264 

internal II..  273 

proof  of  death  by,              II.,  27!) 

suicidal II. ,280 

cases  illustrative  of, II.,  282 

symptoms  in. II.,  258 

treatment  in, II-.  262 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.        931 

PAGE 

HAWAII,  legal  status  of  dead  hotly  in, I.,  789 

statutes  regulating  the  practice  of  medicine  in,    .         I.,  212S.  088,  707 
statutes  relating  to  incompetent  persons  in,     ....     III.,  636 

HEAD,  post-mortem  examination  of,  .  .         .        I.,  843 

wounds  of,        ...........    II.,  103 

HEALTH,  BOARDS  OF,    physicians   reporting   contagious  diseases   to, 

not  liable  for  mistaken  reports, I.,  23 

powers  of,  ho \v  governed,          .         .         .         .         .         .         .    I.,  23,  24 

HEALTH,  medico-legal  significance  of  term,      ....      111.,  138, 139 

HEART,  in  strangulation,          .         .         ....         .         .         .         .      II.,  235 

post-mortem  examination  of,    .         .         .         .         .         .         .1.,  848 

rupture  of,      -.         .         .         .         .         .         .   -  .         .       II.,  124 

wounds  of II.,  121 

HEAT,  effects  of  extreme, I.,  947 

exposure  to,  cases  of,        ...         .         .         .         .         .         I.,  970 

survivorship  in  cases  of  death  by,    ......       II.,  347 

HEIGHT,  determination  of,       .         .         .         .         .         .         .         .1.,  880 

HEMORRHAGE, II.,  29.  43,  232 

death  from II.,  43,  44 

from  antc-mortcin  wound,        .......         II.,  29 

from  post-mortem  wound,        .......         II.,  30 

internal,  death  from,        ........'     II.,  43 

HERMAPHRODITES,          .........      II.,  636 

HKRNIA.  phrenic  or  diaphragmatic,         ......       II.,  126 

HETEROPHEMY II.,  775 

HETEROPHORIA III.,  16 

HETEROTROPIA III.,  16 

HOMOEOPATHIC  PHYSICIANS.     .         .......        I.,  743 

HoMCEOPATHY,  ..........  I.,  744 

HOMOSEXUALITY, II.,  739 

HYMEN II.,  669 

as  sign  of  virginity II.,  066,  672,  676 

destruction  of,  by  accident,  surgical  operations,  etc.,        .         .       II.,  675 
does  absence  of  integrity  of,  indicate  defloration?    .          .         .       II.,  674 

form  of II.,  701 

in  children,        .........       II.,  707 

is  an  intact  hymen  evidence  of  virginity?          .         .         .         .II.,  672 

lacerations  of. II.,  677 

in  children,  after  rape II.,  708,  723 

penetration  of, II.,  673 

rupture  of.  by  masturbation;   .         .         .         .         .         .        II.,  675,  734 

varieties  of,  '.  II.,  669 

HYPERMETROPIA.     .         ...         .         .  .         .         .  III.,  7,  17 

HYPERPHORIA III.,  16 

HYPNOTIC  STATE,  impregnation  during. II..  603 

ra|K>  during II.,  696 

HYPNOTISM  and  abortion.  II.,  385 


932         GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

IlYPOSTASKS,  .  I-,  926)    II.,  232 

internal, ..;.!.,  927 

HYPOTHETICAL  QUESTIONS,  the  expert  witness  and,         .         .         .     III.,  529 

HYPOTKOPIA,  . III..  16 

HYSTERIA,       ...  .        Jl.,  900,  912 

IDAHO,  legal  status  of  dead  body  in,  ...  I.,  790 

statutes  regulating  the  practice  of  medicine  in,  .  .  I.,  231,  689 

statutes  relating  to  incompetent  persons  in,  .  .  .  .  III.,  637 

IDENTIFICATION,  ...........  I.,  866 

by  flash  of  gunpowder, II.,  167 

from  congenital  peculiarities,  .  .  .  .  .  .  I.,  885 

from  deformities, I.,  886,  916 

from  entire  skeleton, I.,  874 

from  hair, .'  .1.,  SS8;  III.,  905 

from  imprints, I.,  910 

from  injuries, '.  I.,  886 

from  isolated  bones,  .  .  .  .  .  .  .  .1.,  874 

from  nails, ...  .  I.,  888 

from  professional  signs "  .  .  I.,  884 

from  scars, -.  I.,  901 

from  stigmata,  .........  I.,  908 

from  tattooings. .  .  I.,  903 

from  teeth, ....  I.,  884 

in  death  from  submersion II.,  324 

of  burnt  remains, •  .  I.,  872 

of  human  bones, f  •  .  .  .  I.,  873 

of  mutilated  remains,       .         .         .         .         .         .         .         .1.,  890 

of  recently  dead,  entire  cadaver,      .         .         .         .         .         .  I.,  897 

surface  signs  of,  .  .  .  .  .  .  .  .1.,  901 

IDIOCY,  see  Insanity. 

IDIOT,  cannot  make  will. III.,  385 

ILLINOIS,  legal  status  of  dead  body  in,  .  .  .  .  .1.,  790 

statutes  regulating  the  practice  of  medicine  in.  .  ...  I.,  236 

statutes  relating  to  incompetent  persons  in,  .  .  .  III..  639 

ILLUSIONS III.,  177 

ILLUSTRATIVE  CASES,  see  Cases  illustrative  of. 

IMBECILITY, III.,  342 

IMPOTENCE,  . II.,  627,  739;  III.,  762 

accidental.  . II.,  633 

and  bastardy, II.,  634 

causes  of, II.,  644 

from  wounds  and  injuries, II.,  639 

in  accusations  of  rape,  .  .  .  .  .  ...  II.,  703 

in  advanced  age II.,  641 

in  man II.,  652 

in  suits  for  civil  damage.  .  II.,  639 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.  933 

PAGE 

IMPOTENCE, 

in  woman, II.,  648 

influencing  conditions  from  accident  or  disease,        .         .         .  II.,  653 

of  castrates,      .         .         .   •              ...         .         .         .         .  II.,  653 

plea  of ,  in  accusations  of  unchaste  conduct ,      ....  II.,  640 

IMPREGNATION, II.,  508,  511 

artificial,  ethical  considerations  of II.,  629 

during  hypnotic  state,      .         .         .         .         .         .         .         .  II.,  603 

former,  effects  of,  upon  foetus, II.,  543 

relation  of,  to  menstruation, II.,  508 

unconscious,     .         .         .         .         .         .         .         .         .  II.,  602 

cases  illustrative  of, II.,  604 

IMPRINTS,        .        .        .        .        .        .        .         .  ^     .         .  I.,  909;  II.,  88 

INANITION,      .         .         .         .         .         .         ...         .         .         .  I.,  979 

INCAPACITY,  SEXUAL,  see  Sexual  Incapacity. 

INCISED  WOUNDS,  see  Wounds,  incised. 

INCOMPETENT  PERSONS,  CARE  AND  CUSTODY  OF,  AND  THEIR  ESTATES  III.,  579-757 

bankruptcy  of  insane  persons, III.,  598 

care  and  custody  of  indigent  insane. III.,  606 

care  of ;  III.,  598 

committees  of, III.,  594 

commitment  of.                 .         .    •     .         .         .         .         .         .  III.,  600 

confinement  of.         .         .         .         .         .         .         .         .         .  III.,  600 

costs  in  lunacy  proceedings.     .......  III.,  593 

death  of  incompetent,  under  guardianship III.,  598 

false  certificate,        ....                 ....  III.,  602 

guardians  of,    .         .         . III.,  594 

inquisition,       ..........  III.,  584 

commission.       .         .         .         .         .         .         .         .         .  III.,  587 

finding  of, III.,  589 

notice  of, III.,  584 

petition, .         .  III.,  587 

traverse  of III.,  590 

liability  of  examiner  for  false  certificate,           .         .         .         .  III.,  602 

of  insane  asylum  for  torts  of  employees.            .         .         .  III.,  606 

for  illegal  detention, III.,  604 

management  of  estates  of III.,  595 

restoration  to  sanity,        ........  III.,  591 

restraint  of,              III.,  598 

statutes  relating  to. III.,  607-757 

in  Alabama,      .         . III.,  607 

in  Alaska.          .     '    .  - III.,  615,  721 

in  Arixonn III.,  616 

in  Arkansas, III.,  617 

in  California,     .         . III.,  621 

in  Colorado III.,  626 

in  Connecticut.  III.,  G2S 


<KU  GENERAL    INDEX    TO    VOLS.    1.,    II.,    AM)    III. 

PAGE 

INCOMPETENT  PERSONS,  statutes  relating  to, 

in  Delaware •  HI.,  630 

in  Florida,         .....                                    .  III.,  G32 

in  Georgia -  III.,  633 

in  Hawaii,      ' •  HI.,  636 

in  Idaho, .  III.,  637 

in  Illinois, .  III.,  639 

in  Indiana, .  III.,  643 

in  Iowa, '     •  III.,  645 

in  Kansas .  III.,  650 

in  Kentucky, III.,  654 

in  Louisiana,     .........  III.,  656 

in  Maine, III.,  657 

in  Maryland, .  III.,  €61 

in  Massachusetts •  .  III.,  664 

in  Michigan,     • .  III.,  668 

in  Minnesota III.,  671 

in  Mississippi.    .........  III.,  674 

in  Missouri III.,  676 

in  Montana III.,  678 

in  Nebraska,     . .  III.,  681 

in  Nevada ••     .         .  III.,  683 

in  New  Hampshire,            .         .          .         i     .    .         .         .  III.,  685 

in  New  Jersey, III.,  687 

in  New  York .         .  III.,  691 

in  North  Carolina III.,  712 

in  North  Dakota,      .                                             ...  III.,  715 

in  Ohio .  III.,  717 

in  Oklahoma III.,  720 

in  Oregon,          .........  III.,  721 

in  Pennsylvania.        ........  III.,  725 

in  Rhode  Island III.,  729 

in  South  Carolina.     ........  III.,  731 

in  South  Dakota,       .         . III.,  732 

in  Tennessee,     .........  III.,  735 

in  Texas, -.  III...  739 

in  1'tah III.,  743 

in  Vermont,       .........  III.,  744 

in  Virginia,        .........  III.,  747 

in  Washington, III.,  749 

in  West  Virginia,       .         .         .         .         .         .         .          .  III.,  751 

in  Wisconsin,     .........  III.,  753 

in  Wyoming III.,  756 

supersedeas,     ..........  III.,  591 

who  are  subject  to  adjudication  as,           .....  III..  580 

writ  of  habeas  corpus.      ......                   .  III.,  605 

INDECENT  EXPOSURE,  II. ,  742 


UKNKKAL    INDEX    TO    VOLS.    1.,    11.,    AND    III.  935 

PAGE 

INDIAN  TERRITORY,  legal  status  of  dead  body  in,         .         .  •  I.,  790 

statutes  regulating  the  practice  of  medicine  in,        .  I.,  255 

INDIANA,  legal  status  of  dead  body  in,     ...  I.,  790 

statutes  regulating  the  practice  of  medicine  in,     .         .         I.,  243,  689 

statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  643 

INDICTMENT, I.,  744 

INFANT  (and  see  Foetus,  Infanticide), II.,  355 

born  before  term,  viability  of, II.,  522,  523 

can  it  live  after  death  of  mother? II.,  453 

death  of,  from  cold  or  exposure II.,  463 

from  drowning,          .         .         .         .         .         .         .         .       II.,  462 

from  hanging,  ........       II.,  474 

from  injuries  to  the  head,  ..*...       II.,  464 

from  neglect,     .         .         .         .         .         .         .         .         .II.,  457 

from  omission,  . II.,  457 

from  poisoning,         .         .         .         .         .         .         .         .II.,  474 

from  starvation,        .         ...         .         .         .         .         .II.,  463 

from  strangulation, II.,  472 

from  suffocation,        .         .         .         .         .         .         .         .II.,  458 

from  violent  causes,  .         .         .         •  '-."•         •         •       H-»  456 

from  wounds,    .         .         .         .         .         .         .         .         .II.,  463 

deformities  of, II.,  543 

effect  of  former  impregnations  upon,        .         .         .         .         .II.,  543 

mature,  characteristics  of,         ......       II.,  528,  534 

diameters  of  head  and  body,     .         .         .         .  .II.,  531 

length  of II.,  528 

ossification  of  lower  epiphysis  of  femur,    .         .         .        II.,  533,  540 

weight  of II.,  529 

rape  upon.        .....  ....       II.,  705 

resemblances  of  (and  see  Mother's  IM  M'  -.  Atavism),        .         .       II.,  542 
substitution  of,         ......         ...       II.,  547 

cases  illustrative  of,  .......       II.,  551 

supposititious,  .         .         .         .         .         .         .         .         .II.,  547 

cases  illustrative  of,  .......       II.,  551 

viability  of II.,  421,  520,  522,  523 

INFANTICIDE  (and  see  Infant,  Foptus), II.,  355,  408 

cases  illustrative  of, II.,  478 

concealment  of  birth,       .         .         .         .         .         .         .         .II.,  409 

dead-birth,  see  Live-birth,  Still-birth. 

death  of  mother  during  delivery,      ......      II.,  453 

evidence  from  autopsy,     ........       II.,  422 

from  changes  in  the  ehest,         .         .  .         .         .II.,  422 

in  the  cord II.,  450 

in  the  diaphragm II..  422 

in  the  lungs,       ........       II.,  422 

from  marks  of  violence II.,  422 

examination  of  woman,    .  II.,  412 


936 


GENERAL    INDEX    TO    VOLS.    I.,    II.,    AND    III. 


INFANTICIDE, 

how  long  did  child  live?  .... 

live-birth  (and  see  Still-birth), 
Breslau's  test  of,      > 

evidence  of, 

from  bladder  and  kidneys, 

from  breathing,          .... 

from  changes  in  cord, 

in  liver, 

in  skin,        ..... 
in  stomach  and  intestines, 
from  crying,       ..... 
from  foetal  heart-beat. 

from  lungs 

from  muscular  movements, 
from  pulsation  of  cord, 
Fodere's  test  of,         ..... 
hydrostatic  test  of,    .         .         .         .         . 
objections  to,     .         .         .         .         . 
iron-lung  test  of, 

legally  considered,  .... 

middle-ear  test  of,     .         . 
Ploucquet's  test  of,  .... 

respiration  as  evidence  uf. 

Schmidt's  test  of, 

signs  of,     ....... 

specific  gravity,  test  of,     . 

static  test  of,     . 

what  constitutes,       .         . 

Zaleski's  test  of,        ..... 

method  of  conducting  autopsy,         .         ! 
rupture  of  cord,        ...  .         . 

still-birth,         ....... 

evidence  of,  from  bacteria, 

from  maceration,        .... 

from  mummification, 
from  putrefaction,      .         .         . 
was  death  due  to  natural  causes  or  to  violence? 
was  the  child  born  alive?          .... 

was  the  cord  torn  or  cut?         .... 

INFANTS,  liability  of,  for  medical  services, 
INFORMATION,  duty  of  patient  as  to  (and  soe  Physician 
INFECTED,  bullets,  ...... 

powder,    ........ 

INJURIES,  coagulation  of  blood  in, 

death  from,      ....... 

fatal,  acts  performed  after,       .... 


.  II.,  443 

1 1. ,409,  416,  520,  526 

.  II..  438 

.  II..  410 

.  II.,  437 

.  II.,  415 

.  II.,  436 

. .  .  II.,  437 

.  II.,  437 

.'  .  .  II.,  438 

.  II.,  414 

.  .  .  II.,  413 

.  II.,  422 

.  II.,  414 

.  .  .  II.,  413 

.  II.,  426 

.  II.,  427 

.  II.,  428 

.  .  II.,  442 

.  II.,  410 

.  .  .  II.,  437 

.  II.,  427 

.  '  .  II.,  419 

.  II.,  426 

.  II.,  410 

.  II.,  427 

.  II.,  426 

.  II.,  526 

.  II.,  442 

.  II.,  474 

.  II.,  450 

.  II.,  416 

.  II.,  442 

.  II.,  416 

.  II.,  419 

.  II.,  416,  418 

.  II.,  446 

.  II.,  409 

.  II.,  452 
I.,  37 
I.,  33 


and  patient). 


II..  169 


.   II.,  170 
II.,  34 

II.,  45,  46,  53 
II.,  39 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.         037 


INJURIES, 

identification  from,  .         .         .         .         .         .         .         .        I.,  886 

medical  inspection  of.  I.,  85,  106 

multiple  death  from,         .  II.,  46 

of  abdominal  viscera,       .         .         .     • II.,  126 

walls .         .       II.,  126 

of  spinal  cord,  .........       II.,  117 

of  spine,  ..........       II.,  117 

severe,  death  from .  .  II.,  45 

signs   of.    external    and    visible,    medico-legal    significance    of 

term,    .         .         .         .         .         .  -    .         .         .         .     III.,  139,  143 

slight,  death  from,  ........        II.,  53 

to  ear,  see  Ear,  injuries  to. 

to  eye,  see  Eye,  Eyeball,  Eyelids,  Orbit,  Vision. 

whether  ante-mortem  or  post-mortem, II.,  28 

INQUEST,  see  Coroner's  Inquest. 

INQUISITIONS  OF  LUNACY, III.,  564 

INSANE  PERSONS,  see  Incompetent  Persons,  Insanity. 

INSANITY  IN  ITS  LEGAL  RELATIONS,          .         .         .  .     III.,  347-576 

adjudications  of,  as  evidence,  ......     III.,  525 

adjudications  of,  as  evidence  against  third  parties,         .         .     III.,  527 

alcoholic III.,  482,  484 

burden  of  proof  of,  .     " III.,  556 

as  to  intoxication,     .         .         .         .         .         .         .         .     III.,  571 

conflict  of  evidence.  .         .         .         .         .         ...     III.,  563 

in  civil  cases,     .........     III.,  564 

in  criminal  cases, .         .     III.,  557 

in  wills, III.,  565 

inquisition  of  lunacy, III.,  564 

of  continuance  of  insanity,        .         .         .         ...         .     III.,  563 

quantum  of  evidence  required,       .  ....     III.,  558 

rule  of  preponderance  of  evidence,    .....     III.,  560 

rule  of  reasonable  doubt  as  to  sanity.        ....     III.,  559 

rule  of  satisfaction  of  jury III.,  560 

where  it  lies,  and  how  it  is  met, III.,  556 

classification  of,  by  various  writers,          .         .         .      III.,  350,  351,  352 
committee,  appointment  of,     .......     III.,  382 

defined III.,  352 

contracts  (including  deeds),  relations  of  insanity  to,         .      III.,  354-376 
competency  to  contract,    .         .         .         .         .         .         .     III.,  355 

conditions  of  avoiding  contracts.       .  ...     III.,  36S 

i lelusional  insanity,  .         .         .  .         .         .     III.,  357 

cases  illustrative  of III.,  357-361 

effects  of  incompeteney.  in  general,  ....     III.,  364 

effects  of  intoxication  on,  .  ....     III.,  374 

effects  of  old  age  and  mental  weakness  on,        .         .         .     III.,  361 
insane  persons,  agreements  of,  not  voidable  before  inquisition,  III.,  367 


1)38  GENERAL -INDEX   TO    VOLS.    1.,    II.,    AND    III. 

PAGE 

INSANITY  IN  ITS  LEGAL  RELATIONS,  contracts,  insane  persons, 

agreements  of,  voidable  after  inquisition,  ,         .     III.,  367 

as  witnesses,       .         .         .         .         .         .         .         .     III.,  421 

contracts  of,  for  necessaries  not  void  or  voidable,  III.,  367,  381 
contracts  on  behalf  of,        .         .         .         .         .         .     III.,  371 

contracts  with,  during  lucid  intervals,        .         .         .     III.,  370 
contracts  with,  subsequent  to  finding  of  insanity,         .     III.,  369 
validity  and  effects  of  judgments  rendered  against.     III.,  380 
insanity,  common  law  rule  not  now  enforced,  .         .     III.,  354 

effects  of,  on  agency  and  agent's  contracts,      .       ..     III.,  371 
effect  of,  on  contract  of  insurance,     ....     III.,  373 

effect  of,  on  liability  for  necessaries,  .         .         .     III.,  381 

effect  of,  on  partnership.    ......     III.,  371 

not  apparent  or  known,  sometimes  does  not   render 

contracts  voidable,          .         .         .         ...     III.,  367 

of  partner, III.,  371 

lucid  intervals, III.,  370 

marriage  contracts,  how  affected  by  insanity,  .         .     III.,  376 

old  age  and  mental  weakness,  .....     III.,  361 

paranoia, III.,  357 

ratification, III.,  366 

after  restoration  of  competency,         .         .         .         .     III.,  368 

undue  influence,  rule  as  to III.,  361 

weakness,  mere  physical  and  mental,  does  not  incapacitate,  III.,  363 
who  may  avoid  contract,  ......     III.,  366 

witnesses,  insane  persons  as,      ......     III.,  421 

criminal  responsibility,    .......      III.,  429-501 

abnormity  or  insufficiency  of  mind,  when  consistent  with 

criminal  responsibility,  .         .         .         .         .         .     III.,  438 

abuse  of  defence  of  insanity,     ......     III.,  433 

adultery,  how  far  a  provocation,        .....     III.,  442 

will  not  justify  homicide,  .....     III.,  442 

alcohol,  insanity  as  result  of  use  of,  ....     III.,  482 

belief  in  spirits,  when  no  defence,      .....     III.,  440 

burden  of  proof  as  to  insanity,  ....      III.,  556-576 

delirium,  insane,  defined,  ......     III.,  462 

delirium  tremens,      ........     III.,  482 

delusional  insanity III.,  462-479 

dipsomania,       . III.,  259,  498 

drunkard,  habitual,  defined III.,  481,  482 

drunkenness  defined, III.,  481 

eccentricity  or  abnormality  of  character,  .         .         .     III.,  438 

emotional  insanity,  .......     III.,  449 

epilepsy  and  kindred  diseases, III.,  445 

evidence  in  cases  of  insanity,    .....      III.,  433,  501 

evidence  of  experts, III.,  529 

evidence  of  non-experts,  ......      III.,  529,  535 


GENERAL  INDEX  TO  VOLS.  I.,  II..  AND  III.         U39 

PAGE 

INSANITY  IN   ITS  LEGAL  RELATIONS,  criminal  responsibility, 

expert  testimony  in  cases  of  insanity,        ....     III.,  529 

fever,  delirium  from,         .......     III.,  481 

fixed  or  complete  insanity,        :        .         .         .         .     III.,  437,  438 

frenzy  not  amounting  to  total  derangement,  no  excuse,     III.,  441 

hypnotism,        . III.,  480 

impulse  insanity,  or  irresistible  impulse,   .         .      III.,  448,  450,  457 
impulsive  insanity,  rule  in  New  York  as  to,  .         .     III.,  451 

insane  delirium,  defined,  ......     III.,  462 

delusion  defined .     III.,  402 

insanity  after  conviction,  .    -     .         .         .         .         .     III.,  433 

as  a  defence  to  criminal  prosecution.          .         .         .     III.,  431 

in, r  III.,  433 

must  be  such  as  to  affect  the  particular  act,       .         .     III.,  435 
intermediate  states  between  sanity  and  insanity,        .      III.,  443-445 

intoxication,  .• III.,  841-500 

involuntary,       . .III.,  490 

irresistible  impulse III.,  450,  457 

limitations  of  this  defence, III.,  456 

States  accepting  the  theory, III.,  455 

States  rejecting  the  theory,        .....     III.,  450 

jealousy, _     .         ...     III.,  440 

jury  trial,          .         .         .         .         .         .         .         .         .     III.,  433 

kleptomania, .     III.,  456 

leading  authorities  and  cases.    ......     III.,  434 

mania  and  melancholia,    ......      III.,  460,  461 

melancholia  and  mania III.,  400.  461 

melancholia,  passion,  or  irritability,  when  no  excuse,         .     III.,  439 
mesmerism,       .         .         .         .         .         .         .         .         .III.,  480 

moral  insanity,  no  defence,        .         .         .         ...     III.,  448 

effect  of,  on  degree  of  crime,      .         .         .  .     III..  460 

morbid  uncontrollable  propensity  to  crime.       .         .         .     III.,  457 

overdose  of  medicine,  delirium  from.          ....     III.,  481 

paranoia, III.,  440 

partial  insanity,         ........     III.,  446 

partial  or  moral  insanity,  illustrative  cases  of,         .      III.,  447,  457 
phases  of  mental  impairment  other  than  insanity,  as  defences 

to  criminal  prosecution,         ......     III.,  479 

plea  of  insanity,         .         .  III.,  433 

practice  in  insanity  cases, III.,  433 

pyrornania III.,  456 

somnambulism.          .         .         .         .         .         .         .         .     III.,  479 

temporary  excitement  or  passion,  when  no  excuse,         .     III.,  440 
theory  of  the  law  in  England  and  the  United  States  favors  a 

right  and  wrong  test,  .         .         .  •  .  III.,  431 

unconsciousness,        ....  ...     III.,  480 

weakmindedness.       .  III.,  438 


940        GEXERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGB 

INSANITY   IN   ITS  LEGAL  RELATIONS, 
deeds,  see  Contracts. 

definitions ....     III.,  350,  353 

delusional  insanity,  .         .         .         .         .         ...     III.,  357 

dementia  ad ventitia, .     III.,  350 

naturalis, III.,  350 

dipsomania,  '. III.,  259,  498 

drugs,  mental  incapacity  from, III. ,481,  500 

persons  stupefied  by,  as  witnesses,  ....     III.,  424 

effects  of, III.,  354 

of  adjudication  on .  III.,  378 

on  civil  liability,        ........     III.,  425 

on  competency  of  witnesses,     ......     III.,  421 

on  contracts,  including  deeds,  .         .         .  .     III.,  354 

on  domestic  relations,        .......     III.,  383 

on  incumbency  of  office,    .         .         .  •  .         .         .     III.,  424 

on  liability  for  necessaries,         .         .         .         .         .         .     III.,  381 

on  liability  to  taxation, III.,  424 

on  marriage, .         .     III.,  376 

on  non-contractual  matters,      ......     III.,  383 

on  partnership,  .         .         .         .         .         .         .  III.    371 

on  residence,     .         .         .         .         .         .         .         .         .     III.,  354 

on  responsibility  for  crime,       .         .         ,         .         .III.,  429-501 
on  wills  and  testaments,  .         .         .         .         .         .     III.,  384 

evidence  of,      .         .         .         .         .         .         .         .         .         .     III.,  501 

adjudications  of  insanity  as  evidence III.,  525 

admissions, III.,  507 

alleged  lunatic  as  witness  of  his  own  insanity,  .         .     III.,  501 

alleged  lunatic's  conduct  as  evidence  of  his  insanity,         .     III.,  503 
collateral  issues  respecting  mental  condition,    .         .         .     III.,  510 

at  other  times, III.,  510 

evidence  on  the  border  line  of  relevancy,            .         .     III.,  514 
evidence  tending  to  show  another  degree  of  mental  in- 
capacity,          III.,  512 

proof  of  influences  acting  upon  the  alleged  incompetent, 

tending  to  produce  insanity,  .         .         .         .     III.,  513 

declarations,. III.,  503 

of  third  parties  in  evidence,       .....     III.,  507 

evidences  of  insanity  of  relatives III.,  508 

of  mental  incapacity  to  make  wills III.,  516 

of  undue  influence,     ......      III.,  518,  521 

illustrations  of  competent  evidence  as  to  conduct,         .     III.,  505 
privilege  against  evidence  of  transactions  with  persons  since 

become  insane,      ........     III.,  515 

expert  witnesses,      .........     III.,  529 

effect  of  expert  testimony, III.,  534 

testimony  of,  upon  hypothetical  questions,        .         .         .     III.,  529 


GENERAL   INDEX   TO    VOLS.    I.,    II.,    AND    III.  941 

PAGE 

INSANITY  IN  ITS  LEGAL  RELATIONS,  expert  witnesses,  testimony  of, 

upon  their  knowledge  of  the  facts,     ....  III.,  531 

who  may  qualify  as,                   .         .         .         .         .         .  III.,  533 

general  definitions, III.,  350,  353 

idiocy,     .        .        ..'....        .        .        .     III.,  338,  350 

idiot,  defined,           .                  .  III.,  351 

imbecility,        .         . III.,  342 

incumbency  of  office,        .         .         .         .         .         .         .         .  III.,  424 

insanity  vacates  office,      .         .         .         .         .         .  III.,  424 

intoxication,  relation  to, III..  424 

insane  person,  defined,     .         .         ....         .         .         .         .  III.,  351 

insanity,  defined,      ;........  III..  352 

intoxication, v=        .                  .  III.,  352 

burden  of  proof  of, III.,  573 

effect  of,  on  contracts,       .......  III.,  374 

effect  of,  on  incumbency  of  office III.,  424 

evidence  of, III.,  523 

habitual,  a  cause  for  divorce  or  separation.       .         .         .  III.,  379 
not  resulting  in  mental  unsoundness  does  not  incapacitate 

for  making  will.              .         .  *               .         .         ,         .  III.,  413 

of  railway  passenger,         .......  III.,  375 

relation  to  marriage, III.,  379 

to  torts,  especially  negligence, III.,  428 

irresistible  impulse,  insane,       .......  III.,  450 

legal  classifications.           ........  III.,  350 

legal  effects  of,  in  general,        .         .         .         .         .         .     III.,  354,  364 

legal  view  of,  contrasted  with  medical  view  of.         ...  III.,  349 

lunacy,     .        ...        .        .        .         .        .                 .         .  III.,  350 

lunatic,  denned,        .........  III.,  351 

liability,  civil,  of  insane  persons, III.,  425 

of  attendants  for  acts  of  insane  persons  under  their  care,  III.,  427 

of  attendants  to  the  insane  under  their  care,     .         .         .  III.,  427 

of  insane  person  for  his  own  torts.    .....  III.,  425 

of  insane  persons  for  medical  services,       .         .         .         .  I.,  39 

of  others  for  torts  of  insane  person,           ....  III.,  426 

to  taxation,  how  affected,                •  .         .         .         .         .  III.,  424 

mania, .  III.,  460 

marriage,  effect  of  insanity  upon, III.,  376 

insanity  as  cause  for  divorce III.,  377 

as  defence  in  divorce  actions.              .         .         .         .  III.,  377 

as  defence  in  separate  actions..    .         .                 .         .  III.,  379 

as  ground  for  avoiding  marriage  ab  in  it  in.           .         .  III.,  376 

as  ground  for  separation, III.,  378 

intoxication  in  its  relation  to, III.,  379 

medical  view  of,  contrasted  with  legal  view  of.        .         .         .  III.,  349 

melancholia,     ..........  III.,  460 

mental  alienation,  defined, III.,  351 


942  GENERAL    INDEX    TO    VOLS.    I.,    II.,    AND    III. 

PAGE 

INSANITY  IN   ITS  LEGAL  RELATIONS, 

non  COW-IMS  mentis,  defined,       ......     III.,  351,  352 

non-expert  witnesses. HI.,  529,  535 

function  of  judge  and  jury  with  respect  to  competency  and 

weight  of  opinion-evidence,  .         .         .         .         .     III.,  546 

Massachusetts  rule, III.,  546 

New  York  rule,          ........     III.,  545 

opinion-evidence  of.  .         .         .         .         .         .      III.,  529,  535 

limits  of, ,     111.,  547 

upon  what  facts  or  knowledge  an  opinion  may  be  expressed 

by  a  non-expert,  .......     III.,  542 

who  may  express  an  opinion,    .         .         .         .         .         .     III.,  538 

attesting  witnesses.    .......     III.,  538 

intimate  acquaintances.     .         .         .         ...     III.,  538 

other  non-expert  witnesses,         .         .         .         .         .     III.,  540 

the  alleged  incompetent  himself,         ....     III.,  538 

opinions  of  expert  and  non-expert  witnesses,  .         .         .     III.,  529 

presumptions  of,       .         .         .         .         .         .         .         .         .     III.,  549 

as  to  undue  influence,        .         .         .         .         .         .      III.,  553,  554 

of  continuance  of  insanity,         ......     III.,  551 

of  continuance  of  sanity,  ......     III.,  553 

of  insanity, III.,  549,  552 

of  sanity. ,.  III.,  549 

of  testamentary  capacity,  ......     III.,  550 

previous  adjudications  as  evidence  in  prosecutions  for  crime,     III.,  526 
quantum  of  evidence  required  to  prove,  ....     III.,  558 

residence,  effect  on,  ........     III.,  354 

statutory  definitions,  words,  and  phrases  denoting.  .         .     III.,  353 

torts  of  others  against  insane  persons,      .....     III.,  428 

vacates  an  office,      .........     III.,  424 

wills  and  testaments,        .         .  .      III.,  384-421 

burden  of  proof  in,    .         .         .         .         .         .  .     III.,  565 

bunion  of  proof  on  contestants,  .         .         .      TIL.  565,  566 

burden  of  proof  on  proponents,  .          .          .      III.,  565,569 

burden  of  proof,  primti  facie  on  whon:'.'       .          .          .     III.,  565 
effect  of  adjudication  of  insanity,        ....     III.,  569 

effect  of  unreasonableness  of  will  on,  .-     •   .         .     III.,  567 

instructions  to  the  jury,     ......     III.,  567 

Massachusetts  rule,  the,      ......     III.,  569 

partial  insanity  as  affecting,      .....     III.,  569 

presumption  of  continuance  of  insanity,  as  affecting,      III.,  568 
propositions   respecting,   as   laid   down   in   the   Parish 

will  case,         ........     III.,  570 

character  of  will  does  not  affect  its  validity  per  se.     .         .     III.,  392 
character  of  will  may  furnish  some  evidence  of  mental  defect,  ITT.,  394 
Christian  science, belief  in.  does  not  necessarily  incapacitate.  III.,  399 
deafness  or  deaf-muteness  not  causing  idiocy  does  not  inca- 
pacitate, III.,  410 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.        943 

PAGE 

INSANITY  IN   ITS  LKUAL  RELATIONS,  will*  and  testaments, 

degree  of  soundness, III.,  385,  401 

delirium  of  fever  may  incapacitate  if  testator  not  rational,  III.,  409 
disease  does  not  necessarily  incapacitate.  .  .  .III.,  401 

disease  of  the  brain  does  not  necessarily  incapacitate,  .  III.,  404 
drugs,  habitual  use  of,  may  destroy  mental  soundness  and 

(''sposing  capacity,         .......     III.,  412 

duvy  of  court  to  instruct  jury, III.,  391 

effect  of  adjudication  of  insanity  on  capacity  to  make  a  will.   III.,  391 

evidence  of  capacity  to  revoke  wills,         ....     III.,  518 

of  mental  incapacity  to  execute,         ....     III.,  516 

by  whom  proved, III.,  516 

of  similar  wills  made  when  sane,         .  ^      .         .         .     III.,  518 
of  testator's  declarations  and  acts,     ....     III.,  516 

of  undue  influence,     ......      III.,  518,  521 

execution  of  a  will  procured  by  fraudulent  devices,          .     III.,  420 
extreme  weakness  does  incapacitate  if  testator  not  rational.    III.,  408 
extreme  weakness  where  testator  is  rational  does  not  inca- 
pacitate,          III.,  406 

fraud,  effect  of.  .         .         .      III.,  420 

general  rule  as  .o  testamentary  capacity  laid  down  in  Dela- 

field  r.  Parish. III.,  570 

highest  degree  of  mental  soundness  not  required,      .         .     III.,  401 

idiots  cannot  make  will, III.,  385 

impairment  of  faculties  does  not  necessarily  incapacitate,  III. ,  401 , 402 
insane  delusions  contrasted  with  mistaken  belief,      .         .      III.,  395 
insane  delusions  or  insane  hallucinations  may  incapacitate.   III.,  394 
insane  delusions  or  insane  hallucinations  must  affect  the  will.  III.,  396 
insane  delusions,  what  are?       ......     III.,  395 

intoxication,  habits  of,  may  destroy  mental  soundness  and 

disposing  capacity .     III.,  412 

intoxication  not   resulting  in  mental   unsoundness  does  not 

incapacitate .     III.,  413 

mistaken  belief  does  not  invalidate  will III.,  394 

moral  insanity  does  not  incapacitate III.,  403 

nervous  disease  does  not  necessarily  incapacitate.  .  .  III.,  401 
old  age  or  feebleness  raises  no  presumption  of  testamentary 

incapacity,  cases  illustrative  of,  ....     III.,  410 

opinions,   mental  peculiarities,  and   religious  beliefs  as  dis- 
tinguished from  incapacitating  delusions,       .         .         .     III.,  398 
pain,  great,  does  not  necessarily  incapacitate,  .         .     III.,  401 

paralysis  with  an  aphasia  does  not  necessarily  incapacitate,  III.,  405 
partial  loss  of  memory  does  not  necessarily  incapacitate,  III.,  401 ,  402 
present  general  rule  as  to  wills  in  England,  ...  .  III.,  387 
present  general  rule  as  to  wills  in  New  York,  .  .  III.,  385,  386 
present  general  rule  as  to  wills  in  United  States  generally.  III.,  388 
religious  belief,  questions  of,  tire  irrelevant,  .  .  .  III.,  398 


944        GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

INSANITY  IN   ITS  LEGAL  RELATIONS,  wills  and  testaments, 

revocation  of  will, .         .  III.,  392 

spiritualism,  belief  in,  does  not  necessarily  incapacitate,     .  III.,  399 

statutory  rules  as  to  wills  in  New  York,             .         .         .  III.,  385 

testamentary  capacity,  general  principle,           .         .         .  III.,  384 
undue  influence,                                    .         .      III.,  414,  415,  518,  521 

cases  illustrative  of, III.,  418,  521 

combined  with  mental  weakness  may  incapacitate,  III.,  416 
evidence  of,        .....                  .      III.,  518,  521 

what  is  not III.,  419 

unjustifiable  ill-feeling  does  not  invalidate  will,         .         .  III.,  394 

when  testator  must  be  competent,                               '.  III.,  391 

will  itself ,  as  evidence  of  insanity,     .         .         .         .         .  III.,  516 

witchcraft,  belief  in,  does  not  necessarily  incapacitate,      .  III.,  399 

witnesses, III.,  421 

insane  persons  as, III.,  421 

intoxicated  persons  as,      .......  III.,  423 

persons  stupefied  by  drugs  as.            .....  III.,  424 

INSANITY.  MEDICAL  ASPECT  OF, III.,  146-346 

affective  insanity, •        .  III.,  239 

alcoholic  insanity,    .........  III.,  328 

alcoholism,  chronic,          .         .         .         .                  .    -',    .         .  III.,  330 

analogous  conditions  in  health III.,  161 

aphasia, III.,  190 

apoplexy,         . III.,  336 

attention,         ..........  III.,  154 

arrested  cerebral  development .         .         .         .                  .         .  III.,  338 

brain,  cortex  of .         .  III.,  159 

physiological  function  of.           ......  III.,  162 

change  of  personality,      ........  III.,  158 

chorea  in  insanity,    .........  III.,  300 

circular  insanity,      ....                   ....  III.,  309 

classification,    ...  .       III.,  199,  201,  342,  343 

conduct,                                                                                   .         .  III.,  173 

consciousness,            .         ,         .         .         .         .         .         ,    .     .  III.,  152 

coprolalia,        .         .                  .......  III.,  257 

cortex  of  brain,         .         .         .         .         .         .         .         .         .  III.,  159 

criminal  brain,                             III.,  198 

delirium.                                                                                            .  III.,  182 

grave.        .......                            .  III.,  313 

delusions,          . III.,  177 

best  proof  of  insanity,       .......  III.,  158 

concealment  of, III.,  179 

definition  of, III.,  177 

imperative  conceptions III.,  178 

lucid  intervals,  ....      III.,  179,  180 

of  persecution,  .         .         .         .  .      III.,  178,  268 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.  945 

PAGE 

INSANITY,  MEDICAL  ASPECT  OF,  delusions, 

of  special  senses, III.,  177 

remission  of,     .         . III.,  180 

systematized,    .                  .                  .         .         .         .         .  III.,  178 

unsystematized,         .         .         .  •      .         .         .         .         .  III.,  178 

without  relation  to  the  act, III.,  151 

dementia,         . III.,  195 

adventitia          .         .         . III.,  161,  200 

alcoholic,           . III.,  330 

complete.           .         .       . III.,  231 

facial  expression  in.            .         .  -      .         .         .         .         .  III.,  187 

heredity  in,       .  '.'."_ III.,  230 

loss  of  identity  in,     .         .         .         .-=?-.         .         .  III.,  232 

naturalis,  .         .         .        .         .         .         .         .     III.,  161,  200 

pracox,     ..........  III.,  345 

primary,             .       -. III.,  230 

secondary, III.,  231 

senile,        .         . .  III.,  334 

varieties  of,       . III.,  234 

with  agitation, III.,  234 

with  apathy .  III.,  236 

difference  between  legal  and  medical  views  of  insanity,    .      III.,  179,  349 

dipsomania,      .         .         .         .         ...         .         .                 •.  III.,  259 

duration  of  time  in  thought,    .         .         .         .         .                  .  III.,  154 

ear,  the  insane,         .         .  .         .         .         .         .         .III..  184 

eccentricity  in  dress.         ........  III.,  188 

ego,  the.    " III.,  152 

epileptic  insanity,                       » III.,  293 

epilepsy, III.,  293 

masked.     .         .         .      •  ...   '      .        '.         .         .         .         .  III.,  296 

simulation  of, .  III..  299 

erotomania, III.,  278 

etiology .  III.,  163 

age.           .         . .  III.,  163 

alcohol.     .         .         ...         .         .         .         .         .  III.,  170 

anaemia,    .         .         .         .         .         .         .         .         .         .  III.,  168 

anaesthetics.      .........  III.,  171 

cerebral  hemorrhage. .  III..  168 

syphilis.     .                           III.,  169 

change  of  climate.     .         .         .         .         .         .         ..  III.,  172 

civilization, III..  163 

cocaine,     .         .         \        .         .               •  .         .         .         .  III.,  170 

cretinism,           .........  III.,  172 

exciting  causes  of,     . III.,  167 

fevers, III.,  164.  169 

genito-urinary  irritation.            ......  III..  171 

gout. III..  170 

III.— 60 


040  GENERAL    INDEX    TO    VOI,S.    I.,    II.,    AND    III. 

PAGE 

INSANITY,   MEDICAL  ASPECT  OF,  etiology, 

grief, III.,  164 

heredity, III.,  164 

imprisonment, III.,  165,  166 

influenza, III.,  170 

inhabitants  of  citie,s          .......  III.,  163 

injuries, III.,  164 

insolation,          .........  III.,  172 

malaria III.,  170 

marriage,            .         .         .         .         .         .         .         .         .  III..  164 

meningitis,         .........  III.,  167 

morphine,           .........  III.,  170 

multiple  sclerosis, III.,  168 

nervous  disease,         ........  III.,  168 

occupation,        .........  III.,  166 

operations,        .........  III.,  171 

predisposing  causes,  ......     III.,  163,  165 

quinine, III.,  170 

race, III.,  164 

reflex  origin,      .........  III.,  171 

religion, III.,  166 

rheumatism, III.,  170 

shock III.,  172 

syphilis III.,  169 

table  of  causes,           ........  III.,  173 

tuberculosis,      .........  III.,  168 

tumors,     ..........  III.,  168 

eye  symptoms,          .........  III.,  189 

facial  expression,      .         .         .         .         .         .         .         .         .III.,  185 

feelings, III.,  153 

folie  raisomiante ,       .........  III.,  241 

genius  and  insanity,          ....                   ...  III.,  163 

gout  and  insanity,    .........  III.,  306 

habit,  changes  in,     .........  III.,  188 

hallucinations  defined.      ........  III.,  175 

absence  of  visual  in  the  blind,            .....  III.,  176 

special  senses  affected  in, III.,  176 

handwriting .  III.,  191 

heredity,  in  diagnosis,       .....                   .         .  III.,  182 

homicidal  insanity, III.,  250 

hypnotism,       ..........  III.,  310 

hypochondriacal  insanity,         .......  III.,  291 

hypochondriasis .  III.,  292 

hysterical  insanity,           ........  III.,  288 

hysteria.            .    *     .         .         .         .                   .         .         .         .  III.,  288 

liystero-epilepsy.      ...                   ....  III.,  289 

idiocv.  III.,  338 


GENERAL  IXDEX  TO  VOLS.  I.,  II.,  AXD  III.        947 

PAGE 

INSANITY,  MEDICAL  ASPECT  OF,  idiocy, 

facial  expression  in,  ......     III.,  341,  342 

illusions,  definition  of,      ........     III.,  177 

imbecility, III.,  342 

impulse,  homicidal, .      III.,  247,  250 

irresistible, III. ,245,  249 

suicidal, III.,  252 

impulsive  insanity, III.,  244 

indications  of ,  .........     III.,  173 

insane  neurosis,        .         .         .         .         .         .         .         .         .III. ,158 

insanity, III.,  155 

affective. ^        .         .         .     III.,  239 

alcoholic, III.,  328 

causes  of, III.,  163 

chorea  in, III.,  300 

circular, III.,  309 

clinical  aspect  of,       ........     III.,  159 

difference  between  legal  and  medical  views  of,  .      III.,  179,  349 

epileptic, III.,  293 

exciting  causes  of, III.,  167 

from  constitutional  neuroses III. ,281 

homicidal.          ..".......     III.,  250 

hypochondriacal, III.,  291 

hysterical,  III..  288 

impulsive,          .         .         .         .         .         .         .         .         .     III..  244 

legal  definition  of,      .......      III.,  155.  156 

medical  definition  of III.,  155,  158 

of  lactation.       .         . III.,  302 

of  menopause, III.,  303 

of  puberty,  . III.,  304 

periodical .III.,  309 

phthisis  and III.,  306 

predisposing  causes  of III.,  163.  165 

puerperal. III.,  301 

religious, III.,  273 

rheumatism  and III.,  305 

synonyms, III.,  156 

syphilitic III..  327 

terminology  of HI..  156,  161,  343 

what  is? III.,  156 

intellection III.,  154 

judgment .  III.,  154 

katatonia.         .         .         .         .         .  .         .         .III.,  345 

kleptomania III.,  253 

in  general  paresis.      ........     III.,  253 

lactation,  insanity  of III.,  302 

legal  view  of  insanity  contrasted  with  the  medical  view  of  the 
same.  III..  349 


insane.         .         .     . 
ill, 

.         .         .         .     III.,  191,227 
.     III.,  239 

[, 

.      III.,  179,  180 

lirious, 
acts  in, 

.      III.,  195,  224,  343 
.     III.,  313 
.         .         .         .     III.  ,229 

948        GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  Iir. 

INSANITY,   MEDICAL  ASPECT  1-1. 
letters  of  the  in: 
loss  of  free  will, 
lucid  interval, 
mania. 


defined,     ....  .      III.,  195,  224 

dementia  in .         ...     III.,  227 

facial  expression  in,  .......     III.,  18G 

forms  of, ...      III.,  224,  226 

hallucinations,  etc.,  of.      .....  .     III.,  224 

hallucinatory,    .         .  III.,  237 

letter-writing  in,        ....  ...     III.,  227 

onset  of,    .         . .     III.,  224 

physical  conditions  in .     III.,  225 

suicidal,    .         ...         .         .         .    .     .         .         .         .     III.,  252 

transitory, .      III.,  261,  298 

manic-depressive  insanity,        .         .         .         .         .         .         .     III.,  343 

manner,  changes  in,          ........     III.,  188 

masturbation,  .         .         .         .         •         .         .   -      .         .     III.,  191 

medical  view  of  insanity  contrasted  with  the  legal  view  of  the 

same,  III.,  349 

melancholia III.,  195,  203,  343 

case,  Field's,     ....  ...     III.,  207 

with  homicidal  intent .        ......     III.,  223 

cataleptic  state  in, III.,  220 

chronic, III.,  221 

definition  of.      .  III.,  195,  205 

facial  expression  in,  ......     III.,  185,  205 

folie  it  <lc.ux,       ....  .  III.,  219 

hallucinations  in,       ...  ...     III.,  20(5 

homicide  in, III.,  207 

simple .  .         .     III.,  218 

with  stupor .         .         .     III.,  181 

without  delusions.     ....  .  III.,  220 

memory,  .....  ...     III.,  181 

activity  of ...     III.,  181 

complete  loss  of.        .  ...     III.,  181 

temporary  loss  of.     ...  ...     III.,  181 

menopause,  insanity  at .  .         .  ....     III.,  303 

mind,  science  of III.,  152 

moral  insanity,          .........     III.,  243 

morphinomania.       .........     III.,  258 

neurasthenia,  .         .         .         .         .         .         ,         .         .     III.,  281 

"non  compos  mentis."      .  ......     III.,  161 

nymphomania,         ...  .  III.,  260 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III.  049 

PAGE 

INSANITY.   MEDICAL  ASPECT  OF. 

optic  atrophy, III.,  190 

organic  psychoses,    .         .         .         .         .         ...         .         .  III.,  312 

paranoia.           .         .   ,               .         ."         .         .         .         .         .  III.,  202 

ambitions,          .         .         . III.,  270 

erotic.                 . III.,  278 

querulent, III.,  272 

religious,             .........  III.,  273 

typical  forms  of,        ........  III..  200 

paresis,  general,        .......                   .  III.,  310 

complications  in,                 .••'.".         .         .         .         .  III.,  323 

eye  symptoms  in,      ........  III.,  189 

facial  expression  in,  ...         '."        .         .      III.,  187,  320 

partial  insanity.        .........  III.,  148 

pathology  of III.,  195 

perceptions,      ..........  III.,  154 

periodical  insanity,            ....                   ...  III.,  309 

previous  attacks,      .         .         .         .         .         .         .         .         .III.,  183 

psychical  degeneration,              ...                   ...  III.,  239 

puberty,  insanity  of.         .         .         .         .         .         .         .         .  III.,  304 

puerperal  insanity.                      .                            ....  III.,  301 

pupillary  changes  in,         .         7        ......  III.,  189 

pyromania,       ...........  III.,  254 

reasoning  insanity.            ........  III.,  241 

mania.       ...                            III.,  242 

melancholia.      ......                  .         .  III.,  242 

monomania,      ....         .         .                   .         .         .  III.,  242 

religious,.         ...  .       III..  100.  107,  273,  270 

rhymings, III.,  194 

self-consciousness.    .         .         .         .         .         .         .         .         .  III.,  152 

senile  dementia,        .........  III.,  334 

somatic  indications.          ........  III.,  184 

special  forms  of  insanity,           .......  III.,  203 

speech,     ...........  III.,  155 

stupor,  delusional.    .         .         .         .         .                   .         .         .  III.,  237 

stuprous  insanity,     .         .         .         .         .         .         .         .         .  III.,  230 

suicidal  mania,          .........  III.,  252 

syphilitic  insanity,             .  .                III.,  327 

thought,  evolution  of,       ........  III.,  154 

mechanism  of,           ........  III.,  152 

transitory  mania.     .         . IIF.,201,298 

typhomania,    : .         .         .  III.,  313 

INSOLATION.             I.,  948 

FNSI'LATION  OF  ELECTRICAL  CONDUCTORS II.,   183 

I.MSrHANCE,  MEDICO-LEGAL  RELATION8  OF,  .  .  .         III.,   129-143 

definitions  of  terms  used  in  policies,                           .         .         .  III..  130 

accident.  III..  130 


0")0  GENERAL    INDEX    TO    VOLS.    T..    IF.,    AND    III. 

PAGE 
l.NSt  KANCK,     MEDICO-LEGAL     RELATIONS     OF,     definitions     of, 

affection III.,  138 

attendance  of  physician.  .....      III.,  138,  140 

breaking  of  limb III..  138 

disease,      .  III.,  138 

epidemics,          .........     III..  138 

external,  violent,  and  accidental  means,  .         .      III.,  136,  138 

external  and  visible  signs  of  injury,  .          .          .III.,  139,  143 

habits III..  139 

health. III.,  138,  139 

intemperance,  death  caused  by.         .....     III.,  139 

intoxicating  liquor  or  narcotics,  death  from  use  of,         .     III.,  139 
loss  of  a  member,      ........     III.,  140 

medical  treatment.    ........     III.,  140 

natural  causes,  death  from,        ......     III.,  140 

over-exertion.    .........     III.,  140 

poison,       .         .         .         .         .         .         .         .         .         .     III.,  140 

proximate  cause  of  death.          ......     III.,  141 

pulmonary  disease,    ........     III.,  142 

serious  illness,  ........     III.,  142 

spitting  blood, III.,  138,  143 

suicide III.,  143 

sunstroke III.,  136,  143 

total  disability III.,  143 

vaccination,  successful,      .         .         .         .         .         .         .III.,  143 

visible  marks  upon  the  body,    .....      III.,  139,  143 

effect  of  insanity  upon  contract  of,  .....     III.,  373 

effect  of  misstatements  on  part  of  insured,        .  .         .III..  133 

medical  examiner  agent  of  the  insurer,     .....     III.,  132 

powers  and  duties  of.  for  life  insurance,     ....     III.,  131 

proofs  of  death,        .........     III.,  13.5 

INTEMPERANCE,  death  caused  by,  medico-legal  significance  of  term.     III.,  139 
INTESTINES,  post-mortem  examination  of,       .....         I.,  853 

wounds  of, .       II.,  132 

INTOXICATED  PERSON,  as  office-holder.     ......     III.,  424 

as  witness,        ..........     III.,  42',] 

INTOXICATING  LIQTTOR,  death  from  use  of.  medico-legal  significance 

of  term , III.,  139 

INTOXICATION,  as  a  defence  to  criminal  prosecution,        .         .         .     III.,  481 

as  a  contempt, III.,  482 

involuntary,     ..........     III.,  496 

voluntary III.,  486 

IOWA,  legal  status  of  dead  body  in,          ......         I.,  791 

statutes  regulating  the  practice  of  medicine  in,     .          .         I.,  258.  689 
statutes  relating  to  incompetent  persons  in,     .         .         .          .     III..  645 

IRELAND,  statutes  regulating  the  practice  of  medicine  in,     I.,  179,  542,  706 
IRRUMATION.  II.,  750 


GENERAL  INDEX  TO  VOLS.  I..  II.,  AND  III.         951 

PAGE 
IT'NEKANT  DOCTORS,  .  .  .  .  .  .      '       .  .  I.,  745 

VENDERS, I.,  746 

KANSAS,  legal  status  of  dead  body  \i(, I.,  791 

statutes  regulating  the  practice  of  medicine  in,  .  .  I.,  268,  691 
statutes  relating  to  incompetent  persons  in.  ....  III.,  650 

KENTUCKY,  legal  status  of  dead  body  in,  .  •  .  .  .  .  I.,  792 
statutes  regulating  the  practice  of  medicine  in,  .  .  I.,  276,  691 
statutes  relating  to  incompetent  persons  in III.,  654 

KIDNEYS,  post-mortem  examination  of,  .....        I.,  852 

rupture  of.        ........  .       II.,  130 

wounds  of,  .  .  .  '  .  1 II.,  130 

KILLING  OK  UNBORN  CHILD '    .         .         .         .       II.,  411 

KLEPTOMANIA ".         .       III.,  Ill,  253,  456 

LABOR *. II.,  507 

disputed II.,  553 

feigned.    .         .         .         . II.,  579 

cases  illustrative  of,  .         .         .         .         .         .         .II.,  580 

protracted,  cause  of  foetal  death,      ......       II.,  447 

LANUGO II.,  531 

LARYNX,  in  death  from  hanging II.,  274 

from  strangulation.  .         .         .         .         .         .         .       II.,  237 

post-mortem  examination  of,   .         .         .         .         .         .         .1.,  851 

LAWS   REGULATING  THE  PRACTICE  OF  MEDICINE  AND  SURGERY,    I.,    179 

-708  and  see, I.,  709-774 

LEGAL  MEDICINE,    ..........  I.,  v 

LEGISLATION, I.,  746 

LEGISLATURE, I.,  747 

LEGITIMACY.  .         . II.,  514,  520,  523 

LESBIANISM II.,  731 

LEUCORRIKEA. II. ,  638.  711 

LIBEL I.,  748 

LICENSE  TO  PRACTISE  MEDICINE  (ami  see  Practice  of  Medicine  and 

Surgery).      .  I..  749 

action  for  services  cannot  be  brought  by  physician  without,  I.,  18 

courts  may  compel  granting  of.        .         .         .         .         .         .  I.,  14 

expert  witnesses'  competency  presumed  from,  .         .         .  I.,  58 

witness  without,  sometimes  held  not  competent.       .         .  I.,  62 

falsely  pretending  lo  have,  generally  a  misdemeanor,       .  I.,  22 

Now  York  statute's  relating  to,          ......     I.,  11-19 

(or  diploma),  how  proved  in  court.  .....  I.,  20 

practitioner  lacking,  causing  death,  guilty  of  crime,       .    •     .  I.,  79 

proved,  how.  in  a  court  of  law,         .  ....  I.,  20 

statutes  requiring,  constitutional.     .         .         .         .         .         .  I.,  7 

when  presumed ...  I..  19 

LIFE  (and  see  Viability,  Infanticide,  Live-birth).  II.,  421 


OEXERAL  INDEX  TO  VOLS.  I..  II.,  AXD  III. 


LIFE  INSURANCE,  see  Insurance. 

LIGHTNING,     ....... 

TT  ,  207 

action  of,  on  clothing, 

II.,  209 

autopsies  after  death  from.       .         .         .         .         . 

II.,  218 

burns  from,      

TT,211 

contusions  by,           .         .         .         •         •         •         .'..'". 

IT  ,  212 

convulsions  from,     .         .         .         .         .         .         ... 

II.,  215 

II    215 

effects  on  internal  organs,         .         .         .         . 

II.,  219 

hearing  affected  by,          

II.,  216 

loss  of  consciousness  from  ,         .         . 

II.,  213 

loss  of  memory  from,        .....                 '. 

II.,  221 

mental  impairment  from. 

II.,  214 

paralysis  from,          . 

II..  214 

pathology  of  stroke  of  

II.,  217 

post-mortem  findings,       

II.,  220 

sight  affected  by,     ......... 

II.,  216 

smell  affected  by,     .         .         .     •    .         . 

II.,  217 

staining  of  skin  by,           

II.,  213 

survivorship  in  cases  of  death  by,    .         .         .    '     .   ,              ». 

II.,  348 

symptoms  produced  by,            .....        II.,  210, 

213,  217 

taste  affected  by,      .         .         .         .         .         .         .         . 

II.  ,217 

treatment  of  injuries  from.       ....... 

II.,  220 

wounds  by,       .........". 

II.,  212 

LITIGATION  PSYCHOSIS,    .         .         .         .         .         .         .'...; 

II  ,  871 

LIVE-BIRTH,             .         .         .         .         .         .         .        II.,  409,  416, 

520,  526 

LIVE-  BORN,     ........... 

TT  ,  416 

LIVER,  post-mortem  examination  of,       .         .          .         .         .         . 

I.,  857 

rupture  of,        .......... 

II.,  128 

wounds  of,        .....                   .                   .         . 

II.,  128 

LIVING  PERSON,  examination  of,      .         .         .         .         .    ~    . 

II.,  497 

as  to  age,  in  civil  cases,    .....                  . 

II.,  502 

as  to  insanity,  in  civil  cases.     .         .         .         .         . 

II.,  502 

in  criminal  cases,       ........ 

II.,  499 

examination  of  plaintiff  in  civil  actions  to  recover  damages  foi 

r 

personal  injuries,            

II.,  502 

in  cases  of  alleged  impotency  in  actions  for  divorce. 

II.,  501 

in  cases  of  infancy,  in  criminal  cases.        ..... 

II.,  497 

in  civil  cases,    .         

TT  ,  501 

in  criminal  cases,      ......... 

II.,  497 

in  disputed  heirship,         

II.,  501 

refusal  of  plaintiff  to  submit  to  medical  examination,  when  ad- 

missible in  evidence, 

II.,  504 

to  determine  age,     .         .         .         .         .         .         .         . 

II.,  497 

to  determine  existence  of  pregnancy  in  capital  cases. 

II.,  499 

when  defendant  in  a  criminal  action  pleads  insanity, 

II.,  499 

LoCHIAL  STAINS,        .             .             .             .             .             .             .             .             .             . 

III.,  843 

CENEKAL  IXDEX  TO  VOLS.  I..  II..  AM)  III.  953 

PAGE 

Loss  OF  A  XIEMBEK,  medico-legal  significance  of  term,     .         .         .  III.,  140 

Loi  LSI  ANA,  legal  status  of  dead  body  in,         .....  I.,  792 

statutes  regulating  the  practice  of  medicine  in,        .         .         .  I.,  2.80 

statutes  relating  to  incompetent  persons  in,     .         .         .  III.,  656 

LUCID  INTERVAL,      .            .                        ....            .            .            .            .  III.,  179 

LUMBAGO,  TRAUMATIC.     .         .  .         .         .         .         .       II.,  818,  821 

LUNACY, .  III.,  161 

LUNACY, III.,  350 

inquisitions  of,                      .;     .......  III.,  564 

LUNATIC,  see  Insanity. 

LUNGS,  in  death  from  strangulation,       .                  .        ,         .         .  II.,  236 

from  submersion,       .         .                   .....  II.,  327 

post-mortem  examination  of,            .         .         ...=     .         .         .  I.,  850 

wounds  of,                 .         .         .-.         .         .         .         .         .  II.,  121 

LUST  MURDER.          .         .  .         .         ...         .       II.,  677,  691 

LYING  IN  STATE,  FEIGNED,  cases  of,         ......  II.,  580 

LYMPHORRHAGIA .  *     .         .         .         .  II.,  16 

MAGNETIC  HEALING,        .                  I.,  750 

.MAINE,  legal  status  of  dead  body  in,                .               •  .         .         .  I.,  792 

statutes  regulating  the  practice  of  medicine  in.         .         .         I.,  286,  691 

statutes  relating  to  incompetent  persons  in,               .         .         .  III.,  657 

MALINGERING,         .......                  .  II.,  952 

MALPRACTICE .         .         .  .     I.,  73-88,  750 

abortion  is,  at  common  law.     .         .         .         .                  .       I..  74,  75,  76 

action  for,  evidence  in,     .         .         .         .         .                  .         .  I.,  87 

injuries  to  married  women  and  minors I.,  85 

inspection  of  injured  persons  at  or  before  trial.         .         .  I.,  85 

acts  forbidden  by  statute,         .......  I.,  74 

care  and  skill  required,  a  mixed  question  of  law  and  fact,         .  I.,  83 
change   and    advancement    in    medical    knowledge   to   be    con- 
sidered  •'•'.' I.,  82 

civil  liability I.,  80 

for  lack  of  ordinary  skill  and  care  only.     .         .         .  I.,  80 

contributory  negligence. I.,  87 

criminal,           .         .          . I.,  73 

damages,  measure  of,         .         .         .         .         .         .         .  I.,  84 

defined,     .         .         .     "    .    * I.,  73 

degree  of  care  and  skill  in,         ......  I.,  80 

experiments  not  to  be  tried  on  patients.             .         .         .  I.,  3(5,  83 

gross  negligence I.,  78 

if  wilful,  honest  intent  no  defence.             .....  I.,  73 

inspection  before  trial  in.           ...         .         .         .         .  I.,  85 

negligent  criminal  liability,        .         .         .         .         .         .  I.,  76 

occult  influences  to  he  considered I.,  81 

partner's  liability  for         ...                   ...  I.,  85 

wilful.        .  I.,  73 


054         GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

MALPRACTICE  SUITS,  x-ray,     ........     III.,  799 

MAMM.E,  changes  in.  during  pregnancy, II.,  568 

in  virgins,         ..........       II.,  675 

MANIA  (and  see  Insanity),      .         .         .         .         .       III.,  195,  224,  343,  460 

MANITOBA,  statutes  regulating  the  practice  of  medicine  in,     .         .         I.,  595 

MARKS  OF  POWDER, .       II.,  155,  160 

MARKS  UPON  BODY,  VISIBLE,  medico-legal  significance  of  term,     III.,  139,  143 

MARRIAGE  AND  DIVORCE,  MEDICO-LEGAL  ASPECT  OF,         .         .      III.,  758-770 

capacity  for  marriage,      ........     III.,  761 

mental  capacity,        ........     III.,  761 

physical  incapacity, .     III.,  762 

legal  effects  of  disease  on  marriage.          .         .         .         .         .     III.,  766 

annulment  for  fraud,          .......     III.,  766 

contracting  venereal  disease  as  a  proof  of  adultery,  .     III.,  769 

disease  as  a  ground  for  divorce,         .         .         .        •;         .     III.,  768 
disease  rendering  cohabitation  dangerous,  as  a  defence  to  an 

action  for  breach  of  promise  of  marriage,  .         .     III.,  767 

pregnancy  at  the  time  of  marriage  as  a  ground  for  annul- 
ment or  divorce,  .......     III.,  769 

MARRIAGE,  effect  of  mental  incapacity  on III.,  761 

effect  of  insanity  upon III.,  376 

effect  of  intoxication  upon.       .         .         .         ..         .         .         .III.,  379 

relation  of  insanity  to,      ........     III.,  376 

sexual  incapacity  and  dissolution  of,         .         .         .         .         .II.,  635 

MARRIED  WOMEN,  liability  of,  for  medical  services,          .  .          I.,  37 

MARYLAND,  legal  status  of  dead  body  in,         .....         I.,  793 

statutes  regulating  the  practice  of  medicine  in,         .         .          .1.,  289 
statutes  relating  to  incompetent  persons  in.     .         .         .         .     III.,  661 

MASK  OF  PREGNANCY V*"     .  •       .         .       II.,  556 

MASSACHUSETTS,  legal  status  of  dead  body  in.         .         .         .         .1.,  793 

statutes  regulating  the  practice  of  medicine  in,         .         .         .         I.,  302 
statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  664 

MASSAGE,        ...  ....     I.,  13,  22,  750 

MASSOCHISM,  .         .         .         .         ...         .         .        ..         .II.,  739 

MASTER,  liability  ot,  for  services  rendered  servant,  ...  I..  39 

MASTURBATION III.,  191 

MECONIUM II.,  440,  532 

MEDICAL  board I.,  750 

College I.,  751 

Council I.,  751 

Education,       ..........        I.,  751 

Examiners  (and  see  Coroners),  .....         I.,  751 

contract  of  coroner  with,  binds  county  to  payment  of  rea- 
sonable compensation,  ....  .1.,  816 

coroners  may  employ,        .......         I.,  816 

for  life  insurance,       ...  III.,  331 

agent  of  the  insurer,  .         .     III..  132 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  ANH  III.         955 

PAf.B 

MEDICAL   Examiners,   for  lift-   insurance, 

may  supplement  the  printed  questions,      .         .         .     III.,  134 

powers  and  duties  of, III.,  131 

in  Massachusetts I.,  818 

cannot  hold  autopsy  unless  authorized,      ...        I.,  818 

cannot  hold  an  inquest,      ....  .1.,  818 

in  place  of  coroners,  ....  .         I.,  818 

New  York  statutory  provisions.         .         .         .         .         .         I.,  819 

powers  and  duties  of I.,  819-830 

legislation,        ..........         I.,  751 

history  of,  in  America,       .         .         .         .         .         .         .1.,  743 

services  of  Physicians  and  Surgeons,  see  Action  for  medical  services, 
societies,  ..........         I.,  752 

students,  .         .         .         .         .         .         .         .         .         .         I.,  752 

treatment,  medico-legal  significance  of  term,    ....     III.,  140 

MEDICAL  JURISPRUDENCE,      ........  I.,  v 

MEDICINE I.,  752 

MEDICINE  AND  SURGERY,  see  Physician  and  Patient;   and  Practice  of 
Medicine  and  Surgery. 

MEDICO-LEGAL  SCIENCE, I.,  v 

MELANCHOLIA •      .  III.,  195,  203.  343,  460 

MELANCHOLIA,  see  Insanity. 

MENOPAUSE,    .         .         .         .         .         .         .         .         .         .         .II.,  649 

MENSTRUAL  blood III.,  842 

stains .         .         .  .     III.,  842 

MENSTRUATION,  age  at  which  begins  and  ends,       ....      II.,  649 
cessation  of,  in  pregnancy,        .         .         .         .         .         .         .II.,  557 

relation  of,  to  impregnation II.,  508 

to  ovulation,     .         .         .         .         .         .         .         .         .II.,  510 

MENTAL  alienation,         .........     III.,  351 

healer I..  752 

incapacity,  effect  of,  on  marriag  •, III.,  761 

unsoundness,  see  Insanity.  Incompetent  persons. 

METAPHYSICAL  HEALING, I.,  752 

METH.TCMOGLOBIN, III.,  855 

MICHIGAN,  legal  status  of  dead  body  in,  .....         I.,  794 

statutes  regulating  the  practice  of  medicine  in.         .         .         I.,  305,  691 

statutes  relating  to  incompetent  persons  in.     ....     III.,  668 

MICRO-SPECTROSCOPE,     .........    III.,  859 

MIDWIFERY I.,  752 

MIND-HEALING I.,  752 

MINNESOTA,  legal  status  of  dead  body  in.        .....         I.,  795 

statutes  regulating  the  practice  of  medicine  in.         ...         I.,  317 

statutes  relating  to  incompetent  persons  in,     ....      III.,  671 

MISSISSIPPI,  legal  status  of  dead  body  in.        .....         I.,  795 

statutes  regulating  t lie  practice  of  medicine  in.         .         .         I..  328,  693 
statutes  relating  to  incompetent  persons  in,     ....     III.,  674 


956         GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

MISSOURI,  legal  status  of  dead  body  in,  .  I.,  796 

statutes  regulating  the  practice  of  medicine  in,  .  I.,  331,  693 

statutes  relating  to  incompetent  persons  in,  .  .  III.,  676 

MONSTERS,      ....  .II.,  448 

MONTANA,  legal  status  of  dead  body  in,  .  .  I.,  796 

statutes  regulating  the  practice  of  medicine  in,  .  I.,  341 

statutes  relating  to  incompetent  persons  in,  .  .  .  III.,  678 

MORNING  SICKNESS,         .....  .       II.,  554 

MOUPHINOMANIA.      .  .  .  .  .        III.,  258 

MOTHER'S  MARKS,                      .         .                                                      •  II-,  542 

cases  illustrative  of,           .....                            .  II.,  544 

MUSCULAR  CONTRACTION,  from  electrical  current,    ....  II.,  194 

MUTILATED  REMAINS,  identification  from, I.,  891 

MYOPIA,  see  Vision. 

NAILS,  identification  from, I.,  888 

NARCOTICS,  DEATH  FROM  USE  OF,  medico-legal  significance  of  term,     III.,  139 
NATURAL  CAUSES,  DEATH  FROM,  medico-legal  significance  of  term,     III.,  140 

NEBRASKA,  legal  status  of  dead  body  in, v   I.,  796 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  350,  695 

statutes  relating  to  incompetent  persons  in,     .  .     III.,  681 

NECK,  contusions  of,       .........       II.,  116 

post-mortem  examination  of,  •  .....         I.,  851 

wounds  of,        .         .         .         ,         .         .         .         .         .         .       II.,  115 

NECROPHILIA, II.,  731,  761 

NEGLIGENCE,  see  Malpractice. 

gross,  in  malpractice,        ........  I.,  78 

in  malpractice,          .........  I.,  76 

NEURASTHENIA,       . III.,  281 

NEVADA,  legal  status  of  dead  body  in,     .          .         .         .         .         .         I.,  797 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  362,  695 
statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  683 

NEWBORN,       ...........       II.,  356 

NEW  BRUNSWICK,  statutes  regulating  the  practice  of  medicine  in,  I.,  604 

NEWFOUNDLAND,  statutes  regulating  the  practice  of  medicine  in,         I.,  614 
NEW  HAMPSHIRE,  legal  status  of  dead  body  in,       .         .         .         .         I. ,797 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  368,  696 
statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  685 

NEW  JERSEY,  legal  status  of  dead  body  in,     .....        I.,  798 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  375,  697 
statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  687 

NEW  MEXICO,  legal  status  of  dead  body  in,     .         .         •    .     •         •         !•>  799 
statutes  regulating  the  practice  of  medicine  in,         .  .         I.,  383 

NEW' YORK,  legal  status  of  dead  body  in I.,  799 

statutes  regulating  the  practice  of  medicine  in,         .  I.,  388,  698 

statutes  relating  to  incompetent  persons  in,     .         .  .     III.,  691 

"NON    COMPOS  MENTIS,"  .  .  .  .  .  ...  .       III.,   161 


GEXERAL   INDEX   TO    VOLS.    I..    II.,    AND    III.  957 


PAGE 


NORTH  CAROLINA,  legal  status  of  dead  body  in,      .      -  .         .         .  I.,  800 

statutes  regulating  the  practice  of  medicine  in,         .         .         I..  40,3,  69S 

statutes  relating  to  incompetent  persons  in,     ....  III.,  712 

NORTH  DAKOTA,  legal  status  of  dead  body  in,         .         .         .         .  I.,  801 

statutes  regulating  the  practice  of  medicine  in.         .         .         .  I.,  414 

statutes  relating  to  incompetent  persons  in III.,  715 

NORTHWEST  TERRITORIES,  statutes  regulating  the  practice  of  medicine 

in, I.,  619,  707 

NOVA  SCOTIA,  statutes  regulating  the  practice  of  medicine  in.         .  I.,  625 

Noxious  THING,      .         .         ...         .                       '   .         .         .  II.,  370 

NUBILITY, " II.,  645 

NURSE, I.,  753 

evidence  of  communication  with,     .         .         .  '*~    .         .         .  I.,  101 

NYMPHOMAMA,       ........       II.,  739;  III.,  260 

OBSCENE  PUBLICATIONS,  prohibition  of.           .....  II.,  740 

OBSTETRICS, .  I.,  754 

OCULIST. I.,  754 

ODOR  OF  BLOOD,  differentiation  of  bloods  by,            ....  III.,  883 

(ESOPHAGUS,  post-mortem  examination  of.      .         .         .     •    .         .  I.,  851 

OFFENCE, I.,  754 

OHIO,  legal  status  of  dead  body  in,          .         .         .         .     •    .         .  I.,  801 

statutes  regulating  the  practice  of  medicine  in.         .         .         I.,  416,  699 

statutes  relating  to  incompetent  persons  in.     .         .         .         .  III.,  717 

OKLAHOMA,  legal  status  of  dead  body  in,         .         .         .         .         .  I.,  802 

statutes  regulating  the  practice  of  medicine  in,         .         .         .  I.,  435 

statutes  relating  to  incompetent  persons  in.     .         .         .         .  III.,  720 

ONTARIO,  statutes  regulating  the  practice  of  medicine  in,         .         .1.,  633 

OPHTHALMIA,  SYMPATHETIC.    . III.,  90 

OPHTHALMOLOGIST, .  I.,  755 

OPIUM  HABIT III.,  258 

OPTICIAN,        .                          I.,  755 

ORBIT,  see  Eye.  Eyeball,  Eyelids. 

contusions  of  the  margin  of,     .......  III.,  30 

enophthalmus,  traumatic.         .         .         .        ..         .         ..    '    .  III.,  49 

exophthalmus,  pulsating.          .......  III.,  50 

direct  fracture  of  roof  of.           .         .         .         .   '      .         .         .  III.,  34 

fracture  of  external  wall  of.      .         .         .         .         .         .  *  III.,  42 

floor  of III.,  42 

inner  wall  of.     .         .         .                   .         .         .         .         .  III..  41 

margins  of.        .........  III.,  31 

indirect  fracture  of  roof  of.       .......  III..  31 

injuries  to.        .         ....         .         .         .                  j '        .  III.,  30 

wounds  of  soft  parts  of, III.,  42 

OREGON,  legal  status  of  dead  body  in I..  803 

statutes  regulating  the  practice  of  medicine  in.         ...  I.,  442 

statutes  relating  to  incompetent  persons  in.     ....  III.,  721 


958         GENERAL  INDEX  TO  VOLS.  I..  II.,  AND  III. 

PAGE 

OSTEOPATHY,  .         .         .         .         .         .         .         .'-.'•,         .       .!.,  755 

OVEKEXEHTION.  medico-legal  significance  of  term,     '  III.,  140 

OVERLAYING.  .         .         .         .         .         .         .         .         ...       II.,  290 

OVULATION.  relation  of,  to  menstruation,         .         .         .         .         .II.,  510 

OVUM,  when  liberated  from  ovary,  ......       II.,  510 

OXYH.EMOGLOBIN. III..  854 

resistance  of  to  acids  and  alkalies,  a  method  of  differentiating 

bloods, .         .     III.,  883 

PANCREAS,  post-mortem  examination  of.       .         .         .         ...      I.,  857 

PARANOIA  (and  see  Insanity,  medical  aspect  of),  .         .        III.,  262,  357 

PARESIS,  GENERAL,        ........  Ill,,  316 

PARTURITION,  survivorship  in  death  during.  .  .         II.,  348,  454 

PATENT  MEDICINES.        ..........          I.,  756 

administering,  is  practice  of  medicine,    .         .         .         .         .          I.,     13 

PATIENT,  see  Physicians  and  Surgeons,  and  Privileged  Communications. 

rights  of,  concerning  confidential  communications,  .         .  I.,  91 

PEDERASTY II.,  737,  740 

examination  of  persons  accused  of,  .....       II.,  759 

practices  and  manifestations  of,        ......       II.,  748 

PENNSYLVANIA,  legal  status  of  dead  body  in,  ....         I.,  803 

statutes  regulating  the  practice  of  medicine  in,         .         . "      I.,  448,  699 
statutes  relating  to  incompetent  persons  in,     .          .         .         .     III.,  725 

PERICARDIUM,  post-mortem  examination  of.    .....         I.,  848 

PERSONAL  IDENTITY,        ...         .         .         .         .         .         .         I.,  865-917 

PHOTOGRAPHY.         ..........         I.,  878 

PHYSICIANS  AND  SURGEONS  (see  also  Privileged  Communications),  I.,  757 

action  for  professional  services.         .         .         .         .         .         .         I.,  168 

his  books  containing  confidential  entries.  ...         I.,  124 

his  rights  and  duties  concerning  confidential  communica- 
tions. .         .         .         .         .         .         .         .         .         I.,  J66 

receiver  not  entitled  to  his  books  of  account,    .         .         .         I.,  124 
what  is  a  professional  capacity?         .....         I.,  152 

attendance   by.    medico-legal   significance   of   term,        .       III.,  138,  140 
contract  with  patient,      .         .         .         .         .         .         .         .     I.,  25-36 

compensation  for  services,          .         .          .'        .          .         .  I.,  37 

conditional  and  unconditional.  ....  I..  34 

consulting  physicians,        .         .          .          .         .         .          .  I.,  44 

either  express  or  implied,  .  .         .         .         .  I.,  26 

implied,  elements  of.          .         .         .         .         .         .         .  I..  28 

may  include  what  stipulations.  .          .          .          .          .    I.,  27,  34 

may  make  payment  contingent  upon  success.  .         .  I.,  28 

may  not   stipulate  non-liability  for  want  of  ordinary  care 

and  skill I.,  35 

definition  and  history  of  terms.        .         .          .         .         .         .         I.,  5,  6 

duties  of.  average  skill  of  any  school  must  be  attained.  .  I..  31 

ordinary  and  usual  skill  required.  .         .         .         .     I.,  38,  80 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  111.         959 

PAGE 

PHYSICIANS  AND  SURGEONS,  duties  of, 

stranger  not  physician  may  not  be  brought  into  sick-room 

without  consent  of  patient , I.,  44 

to  instruct  patient  how  to  care  for  himself,       .         .         .          I.,  33 
to  patients,        ........      I.,  28,  29,  33 

to  report  contagious  diseases,  .         .         .         .         .  -       I.,  23 

duties  of  patients  to,         .         .         .         .  .         .         .1.,  29,  33 

employment  terminable  by  patient  at  will  unless  time  contract 

made,  .         .         . I.,  26,  27 

terminable  by  physician  only  on  notice,  .         .         .     I.,  26,  28 

voluntary,         .         .         .  .         .         .  I.,  26 

evidence  of  communications  between  patient  and  physician,  I.,  91 

legal  relations  of,     .         .         .         .         .         .         .         .         .1.,  3-88 

license  to  practise  medicine,  see  License, 
malpractice,  see  Malpractice. 

services  of.  bill  against  estates  of  deceased  persons.          .         .  I.,  43 

bill  presented  and  retained  raises  no  presumption  of  liability,    I.,  44 
bill  presented  not  conclusive  of  value.       .         .         .         .          I.,  49 

in  consultation,  patient  liable  for,     .....  I.,  43 

insane  person's  estate  liable  for,         .         .         .         .         .  I.,  33 

legal  right  to  recover  compensation,  .         .         .         .  I.,  37 

liability  to  compensation  for, I.,  37 

married  women  and  infants  not  generally  liable,        .         .  I.,  37 

minor's  mother  probably  liable  after  father's  death.  .  I.,  38 

person  treated,  and  not  person  calling  in.  liable  to  pay  for.  I.,  37 

railway  company  calling  physician  in  case  of  accident,  when 

liable.  ....         .         .         ...     I.,  41,  42 

relation  of  physician  and  patient  does  not  exist  in  case  of 

medical  examiner  for  insurance,  ....     III.,  132 

third  person  calling  a  physician,  when  liable.    .         .         .  I.,  41 

to  minors,  burden  to  show  necessary,         .         .         .         .  I.,  38 

to  physician,  presumed  gratis  at  law!         .         .         .         .  I.,  47 

to  servant,  master  not  liable  without  a  special  contract,  I..  39 

who  are.  in  law  of  privileged  communications.          .         .         .         I.,  114 

PHYSICIAN'S  RESPONSIBILITY  in  case  of  a;-ray  dermatitis,         .         .     III.,  798 

PITHING II.,  118 

POISON,  medico-legal  significance  of  term III.,  140 

POISONING .         .         .         .         .       II.,  143 

survivorship  in  cases  of  death  by II.,  348 

POUTO  Rico,  statutes  regulating  the  practice  of  medicine  in.         .         I..  461 

POSITION  OF  VICTIM 1 1. ,84,  88,  89 

POST-MORTEM,  see  Coroners. 

POST-MORTEM  APPEARANCES,  in  death  from  burns.  ...        I.,  960 

from  cold,         ..........        I.,  946 

from  electrocution,  .         .    • II.,  219 

from  lianging.  .         .  • II.,  264 

from  lightning.  II..  220 


960  GENERAL   INDEX   TO    VOLS.    I.,    II.,    AND    III. 

PAGE 
POST-MORTEM     APPEARANCES,     ill    deaths. 

from  starvation.        .  .         .         .         .....         .1.,  984 

from  strangulation, .         .         .11.,  229 

from  submersion,      .  .         .         .         .         .         .         .II.,  323,  320 

from  suffocation,      .  .         .         ...         .         .         .       II.,  303 

from  sunstroke,         •  •         •         •         •         •         •         •         •         !•>  950 

POST-MORTEM   BIRTH, II.,  366,  613 

can  foetus  live?         .         .         .         .         .         ...         .       II.,  623 

cases  illustrative  of,  .         .         .         ..  .         .         .       II.,  616 

causes  assigned  for,  .         .         .         ...         .         .       II.,  622 

POST-MORTEM  CHANGES,          .        .        .  t        .        .        .        I.,  923 

cooling  of  the  body,          . I.,  923 

ecchymoses,      .         .         .         .         .         .         .  I.,  925;   II.,  31 

flaccidity, .;        ..       .         I.,  924 

hypostasis,        .         .         .         .         .         .         .         .'•.'.         I.,  925 

lividity,    .         .         ,         .         .         .         .         ...         .         I.,  925 

putrefaction, .         .''     I.,  927,  935 

rigidity, .         .          I.,  924,  935 

rigor  mortis,  .         .         .         .         .         .         .  I.,  924,  935 

saponification,  .         .         .         .         .         .         .         .         .         I.,  933 

POST-MORTEM  ECCHYMOSES,       .  .  .  .  .  .     I.,   925j    II..  31 

POST-MORTEM  EXAMINATIONS  (and  sec  Autopsies.  Coroners),         .        I.,  836 

when  and  how  made  by  coroner.      .         .         .         .         "...         I.,  817 

POST-MORTEM  EXAMINATION  of  infants.  .         .         .         .      '  .       II.,  474 

POST-MORTEM  WOUNDS, I.,  837 

POWDER,  SMOKELESS .         .  .II.,  161 

POWDER-BRANDS,    .         .         .         .         .  .         .         .         .       II.,  155 

POWDER-MARKS,      .         .         .         .         .         .         .         .II.,  155,  160,  161 

PRACTICE  OF  MEDICINE  AND  SURGERY  (and  see  Physician  and  Sur- 
geon), .         .         . -  I.,  7-24,  759 

courts  may  compel  granting  of  license,     .         .         ..  .  I.,  14 

how  proved,     .         .         ...         .         .         ,         .         .  I.,  20 

New  York  statutory  regulation.       .         .         .         ....     I.,  11-13 

now  generally  regulated  by  statute,          ....       -f  "          I.,  7 

PRACTICE  OF  MEDICINE  AND  SURGERY. 

regulation  by  statute  constitutional.         .         .         .  .  ,          I.,  7 

statutes  regulating.  .  .....          I.,  179-708 

Alabama,  .         .     '  .         .         .         ...         .         .        I.,  180 

Alaska,      .  ..'...        I.,  182 

Alberta I.,  619,  707 

Arizona,    ..........        I.,  184 

Arkansas,  I.,  187,  679 

British  Columbia. I.,  579,  707 

British  Possessions.  .         .         .         .         ,         .         .1..  542,  706 
California,  I..  194.  680 

Canada.     .         .         .  I..  589.  707,  714 

Colorado.  I.,  203,  680 


GENERAL  INDEX  TO  VOLS.  I..  II.,  AND  III.         961 


PRACTICE  OF  MEDICINK  AND  STKOKKY.   statutes  regulating. 

Connecticut,     ........          I.,  205,  685 

Delaware I.,  211 

District  of  Columbia,        ....         .         .         .          I.,  214,  685 

Florida,  .         .         .         .         .         .         .         .          I.,  220,  687 

Georgia,  .         .         .         .         .         .         .         .         .         I.,  222 

Great  Britain  and  Ireland,         ....  I..  179,  542.  706 

Hawaii, I.,  228.  688,  707 

Idaho.  .         .  .         .         .         .          I.,  231,  689 

Illinois I..  236 

Indian  Territory,       .         .         .         .         .         .         .         .         I.,  255 

Indiana, .         .         .         I.,  243, 689 

Iowa,         .         .         .         .         .         .  .         .         I.,  258.  689 

Ireland .          I.,  179.  542,  706 

Kansas,    .         .  ......         I.,  268,  691 

Kentucky,  1..  276,  691 

Louisiana.          .         . I..  280 

Maine,       .         .         . I.,  286,  691 

Manitoba,          ......         ...         I..  595 

Maryland.          . "       .         I.,  289 

Massachusetts,          .        .        .        .         .         .         .         .        I.,  .'{02 

Michigan I..  305,  691 

Minnesota,         .........         I.,  317 

Mississippi,         .      • I..  328.  693 

Missouri,   .          .         .         ;         .         .         .         .  I.,  331.  693 

Montana, .         .         I.,  341 

Nebraska, I.,  350.  695 

Nevada,  I..  362, 695 

New  Brunswick,         .         .         .         .         .         .         .         .1..  604 

Newfoundland.  .......  .      I.,  614 

New  Hampshire I.,  368.  696 

New  Jersey,        .....  .         .        I.,  375,  697 

New  Mexico,      .........        I..  383 

New  York I.,  388.  698 

North  Carolina, .1.,  405.  698 

North  Dakota,  .         .         .         .         .    •     .         .         .        I.,  414 

North  west  Territories, I.,  619,  707 

Nova  Scotia,      .........        I..  625 

Ohio .         I. .416,  699 

Oklahoma I.,  435 

Ontario,    . I.,  633 

Oregon T.,  442 

Pennsylvania ...          I.,  448,  699 

Porto  Rico. I..  461 

Prince  Edward  Island,      .  I.,  651 

Quebec I..  661 

Rhode  Island I.,  465 

III.— 61 


962  GENERAL    INDEX    TO    VOLS.    I.,    II.,    AND    III. 


PRACTICE  OF  MEDICINE  AND  SURGERY,   statutes  regulating, 

South  Carolina, I.,  470,  700 

South  Dakota,  .         .         .         .         .     •    .         .         I.,  476,  700 

Tennessee,         .         ,         .         .         .         .         .         .         L,  483,  701 

Texas, .1.,  488,  703 

Utah, I.,  498,  704 

Vermont, I.,  501 

Virginia,    .         .         .         .         .         .         ......".         .        L,  507 

Washington.      .         .         .         .         .         .         .         .         .        I.,  514 

West  Virginia, I.,  521 

Wisconsin, .         I.,  527,  704 

Wyoming, .1.,  537 

Yukon, '   ...        L,  672 

PRACTITIONER  OF  MEDICINE,    ........        I.,  761 

PRECIPITIN  REACTION,  nature  of,     .         .         .         .  .         .     III.,  865 

specificity  of,    ..........     III.,  870 

PRECIPITIN  SERUM  TEST  FOR  BLOOD,        .         .         .         .         .         .     III.,  862 

artificial  and  spontaneous  changes  in  precipitin  serum,         .     III.,  865 
changes  in  the  precipitable  substances,     .         .         .         .         .     III.,  866 

action  of  acids,          .         .         .         .         .         .         .         .     III.,  868 

action  of  neutral  salts, III.,  868 

action  of  earth  on  blood.  .         .         .         .         .         .     III.,  869 

effect  of  antiseptics,  .......     III.,  869 

results  obtained   from   blood-stains  on  "miscellaneous   ma- 
terials,   III.,  869 

complement  fixation,        ........     III.,  878 

diagnosis  between  monkey  and  human  blood,           .          .         .III.,  872 
forensic  significance   of   the    Bordet-Gengou-Moreschi    phenom- 
enon,   III.,  878 

miscellaneous  methods  in  differentiation  of  bloods,  .         .     III.,  882 

form  of  haemoglobin  crystals,  III.,  882 

odor  of  blood, .     III.,  883 

resistance  of  oxyhaemoglobin  to  acids  and  alkalies,          .     III.,  883 

nature  of  precipitin  reaction, ".         .     III.,  865 

precipitoids,     ..........     III.,  866 

specificity  of  precipitin  reactions,     .         .  ...     III.,  870 

character  of  the  precipitate,      .         .    ,     .         .         .         .     III.,  871 

dilution  of  the  test  serum, III.,  870 

potency  of  the  test  serum, III.,  871 

time  limit,         . III.,  872 

technique,         . III.,  874 

controls,    . III.,  874 

drawing  and  preservation  of  serum,  ...         -      III.,  875 

methods  of  injection,         .......     III.,  875 

preparation  of  injected  material III.,  876 

preparation  of  stain  for  testing III.,  876 

production  and  use  of  precipitin  serum,    .  III.,  874 


GENERAL    INDEX   TO    VOLS.    I.,    II..    ANWD    III.  963 


PAGE 


PKECIPITOIDS,          .  III.,  866 

PREGNANCY, II..  507 

at  time  of  marriage  as  a  ground  for  annulment  or  divorce,          .     III.,  769 

ballottement  in.        .         .         . II.,  565 

beginning  of II.,  508 

bladder  disturbances  in,  .......       11,556 

certain  signs  of,        .         .         .         .         .         .         .         .         .II..  572 

cessation  of  menstruation  in,    .         .         .         .         .         .         .II.,  557 

changes  of  external  genitals  in, II..  558 

of  mamma*  in,  ...         .         .         .         .       II..  568 

of  portio  vaginulis  in,        .......       II.,  561 

of  skin  in,          . II.,  556 

of  umbilicus  in,          ........       II.,  572 

of  uterus  in, II..  562 

of  vagina  in, II.,  559 

of  vulva  in,        .         .         .         .         .         .         .         .         .II..  558 

diagnosis  of ,     .......         .         .         .II..  553 

cases  illustrative  of,  .         .         .         .         .         .         .       II..  576 

diminished  duration  of II..  .520,  523 

disputed, II.,  553 

doubtful  signs  of ,      .........       II.,  554 

duration  of,      .........        II..  507.  511 

enlargement  of  abdomen  in,     '.         .         .         .         .         ,         .       II.,  556 

examination  to  determine  existence  of,  in  capital  cases,         .       II..  499 

false, II.,  578 

feigned, II.,  578 

cases  illustrative  of,  ...         .         .         .         .         .II.,  .380 

foetal  heart-sounds  in, II.,  573 

following  rape. .       II.,  689 

how  soon  can  it  occur  after  delivery? II.,  600 

intermittent  uterine  contractions  in,         .....       II.,  566 

mask  of,  .         ... II..  556 

miscellaneous  signs  of,  *         .         .         .         .         .         .II..  576 

morning  sickness  in, II.,  554 

movements  of  foetus  in,    ........       II.,  574 

nervous,  .         .         .         .         .         .         .         .         .         .II.,  578 

•  edema  in.         .         .         .         .         .         .         .  .         .       II.,  556 

pain  in II..  556 

palpation  of  frrtus  in,       .         .         .         .         .         .         .         .II.,  572 

popular  signs  of II.,  576 

probable  signs  of,     .         .  .         .         ;         .         .         .II.,  557 

prolonged, II.,  514 

cases  illustrative  of.  .    • II.,  515 

rectal  disturbances  in,  .         .         .         .         .         .         .II.,  555 

spurious. II.,  578 

strise  in. II..  572 

sympathetic  disturbances  in II.,  555 


964 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 


PREGNANCY, 

symptoms  of.  .         .         .         .         .         .         .         .         .II.,  553 

umbilical  murmur  in,        .         . II.,  575 

unconscious.     .         .         .         .         .         ,         .         ...       II.,  605 

cases  illustrative  of,  .         .         .         .         .         .       '  .       II..  600' 

uterine  murmur  in,  .         .         .         .         .         .         .         .       II.,  567 

varicosities  in,  .         .         .         .         .         .         .         .         .II.,  550 

PRESBYOPIA,  see  Vision. 

PRINCE  EDWARD  ISLAND,  statutes  regulating  the  practice  of  medicine  in,     I.,  651 

PRIVILEGED  COMMUNICATIONS  BETWEEN  PATIENT  AND  PHYSICIAN.     I.,  91,  762 

advice, I.,  145 

analysis  of  the  statutes,  .         .         .         .         .         .         .          I.,  97 

nature  of  the  action,  .         .         .         .         .         .         .  I.,  98 

privileged  matter,      .         .         .         .         .         .         .          .1.,  102 

waiver  of  the  privilege, I.,  99,  125 

the  witness, I.,  101 

at  common  law,        .........  I.,  91 

communications,      .........        I.,  144 

by  the  patient,  .         .         .         .         .         .         .         .        I.,  145 

from  the  patient,       ........        I.,  145 

confidential  communications,  .         .         .         .         .         .1.,  143 

criticisms  of  the  common-law  rule.  .         .         .         .         .  I.,  93 

effect  of  enforcing  privilege,     .         .         .         .         .         .         .         I.,  J63 

evidence  excluded.  .         .         .         .         .         .         .         .        I.,  135 

in  criminal  actions,  .         .         .         .  I.,  107 

in  lunacy  proceedings,       .         .         .          .         .         .         .         I.,  Ill 

of  abortion,        .         .         .         .         .         .         .         .         .1.,  109 

of  adultery,        ...  I.,  110 

of  crime  in  civil  actions,    .         .         .         .         .         .         .         I.,  107 

of  criminal  intimacy,         .         .         .         .         .  .1.,  109 

of  habitual  drunkenness,  ......        I.,  Ill 

to  establish  privilege,        .......        I.,  116 

to  sustain  objection,  .......         I.,  165 

function  of  the  court,        .         .         .         .         .         .         .         .        I.,  160 

ground  of  privilege,  .         .         .         .         .         .         .         .  I.,  92 

how  privilege  established, I.,  161 

in  actions  for  divorce, I.,  110 

in  criminal  actions,  .         .         .         .         .         .         .         .1.,  107 

information,     . I.,  136 

judicial  interpretation  of  the  statutes.      .....         I.,  104 

classes  of  actions  in  which  tho  privilege  is  enforced,         .         I.,  107 
criminal  actions  and  evidence  of  crime  in  civil  actions,         L,  107 

divorce  causes, I.,  110 

fraud I.,  112 

lunacy  and  habitual  drunkenness,      ....        I.,  Ill 

testamentary  causes,  .         .         .         .         .         .        I.,  110 

West  Virginia  justice  courts,       .....         I.,  113 

objections   to   admission   of   privileged    communications.         I.,  123 


GENERAL    INDEX    TO    VOI,S.    I.,    II..    AND    III.  965 

PAGE 

PRIVILEGED  COMMUNICATIONS  BETWEEN   PATIENT  AND  PHYSICIAN, 
judicial  interpretation  of  the  statutes, 

patient,     . I.,  113 

dead  Arsons,     .                  I.,  113 

infants,      ....         .....  I.,  113 

lunatics  and  drunkards I.,  113 

rules  of  construction,         .         .         .         .         .         .         .  I.,  104 

waiver  of  the  privilege,     .         .         .         .         .         .         .  I.,  117 

persons  other  than  the  patient,           .         .         .         .  I.,  119 

what  constitutes  a  waiver. I.,  125 

who  may  waive, I.,  117 

witness,     .         .         .         .         .         .         .         .         .         .  I.,  114 

matter  communicated,     ........  I.,  142 

necessary  to  enable  physician  to  prescribe  or  surgeon  to  act,  I.,  154 

mental  condition  of  patient,     .......  I.,  Ill 

partner  of  physician  as  privileged  witness,  •     .         .         .         .  I.,  151 

patient's  ignorance  immaterial, I.,  124 

privilege  is  patient's,  not  physician's.       .....  I.,  113 

professional  business.        .         .         .         .         .         .         .         .  I.,  152 

capacity,  .         .         .         .         .         .         .         .         .1.,  152 

province  of  the  court,       .         .         .         .         .         .                  .  I.,  160 

reasons  for  distinction  between   communications   to  legal  and 

medical  advisors,          .         .         .         .         .         .         .    <    .  I.,  92 

relation  of  physician  and  patient.     ......  I.,  146 

result  of  legislation,          .         .         .         .         .         .         .         .1.,  169 

rights  and  duties  of  physician, I.,  166 

rule  in  federal  courts,       .         .         .         .         .         .         .         .  I.,  96 

in  the  United  States I.,  94 

does  not  apply  between  medical  examiner  and  applicant  for 

insurance, .  III.,  132 

states  anil  territories  in  which  there  are  no  restrictive  statutes,  I.,  94 

in  which  there  are  restrictive  statutes,      .         .         .         .  I.,  95 

statutes,           .        .        .        . I.,  97 

PROCEDURE, I.,  762 

PRO.IE(,TLLK,  course  of, II.,  163 

evidence  from,          .........  II.,  146 

PROPRIETARY  REMEDIES, ..I.,  763 

PSEUDO-CYESIS, II.,  578 

PSYCHONEUROSES,  TRAUMATIC, II.,  868 

PSYCHOSIS.  LITIGATION, II.,  871 

PrOSlS,  TRAUMATIC,             . III.,  55 

PUBERTY,        .........       II..  645,  648,  728 

PUERPERAL  STATE, II.,  507 

disputed, II.,  553 

feigned II..  578 

cases  illustrative  of, II..  580 

PULMONARY  DISEASE,  medico-legal  significance  of  term,  III..  142 


!)(>(>         GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

PUNCTURED  WOUNDS,  see  Wounds,  punctured. 

PUTREFACTION I.,  927,  936 

bacteriological  appearances  in,  .       II.,  442 

circumstances  favoring,     .         .         .         .         .          .         .         .         I.,  929 

retarding.  .         .         .         .         .         .         .--....         .         I.,  980 

evidence  from,  in  infanticide,  .         .         .         .         .        II.,  416,  418 

of  immersed  bodies,  .  .  .  .  ...  I.,  932;  II.,  332 

PY.EMIA. II.,  57 

PYROMANIA, III.,  254 

QUEBEC,  statutes  regulating  the  practice  of  medicine  in,          .         .        I.,  661 
QUICK  WITH  CHILD,  defined,    ........          I.,  75 

RACE,  DETERMINATION  of,  from  hair,        ....        I.,  876;    III.,  906 

from  skeleton,          V .         .        I.,  875 

RADIO-DERMATITIS,          . III.,  783,  794 

RAILWAY  COMPANIES,  when  liable  for  medical  services,  .         .          I.,  41 

RAILWAY  INJURIES. II.,  765 

accident  aboulia, .II.,  872 

attitude,  study  of,    .         . II.,  935 

autohypnosis  as  cause  of, II.,  775 

back,  injuries  to, II.,  816,  819,  820 

sprains  of,          .         . II.,  818,  819 

strains  of, II.,  819,  823 

bi-kinesic, II.,  795,  796, 882 

brain,  compression  of .         !       II.,  847 

concussion  of,    .         .         .         .         .         .         .         .         .II..  843 

bridges  as  cause  of, .         .II.,  784 

catastrophes II.,  773 

causal  factors  of, II.,  778 

causes,  classification  of, II.,  773,  795 

cervical  region,  strains  and  injuries  of.     .....       II.,  823 

classification  of, II.,  807 

character  of, II.,  807 

compensation,  influence  of,  on  clinical  features,        .         .         .II.,  949 

concussion,  of  brain, ,.!!.,  843 

of  cord II.,  825 

of  spine II.,  870 

conditions  necessaiy  to  the  safe  operation  of  railway,      .         .       II.,  778 

contractures II.,  910 

co-ordination,  tests  of, II..  938 

cord,  concussion  of, .II.,  825 

lesions  of II.,  831 

traumatism  of  membranes  of, II.,  836 

curves,  as  cause  of, II.,  781 

detective  motor  power,  as  cause  of, II.,  792 

defects  of  vision,  as  diagnostic  sign  of  traumatic  neurosis,       .      II.,  927 


GENERAL    INDEX   TO    VOLS.    I.,    II.,    AND    III.  967 


RAILWAY  INJURIES, 

disease  of  employees,  as  cause  of,     .         .         .        .        .        .      II.,  788 

disturbances  of  circulatory  system,  ....       II.,  901,  941 

of  digestion, II.,  901, 943 

of  respiration  and  speech,          .         .         .         .         .         .       II. ,911 

of  special  senses, 1 1.,  900,  940 

epilepsy,  traumatic,          .         .         .         .         .         .         .  II.,  848 

examination  of  patient, II.,  932 

danger  of  long-continued  and  multiple,     ....       II.,  934 

expert,  why  employed,     .         .         .         .         .         .         .         .II.,  921 

face,  study  of,  .         .         ...         ,         .         .         .       II.,  935 

fracture-dislocation  of  spine II.,  830,  831 

fracture  of  vertebrae,         .         .         .         .         f        .         .         .II.,  830 

gait,  disturbances  of,        .         .         .         .         .         .         .         .II.,  935 

gradient,  as  cause  of,  .         .         .         .         .         .         .II.,  782 

haematomyelia,  traumatic.        .......       II.,  840 

haematorrhachis,       .         . II.,  839 

haematuria,  from  back  injuries II.,  859 

diagnosis  of,      .         .         .         .         .         .         .         .         .II.,  860 

general  causation  of,          .         .         .         .         .         .         .II.,  860 

producing  albuminuria, II.,  863 

prognosis  of,      .         .         .        '. II.,  861 

hemianjesthesia,        .         . II.,  906 

hemorrhages,  extramedullary, II.,  839 

hernia, II.,  853 

heterophemy,  as  cause  of,         -.- II.,  775 

history,  importance  of  complete,      ......       II.,  931 

hyperaesthesia,          ...         .         .         .         .         .         .         .II.,  906 

hysteria,  .        .        . II.,  902, 912 

hysterical  contractures, .       II.,  910 

joints, II.,  910 

individual  accidents,         .         .         .         .         .         .         .         .II.,  773 

injuries  of  thorax  and  contents, II.,  857 

insanity,  traumatic, II.,  850 

introductory,    .         .         .         .         .         .         .         .         .         .II.,  765 

kidney,  position  of,  a  predisposing  cause,          .         .         .         .II.,  859 

kinetic-kinesic II.,  795,  796,  882 

laws  of  liability  for,          . II.,  773 

litigation  after, II.,  917 

psychosis, II.,  871 

locomotion,  impairments  of, II.,  938 

locomotor  ataxia .  x  .         .         .         .         .         .         .         .       II.,  842 

lumbago,  traumatic, II.,  818 

lumbar  sprain, II.,  818,  821 

strain,       . II..  819, 821 

malingering II.,  952 

manipulation  of  trains,  as  cause  of. II.,  788 


968  GENERAL    INDEX   TO    VOLS.    I.,    II.,    AND    III. 

PAGE 

RAILWAY  INJURIES, 

manner  of  injury  to  citizen,     .......       II.,  797 

to  employees,    .         .         .         .         .         .         .         .         .II.,  799 

to  passengers,    .         .         .         .         .         ....         .       II.,  798 

to  trespassers,   .         .         .         .         .         ....         .       II.,  797 

Mannskopf  sign, II.,  948 

mental  condition  of  employees,  as  cause  of,      .        II.,  771,  775,  776,  801 
diseases,  following,    .         .         .         .         .         .         .         .II.,  850 

mono-kinesic,  .         ...         .         .         .        II.,  795,  796,  883 

monoplegia, II.,  909 

muscles  of  face,  trembling  of,  .         .         .         .         ...       II.,  942 

natural  phenomena,  as  causes  of,     .         .         .         .         .         .II.,  794 

negligence  of  employees,  as  cause  of,       .         .         .  II.,  771,  788 

neurasthenia ......      II.,  873,  889 

overwork  of  employees,  as  cause  of,          .         .         .         .         .       II.,  788 

paraplegia,       .         .         .         .         .         .         .         .         .         .       II.,  909 

paralyses,  motor,      .         .         .         .         .         .         .         .         .II.,  908 

precedent  diseases,  influence  of.        .         .         .         .         .         .       II.,  960 

predisposition,  as  a  factor  in  psycho-neuroses,  .         ..        .II.,  885 

prognosis.          . .        II.,  914,  963 

psycho-neuroses,  traumatic,      .         .         .         .         .II.,  868,  877,  913 
causes  of,  .         .         .  •  .         .         .  .       II.,  915 

classification  of,         .         .         .         .         .         .         .  II.,  882 

factors  in, II.,  878 

hysterical  type  of, II.,  902 

mental  state  in,         .         .         .         .         .         .         .         .II.,  893 

motor  disturbances  in,       .         .         .         .         .         .II.,  896,  908 

muscular  tremors  in ,          .         .         ...         .         .         .       II.,  897 

neurasthenic  type  of, II.,  889 

paralysis  in .II.,  908 

prognosis  of,      .         .         .         .         .         ...         .       II.,  960 

reflexes  in,         .         .  '  .         .         .         .  II.,  897 

sensory  disturbances  in,    .         .         .         .         .         ,  II.,  898 

symptoms  of II.,  892 

road-bed,  as  cause  of II.,  779 

sensibility,  tests  of,  .         .         .         .         .         .         .         .II.,  945 

shock,  corporeal  and  psychic.  .         .         .         .         .II.,  808,  810 

simulation,  frequency  of,          .......       II.,  923 

speech,  modification  of .       II.,  942 

spinal  meningitis,  infrequency  of II.,  838 

statistics  of,      .         .         .         .          II.,  769,  797,  798,  799,  800,  807,  884 
switches,  as  cause  of,   .          .         .         .         .         .         .         .II.,  783 

symptoms,  study  of, II.,  935 

syringomyelia,  traumatic, II.,  841 

traumatic  hysteria, II.,  872 

un-kinesic II.,  795,  796,  883 

vertebra?,  dislocations  of,  ...  ...      II.,  828 


<;  i:\KKAL    INDEX    TO    VOLS.    I.,    II..    AM)    III. 

PAGE 

RAILWAY  INJURIES. 

vertebra1,  distortions  of.  .......       II.,  828 

fractures  of,       . .         .       II.,  830 

traumatism  of.          ..         .         .         .         .         .         .         .II.,  826 

why  considered  specially.          .......       II.,  813 

why  of  fre<|iient  occurrence.     .......       II..  800 

RAILWAY  PASSENGER,  intoxication  of III.,  375 

RAILWAY  PHYSICIANS,  authority  as  to  employing  nurses,         .         .  I..  42 

RAILWAY  SPINE II..  869 

RAPE  (and  see  Defloration.  Virginity),    .         .         .         .         .         .       II.,  659 

absence  of  will  in.  .         . 1 1. ,691 

accidents  following.  .         .         .  .         .         .         .II.,  689 

age  of  consent .         .         .        II..  660.  664 

attempt  at.       . i         .         .       II.,  706 

by  boys.  .         .         .         ...         .         .         .        II.,  680.  727 

by  females  on  females.      ........       II.,  731 

by  females  on  males.         .         .         .         .         .         .         .         .II..  729 

by  fraud II..  (560,  693 

by  women.       .........        II.,  727.  729 

can  a  woman  be  violated  against  her  will?        .         .         .         .        II  ,  691 

can  rape  be  accomplished  during  natural  sleep?       .          .          .        II.,  692 

consent  in II.,  660.  691 

death  following.       .         .         .      -  .         .         .         .        II.,  677,  690,  716 

defence,  in  accusations  of.        .         .         .         .         .         .         .II.,  703 

disproportion  in  size  of  organs,  in  accusat ions  of.      .         .        II.,  703,  706 
during  anaesthesia.  .         .         .         .         .         .         .         .       II..  694 

epilepsy,    .         .         . II.,  696 

sleep.         .  II.,  692 

unconsciousness.        .         .         .         .         .         .         .         .II.,  694 

errors  in  examinations,  in  cases  of.          ..         .         .         .         .       II.,  70] 

evidence  of,  see  Hymen.  Vagina. 

after  death.        .         . II.,  704 

from  discharges.         . II.,  711 

venereal  diseases.        .         .         .         .         II..  683.  687.  705,  713 

examination  of  the  accused,     .         .         .         .         .         .         .       II..  702 

locality  of  the  assault,       .         .         .         .         .         .         .       II.,  703 

false  accusations  of.  .' II..  661,  700.  717 

in  hypnotic  state,     .........       II..  696 

somnambulism.          .         .         .         .         .          '.         .         .       II..  69S 

interval  between  assault  and  examination,       ....       II.,  720 

law  of II..  659 

locality  in  which  committed,    .......       II.,  703 

marks  of  a  struggle.          .         .         .         .         .         .         .    :  II..  721 

of  violence II..  681 .  715 

medical  examination,  in  cases  of II..  662 

how  recorded, .II..  663 

on  children, ...       II.,  705.  719 


!)7<)         GENERAL  INDEX  TO  VOLS.  I..  11.,  AND  III. 

PAGE 

RAPE,  on  children 

diagnosis  of .II.,  725 

false  accusations  of,    .         .         .         .         .         .       II.,  714,  717 

intervals  between  assault  and  examination,        .         .       II.,  720 

marks  of  a  struggle, II.,  721 

statistics  of  trials II.,  725 

study  of  200  cases  of.         ......       II.,  719 

females  after  puberty,       .         .         .         .         .         .         .       II.,  665 

infants, II.,  705 

insane  women,  .         .         .  ...         .         .     III.,  383 

married  women .         .         .       II.,  681 

psychopathic  individuals.          .         .         .  .  II.,  696 

the  dead, .         .         .       II.,  731, 761 

penetration  in, "...        II.,  710,  715 

pregnancy  following, II.,  689 

rules  for  examination,  in  cases  of,  ....          .II.,  701 

simulation  of,  ....  ....       II.,  700 

stains  and  other  marks,    .         .         .         .         .         .         .         .II.,  682 

testimony  concerning -      .         .       II.,  661 

corroborative, II.,  661 

of  woman  herself .         .         .II.,  661 

violence,  marks  of,  .......      II.,  681,  715 

vulva,  appearance  of,  after. II.,  721 

REGISTRATION I.,  766 

REMEDIES, I.,  767 

REPORTS,  MEDICO-LEGAL, I.,  863 

RESEMBLANCES   BETWEEN    PARENT   AND   CHILD    (and   see  Mother's 

marks,  Atavism),  .         .         .         .         .         .         .II.,  542.  645 

cases  illustrative  of,          ........       II.,  544 

RESIDENCE,  EFFECT  OF  MENTAL  UNSOT-NDNESS  ON.  .         .         .     III.,  354 

RESISTANCE,  ELECTRICAL II.,  189 

RESPIRATION,  SUSPENDED,       .         .         .         .  .         .1.,  922 

REVOCATION  OF  LICENSE. I.,  769 

RHODE  ISLAND,  legal  status  of  dead  body  in,  .         .         .         .        I.,  804 

statutes  regulating  the  practice  of  medicine  in,         .         .         .        I.,  465 

statutes  relating  to  incompetent  persons  in III.,  729 

RIBS,  fracture  of II.,  120 

RIGOR  MORTIS.         .         . I..  925, 936 

in  deaths  from  electricity, II.,  218 

ROENTGEN  PHOTOGRAPHS,  as  evidence,  in  gunshot  wounds.     .         .       II.,  172 
RAYS,  see  x-rays. 

RUPTURE,  of  abdominal  viscera, II.,  128 

of  bladder, II.,  131 

of  diaphragm, II.,  125 

of  gall  bladder II.,  130 

of  heart II.,  124 

of  internal  organs,    .         .         .         .         .         .         .         .         .      II.,    99 


GENERAL    INDEX    TO    VOLS.    1.,    II.,    AND    III.  971 

PAGE 
RUPTURE, 

of  intestines II.,  132 

of  kidneys II.,  130 

of  liver. II.,  128 

of  spleen.  ..........  II.,  130 

of  stomach II.,  132 

SADISM II..  691,  739 

SANITY,  difference  between  legal  and  medical,  view  of.         .         .     III.,  349 

SAPHISM, II.,  75,5 

SAPONIFTCATION,     .         .         .......         .         .         .        I.,  933 

SATYRIASIS, .     .    .         .         .         .       II.,  739 

SCALDS. a.         .         I.,  951, 952 

SCAKS.  in  relation  to  identity.          ...         .         .         .         .         I.,  902 

SCHOOLS  OF  MEDICINE.    .         .         .'        .    '     .         .         .         .         .        I.,  770 

not  recognized  by  courts.          .......     I.,  15-18 

SEBACEOUS  CYSTS.  .........       II.,  532 

SEMEN,    .';.... III.,  885 

examination  of,        ......         1         ..     III.,  887 

Florence's  test  for.  .         .  ,  .         .         .         .     III.,  889 

stains  of.  .         .         .         .         .         .       II..  «73.  (>82:    III. ,885, 886 

SEMINAL  STAINS .       II..  673.  682;    III..  885.  886 

method  of  examination  of III.,  887 

results  of  examination  of.         .......     III.,  889 

SEPARATION,  insanity  as  a  ground  of III.,  378 

SEPTICAEMIA - II.,  56 

SERIOUS  ILLNESS,  medico-legal  significance  of  term.         .         .         .     III.,  142 

SEX.  determination  of, I.,  882 

as  indicated  by  hair III.,  906 

SEXUAL  FUNCTION,  abolished,          .......       II..  739 

exaggerated.     .         .         .         .         .         .         .         .         .         .II..  739 

perverted .         .         .         .       II.,  731,  739 

SEXUAL  INCAPACITY  (and  see  Impotence.  Sterility),         .         .         .       II.,  625 
and  adoption.  .........       II.,  634 

artificial  fecundation  in.  .         .         .         .         .         .         .II.,  629 

as  it  concerns  the  dissolution  of  marriage II.,  635 

disputed  capacity.    .         .         .         .         .         .         .         .         .II.,  632 

paternity.  .         . II..  632 

expert  conclusions  concerning, 1 1. ,655 

in  criminal  affairs.    .........       II.,  639 

influence  of  hybridity II.,  646 

relevant  ethical  conditions. II.,  629 

SEXUAL  INVERSION.          .         .        .        .         .         .        II.,  737,  739,  745, 748 

conditions  affecting. .         .II.,  753 

SHARK-BITES, II.,  330 

SHOCK,  death  due  to II..  45 

in  railway  injuries,  .  II.,  808 


972         GENERAL  IXDEX  TO  VOLS.  I.,  II.,  AM)  III. 

PAGE 

SHOT-GUNS,  wounds  by, II.,  154 

SIGNS  OF  DEATH I.,  92.3 

SIMULATED  BLINDNESS III.,   19 

SKIAGRAMS,  as  evidence  in  gunshot  wounds.    .         .         .  .       II..  172 

SKIAGRAPHS  (and  see  x- Rays  and  Skiagraphs),  medico-legal  relations 

of III. ,771-806 

SKIN,  marks  on,      .....         ......        I.,  901 

SKULL,  fracture  of, II.,  105,  158 

measurements  of,  .         .         .         .         .         .         .         .         I.,  876 

resistance  of,  in  the  dead,          .         .         .         .         .         .         .       II.,  153 

SLANDER,         .         .         .         .        «...         .         .  .         .        I.,  771 

SMALL  SHOT,  wounds  by, II.,  165 

SMOKELESS  POWDER,  marks  from,  ......       II.,  161 

SMOTHERING,  .         .         .         .         .         .         .         ,  II.,  296 

SODOMY. II.,  744 

SorTH  CAROLINA,  legal  status  of  dead  body  in,       .         .         .         .        I.,  804 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  470.  700 

statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  731 

SOUTH  DAKOTA,  legal  status  of  dead  bodies  in,        .         .         .         .        I.,  804 

statutes  regulating  the  practice  of  medicine  in,         .         .         I.,  476,  700 

statutes  relating  to  incompetent  persons  in,     ....     III.,  732 

SPECTROSCOPIC  EXAMINATION  OF  BLOOD,          .....     III.,  854 

methods  of.      . .         .     III.,  859 

preparation  of  specimens,          .......     III.,  860 

transformation  of  spectra,         .......     III.,  858 

SPERMATOZOA, II.,  682;   III.,  885 

movements  of,          .         .         .         .         .         .         .         .         .II.,  510 

vitality  of.  II.,  509,  510 

SPINAL  CORD,  concussion  of II.,  119,  825 

lesions  of,          . II.,  831 

post-mortem  examination  of.  .         .         .         .         .         .         I.,  859 

wounds  of II.,  117 

SPINE,  concussion  of, II.,  870 

contusions  of. II.,  829 

dislocation  of, II.,  118 

fracture  of >      .     •     .         .       II..  117 

fracture-dislocation  of II.,  830,  831 

traumatisms  of.        .         .         .         .         .         .         .         .         .II..  826 

wounds  of,  .         .         .         .         .         .         .         .         .       II.,  117 

SPITTING  BLOOD,  medico-legal  significance  of  term,          .         .      III.,  138,  143 

SPLEEN,  post-mortem  examination  of I.,  853 

rupture  of.        .         .         .         .         .         .         .         .  .II.,  130 

wounds  of II..  130 

SPONTANEOUS  COMBUSTION.     ........        I..  959 

STAB  WOUNDS  (and  see  Wounds,  punctured),          .         .  .  '  II.,  9,  65 

STAINING  OF  SKIN,  by  lightning, II.,  213 

STAINS,    .  I.,  909 


GENERAL    INDEX    TO    VOLS.    I.,    II.,    AND    III.  973 


PAGE 


STAINS,  blood. III.,  807,  843 

could  assailant  have  escaped  without? II.,  84 

in  cases  of  rape, II.,  682 

lochial III.,  843 

menstrual III.,  842 

of  meconium, II.,  442 

on  murderer, II.,  84 

seminal, II.,  673,  682;  III.,  885, 886 

method  of  examination  of, III..  887 

results  of  examination  of.  ......     III.,  889 

STANDARD  OF  QUALIFICATION.          .         .  .         .         .         .1.,  771 

STARVATION.  I.,  977 

acute I.,  979 

chronic I.,  980 

death  due  to  disease  or?  .         .         .         .         .         .         .         I.,  985 

death  from,      ..........        I.,  975 

period  of  occurrence  of I.,  982 

diseases  produced  hy I.,  986 

post-mortem  appearances,        .......        I.,  984 

survivorship  in  cases  of  death  by,  .         .         .         .         .II.,  346 

whether  accompanied  by  other  ill  treatment,  .         .         .        I.,  984 

STATE  MEDICINE I.,  v 

STATUKE.  determination  of.     ........        I..  880 

STATUTES  RELATING  TO  DEAD  BODIES I. ,785  to  808 

Alabama,          ..........         I.,  785 

Alaska, I.,  785 

Arizona. I.,  785 

Arkansas, '.I.,  786 

California, I.,  786 

Colorado. I.,  787 

Connecticut *.....        I.,  788 

Delaware,         .         .         .         .        >         .         .         ...         .        1.,  788 

Florida, :. I.,  789 

Georgia,  .         .         .         .       *.         .         .         .         .  I.,  789 

Hawaii , I.,  789 

Idaho V.         ...  I.,  790 

Illinois • I.,  790 

Indian  Territory.      ......  I..  790 

Indiana,  .         .         . .,  790 

Iowa ......  791 

Kansas .,  791 

Kentucky.        .         . 792 

Louisiana.         ..........          .,  792 

Maine 792 

Maryland .'          .,  793 

Massachusetts, ,  .          .,  793 

Michigan, I.,  794 


974         GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 

PAGE 

STATUTES  RELATING  TG   DEAD  BODIES, 

Minnesota, I.,  795 

Mississippi, I..  795 

Missouri,           . I.,  796 

Montana, I.,  796 

Nebraska,         .         .         . I..  796 

Nevada,            ..........  I.,  797 

New  Hampshire I..  797 

New  Jersey,      . I.,  798 

New  Mexico,    ..........  I..  799 

New  York,       .         .         .         .         .         .         .         .         .         .  I.,  799 

North  Carolina .         .  I.,  800 

North  Dakota, .  I.,  801 

Ohio, I.,  801 

Oklahoma. I.,  802 

Oregon, .  I..  803 

Pennsylvania,           ....         .....  I..  803 

Rhode  Island, I.,  804 

South  Carolina, I.,  804 

South  Dakota, .         .         .  I.,  804 

Tennessee. .         ....  I..  805 

Texas. '    ...         .         .  I..  805 

I'tah, I..  806 

Vermont, .  I..  806 

Virginia. .  I..  807 

Washington I.,  807 

West  Virginia,          .         .         .         .         .         .         .         .         .  I.,  807 

Wisconsin,        ..........  I.,  808 

Wyoming ...     I.,  808 

STERILITY .         .  II.,  627 

causes  of,          ..........  II.,  644 

from  congenital  and  other  defects.  .         .         .  ~       .         .II.,  650 

in  women, II.,  648 

medico-legal  aspect  of. HI.,  762 

meteorological  influences.          .         .         .         .         .         .         .II..  646 

pathological  conditions  of,        .......  II..  651 

relative, II.,  638 

STERNUM,  fracture  of,      .........  II.,  120 

STIGMATA .  I.,  908 

STILL-BIRTH.            .         .     - II.,  416 

STOMACH,  post-mortem  examination  of. I.,  855 

rupture  of II.,  132 

wounds  of II.,  132 

STRABISMUS III.,  44 

STRANGULATION II..  223,  224 

accidental.        ..........  II.,  241 

cases  of,  II..  251 


GENERAL    INDEX    TO    VOLS.    I.,    II.,    AND    III.  97o 

PAGE 

STRANGULATION, 

anto-mortem  or  post-mortem, II.,  267 

cases  of,            ..........  II.,  243 

external  appearances  due  to,    . II.,  229 

homicidal II.,  242 

cases  of,    ..........  II.,  243 

internal  appearances  due  to,    .......  II.,  234 

post-mortem  appearances, II.,  229,  234 

prognosis,         ..........  II.,  229 

proof  of  death  by,    . II.,  238 

simulated II.,  242 

stages  of, II.,  226 

suicidal **  ,         .         .  II.,  241 

cases  of, II.,  249 

symptoms  of,            .         .    •     .         ,         .         .         .         .II.,  224,  226 

treatment  of, II.,  228 

STRUGGLE,  signs  of,         .        . II.,  82 

SUBMERSION, II.,  317 

asphyxia  by, II.,  318,  319 

cadaveric  signs  in  death  by, II.,  326 

circumstances  modifying  time  of,     ......  II.,  332 

definition  of, II.,  318 

mode  of  death  by II.,  319 

post-mortem  appearances. II.,  323,  326 

stages  and  symptoms  of  death  by, II.,  320 

survivorship  in  cases  of  death  by,    ......  II.,  344 

treatment  of  apparently  drowned, II.,  324 

whether  accidental,  suicidal,  or  homicidal.        .         .         .         .II.,  329 

SUFFOCATION, II.,  223, 296 

accidental,        ;...-....;.  II.,  307 

cases  of,    .        .        .        .        .        .        .        .        .        .  II.,  309 

by  submersion,         .         .     - II.,  318 

cases  of, II.,  309 

cause  of  death  in II.,  299 

death  of  infant  from II.,  458 

external  causes  of.    .        .         .         .         .         .         .         .         .II.,  296 

homicidal II.,  307 

cases  of,    .        .        . II.,  312 

internal  causes  of,    .........  II.,  297 

mechanical, II.,  223 

of  infants, II.,  458 

post-mortem  appearances,        .         .         .         .         .         .         .  II.,  303 

in  infants, II.,  461 

proof  of  death  by, II.,  306 

suicidal,            II.,  307 

cases  of ,            II.,  312 

survivorship  in  cases  of  death  by II.,  345 


976 


GENERAL  INDEX  TO  VOLS.  I.,  II.,  AND  III. 


.SUFFOCATION, 

symptoms  of.  ...... 

treatment  of.    ....... 

SUICIDE,  medico-legal  significance  of  term. 
SUNSTROKE,    .         •  .   >/•         •         •         •         • 

a  disease,  not  an  accident,  in  insurance  policies, 

medico-legal  significance  of  term,      . 

SUPERFECUNDATION,  ...... 

St'PEKFUSTATION,       ....... 

cases  illustrative  of, 

SUPERIMPREGNATION, 

SURGEON 

definition  of  the  term, 

duties  of,  see  Physician  and  Surgeon. 
SURGERY.         ........ 

SURGICAL  OPERATIONS,  death  from, 

SURVIVAL, 

SURVIVORSHIP, 

determination  of,     ...... 

from  position,  ..... 

from  stage  of  putrefaction, 
determination  of  time  of  death, 
expert  medical  testimony  in,    . 
influence  of  age,        ...... 

of  constitution,  ..... 

of  degree  of  danger,  .... 

of  mode  of  death, 

asphyxia,  ..... 

cold.  ...... 

drowning.  ..... 

electricity,  including  lightning, 
heat,  ....:. 

parturition,         .         .  . 

poisoning,  ..... 

starvation,  ..... 

suffocation,         ..... 

of  sex,        ....... 

legal  presumption  of 

medical  aspects  of.  ..... 

of  persons  who  have  disappeared,    . 
SYNCOPE,         ........ 

SYPHILIS, 

SYRINGOMYELIA,  TRAUMATIC, 


.  II.,  299 
.  II.,  301 
.  III.,  143 

I.,  948 
.  III.,  137 
III.,  136,  143 
.  II.,  59b 
.  II.,  596 
.  II.,  600 
.  II.,  596 

I.,  772 
.  I.,  5,  6 


I.,  772 
II. ,61,  173 
.  II.,  102 
.  II.,  337 
II.,  337,  342 
.  II.,  349 
.  II..  349 
.  II.,  350 

.  '  .  .  .  II.,  340 
.II..  343 

.  ;  .  .  II..  343 
.  II.,  342 

.  .  .  .  II.,  344 
.  II.,  346 
.  II..  347 
.  II.,  344 
.  II.,  348 
.  II.,  347 
.  II.,  348,  454 
.  II.,  348 
.  II.,  346 
.  II.,  345 
.  II.,  343 
.  II.,  337 
.  II.,  342 
.  II.,  341 
II.,  225,  318,  321 

II.,  687,  705,  713,  729,  750 
II.,  841 


TATTOOING I.,  903 

TAXATION,  liability  to,  affected  by  insanity, III.,  424 

TEETH,  determination  of  identity  from, I.,  883 


GENERAL   INDEX    TO    VOLS.    I.,    II..    AXD    III.  !>77 

PAGE 

TEICHMANX'S  CRYSTALS  (and  see  Hwmin  crystals),  .        .         .     III. ,848 

TEMPERATURE  of  the  body I..1M1 

of  dead  body I.,  923,  93.5 

TENNESSEE,  legal  status  of  dead  bodies  in I.,  805 

statutes  regulating  the  practice  of  medicine  in,         ,        .         I.,  483,  701 
statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  735 

TESTIMONY,  expert  (and  see  Expert  Witness),        ....    III.,  529 

definition  of,  .         .         .         .         .         .  .  I.,  49 

non-expert,       .         ...         .         .  .         .      III.,  529,  535 

definition  of,      .........  I..  49 

TEST  TYPES,  SNELLEN'S, III.,  8 

TETAXI-S. II.,  59 

TEXAS,  legal  status  of  dead  bodies  in,  .  .  .  *  ...  I.,  805 
statutes  regulating  the  practice  of  medicine  in,  .  .  I.,  488,  703 
statutes  relating  to  incompetent  persons  in,  .  .  .  .  III.,  739 

THOMPSONIAN  PHYSICIANS .        I..  773 

THOKAX,  injuries  to, II..  857 

post-mortem  examination  of,  ......         I.,  847 

wounds  of,        .          .          .          .          .          .         .          .          .  II.,  119 

THROAT,  incised  wound  of, II.,  72 

THROWING  BACK II.,  644 

TIME  OF  DEATH,       ..........         I.,  921 

how  determined,       .         .         .         .         .         .         .         .         .        L,  934 

TOXICOLOGY  (and  see  Volume  IV.,  passim).    .....  L,  v 

TRANSFORMATIONS  OF  SPECTRA  or  BLOOD,       .....    III.,  858 

TRIBADISM, II.,  731,  737,  740,  755,  760 

TYPHOMANIA, III.,  313 

I  MHILICAL  COHD.  see  Abortion,  Infanticide. 

UNBORN  CHILD,  killing  of II.,  411 

I  "NCONSCIOUS.  delivery. II..  608 

impregnation.  .........       II..  602 

pregnancy II.,  605 

I  "SITED  STATES,  statutes  regulating  the  practice  of  medicine  in,      I.,  179,  497 

IN  LICENSED  PHYSICIAN,  ...  .  .  .  .  .  I. ,773 

UNNATURAL  CRIMES,  .  .  .  i II.,  737 

examination  of  persons  charged  with.  .  .  .  II.,  757 

UNSOUNDNESS.  MENTAL,  see  Insanity. 

URANISM, II..  739 

TTAH,  legal  status  of  dead  body  in,  •  • I..  806 

statutes  regulating  the  practice  of  medicine  in,  .  .  I.,  498,  704 

statutes  relating  to  incompetent  persons  in,  ....  III.,  743 

I'TEHO-GESTATION.  see  Pregnancy. 

I  TERUS,  changes  of.  in  pregnancy.  ......  II.,  562 

injuries  to,  in  abortion II.,  390 

post-mortem  examination  of, I..  858 

rupture  of II.,  390 

III.— 62 


;)78        GENERAL  INDEX  TO  VOLS.  I..  II.,  AND  III. 


UTERUS, 

sounds  heard  in  connection  with,  in  pregnancy,        .         .         .  II.,  575 

VACCINATION,  SUCCESSFUL,  medico-legal  significance  of  term,          .  III.,  143 

VAGINA,  changes  in,  in  pregnancy, II.,  559 

discharges  from, II.,  683 

in  children,       .         .         .         .         .         .                  ...  II.,  708 

after  rape,          .         .         .         .         .         .         .   '     .         .  II.,  724 

in  virgins,         .         .         .         .         .      •  .         .         .         .         .  II.,  675 

secretions  of, .  II.,  724 

VEINS,  air  in,           .         ....         ......  II.,  125 

wounds  of,        .         .         .         .         .         .         .         .         .         .II.,  124 

VENEREAL  DISEASE,  contracting,  as  a  proof  of  adultery,          -.         .  III.,  769 

medico-legal  aspect  of, .  III.,  766 

VERMONT,  legal  status  of  dead  body  in,           .         .         .         .         .  I.,  806 

statutes  regulating  the  practice  of  medicine  in,         .         .         ,  I.,  501 

statutes  relating  to  incompetent  persons  in,     .         .         .  ,      .  III.,  744 

VERNIX  CASEOSA, .       II.,  531,  532 

VERTEBRAE,  dislocations  of II.,  828 

distortions  of,           .         .         .     ,    .         .         .         .         .         .  II.,  828 

fractures  of,     .         .         .         .         .         .         .         .         .         .  II.,  830 

traumatism  of, .  II.,  826 

VIABILITY,       . II.,  421,  520,  522,  523 

cases  of  early,           .         .         .         .         .         .         .         .         .  II.,  541 

of  children  born  before  term,             II.,  522 

VIOLATION, II.,  706 

VIRGINIA,  legal  status  of  dead  body  in, I-,  807 

statutes  regulating  the  practice  of  medicine  in,         ...  I.,  507 

statutes  relating  to  incompetent  persons  in,     ....  III.,  747 

VIRGINITY,  see  Defloration. 

condition  of  mammae, .II.,  675 

is  an  intact  hymen  evidence  of  ?      .         .         .         .         .         .  II.,  672 

signs  of,            II.,  666 

simulation  of,            .........  II.,  675 

VISION,  see  Eye. 

abnormal,  cause  of, III.,  11 

acuteness  of, .         .     III.,  5,  11,  12 

amblyopia, III..  19 

amaurosis, III.,  19 

astigmatism,    .         .         .         .         .         .         .         .         .         .  III.,  7 

•  iiplopia, III.,    16,  44 

osophoria, III..  16 

csotropia, ,         .         .    '     .  III.,  16 

exophoria, III.,  16 

exotropia III.,  16 

heterophoria .    .         . III.,  16 

heterotropia, .  III.,  16 


(iKNERAL    INDEX   TO    VOLS.    I.,    II..    AND    III.  !)?'.» 

.PAGE 

Vision, 

hypermetropia, III.,  7,  17 

hyperphoria.  .         ........       III.,  16 

hypertropia, III.,  16 

myopia HI..  10,  17 

presbyopia III.,  15 

testing  of III.,  8,  10,  14 

VlTIUOL  THKOWlN(i.  * I.,  953 

Vi'LVA,  appearance  of, II.,  666 

changes  of.  in  pregnancy,         .......       II.,  558 

in  children, II.,  707 

after  rape, ^       .  II.,  708,  721 

WASHINGTON,  legal  status  of  dead  body  in.     .         .         .         .         .        I.,  807 

statutes  regulating  the  practice  of  medicine  in,        ...        I.,  514 
statutes  relating  to  incompetent  persons  in,     .         .         .         .     III.,  749 

WEAPONS, II.,  70 

evidence  from,  .         .         .         .         .         .         .         .         .II.,  146 

as  to  origin  of  wounds.      .         .         .         .         .         .  II.,  79.  95 

examination  of.         .......         I.,  835;  II.,  159 

presence  of  blood  and  hair  on,  ......         II. ,81 

was  it  fired  from  a  distance  or  near?         .         .         .         .         .II.,  160 

which  of  two  caused  certain  wounds.        .         .         .         .         .         II.,  70 

WK.ST  VIRGINIA,  legal  status  of  dead  body  in,  .  .  .  .  I.,  807 
statutes  regulating  the  practice  of  medicine  in.  .  .  .  I.,  521 
statutes  relating  to  incompetent  persons  in,  .  .  .  .III.,  751 

WISCONSIN,  legal  status  of  dead  body  in.         .....         I.,  808 

statutes  regulating  the  practice  of  medicine  in,         .         .          I.,  ">27,  704 
statutes  relating  to  incompetent  persons  in,     ....     1 1 1.,  753 

WITNESS  (see  Expert  Witness;    Privileged  Communications). 

insane  person  as  (and  see  Insanity),         .         .         .         .  III..  421 

intoxicated  person  as,       ........     III.,  423 

person  stupefied  by  drugs  as,  .         .         .         .         .         .     III.,  424 

physician  as  expert,  and  ordinary,  .         .         .         .         .         I.,   49 

when  must  testify  as.        .         .         .         .         .         .         *  I.,  60 

WOMEN,  MAKKIKD.  liability  of.  for  medical  services.         ...  I.,  37 

WOUNDS,         .         .         .         .         .         .         .         .     •    .        .        .          II.,  3 

ante-mortem,  signs  of,      .         .         .         .         .         .         .         .         II.,  29 

as  direct  cause  of  death.         ........        II.,  43 

as  secondary  cause  of  death II..  55 

by  what  instrument  made?  ......  II..  63,  70 

cause  of  death  from.         .  IT..  42,  43,  49 

coagulation  of  blood  in,    .         .         ....         .         .         .         II.,  34 

consequences  of  non-fatal,        .         .         .         .         .         .         .II.,  102 

contused,  • II.,  13.  16,  69 

death  from,  after  long  period.  ....  .     .         II.,  54 

definitions  of. II.,  5 


!)S()  CEXERAL   INDEX   TO    VOLS.    I..    II..    AXD    III. 


WOUNDS. 

description  of,  ...         .         .         .         .         .         .         .         II.,  28 

direction  of,  .         .         .         .         .         .         .         .         .         IJ.,  7,1 

eversion  of  lips  of,    .         .         .         .         .         .         .         .         .         II.,  35 

evidence  from  weapon.     ......  II..  79.  95,  140 

examination  of, I.,  840;  II..  22 

of  clothes  and  body  of  accused,          .  _  .         .         .         II.,  83 

fatal,  acts  performed  after,       .         .  .         .         .         .         II.,  39 

from  crushing,  ...         .         .         .         .         .         .         .         II.,  99 

falling. .         .  II.,  95,98 

lightning, .         .  II.,  212 

gunshot. '.'....       II.,  139 

accidental,         ..........       II.,  166 

by  blank  cliarges,      .         .         .*  .         .         .         .       II.,  J66 

by  infected  bullets,    .         .         ...         .         .         .       II.,  169 

by  shot-guns,    ...         .         .         .         .         .         .       II.,  154 

by  small  shot,  .........       II.,  165 

complications  of,        .         .         .         ...         .         .II.,  173 

course  of  projectile,  .         .         .         .         .         .         .II.,  163 

death  from  surgical  operations  in,     .....       II.,  173 

description  of, '    .   "      .         .       II.,  140 

dimensions  of  perforations,        ......       II.,  157 

direction  of,       .         .         .         .         .         .         .  .       II.,  14"> 

examination  of.          .         •.         .         .         .  .         .       II.,  140 

of  body  in .         .       II.,  158 

of  weapon  in,     .         .         .         .         .         .  .II.,  159 

fracture  caused  by.  .         .         .         .    '     .    .     ;         .       II.,  144 

infection  from,  .........       If..  170 

of  entrance,       .         .         .         .         ......         .       II..  162 

of  exit. '•.-..         .       II.,  162 

Roentgen  rays  as  evidence  of.  .         .         .         .         .II.,  172 

situation  of.       .         .         .         .         .         .         .         .         .       II.,  144 

treatment  of. .      II.,  168 

whether  suicidal,        ...--.         .         .         .         .         .       II.,  144 

hemorrhage  from.     .         .         .         .         .         .         .         .        •,         II..  29 

imputed.  .         . II..  90 

incised,  II.,  (i.  63.  103 

diagnosis  of.       .........  II.,  8 

prognosis  of.      .         .         .         .         .         .         .         .         .  II.,  9 

kinds  of,  .         . .  II.,  5 

lacerated II.,  17,  69 

mortal, • II..  6 

nature  of.          .         .         .         .         .         .         .         .         .         .         II.,  72 

number  and  extent  of II.,  77 

of  abdominal  viscera II.,  126,  128 

wall,  ...  II..  126 

arteries  and  veins.     ........       II..  124 


(JENEKAL    INDEX    TO    VOLS.    I.,    II.,    AM)    111.  981 

PAGE 
S  of 

bladder, II.,  131 

brain II.,  115 

ciliary  body,      .........  III.,  74 

cornea,      .         .         ........  III.,  7.'! 

diaphragm II..  125 

extremities,       .         .         .         .         .         .                  .         .  II..  1-15 

eyeball, "  .  HI.,  72 

face.           .         .         .         .         .         ....         .  II.,  115 

gall-bladder .         .  II.,  130 

genital  organs,            ........  II.,  134 

head II.,  103,  104 

licart, r\     .         .         .  II.,  121 

intestines.                 -  .         .         .         .         .         .         .         .  II.,  132 

iris. III.,  75 

kidneys II.,  130 

lens.  ' .          .  III.,  74 

liver.           . .  II.,  12S 

lungs II.,  121 

neck,          ..........  II.,  115 

spinal  cord,        .         .         .         .         .         .         .         .         .  II.,  117 

spine II.,  117 

spleen II..  130 

stomach. II.,  132 

thoracic  viscera,         .         .         .         .         .         .         .         .  II.,  119 

thorax .  II.,  119 

throat,  incised.           ...       .         .         .         .                - '  .  II.,  72 

origin  of,  evidence  from  weapons II.,  79,  95 

post-mortem.            .         .         .         .         .         .         .         .         .,  I.,  837 

signs  of,    .         .         .         .         .         .         .                   .         .  II.,  37 

punctured, II.,  9.  64,  103 

regionally  considered.       .         .         .         .         .         .         .         .  II..  103 

retraction  of  sides  of.                 .         .         .         .         .         .  II.,    36 

severe,      .         .         .         .                  .         .         .         .         .         .  II..  (5 

situation  and  position  of.          ......  II.,  73,  94 

slight II..  (i 

whether  accidental, 1 1..  93 

ante-mortem  or  post-mortem.    .....     II..  2X.  :i6.  37 

made  by  instrument  described,           .....  II.,  63 

necessarily  the  cause  of  death.            .         .         .         .         .  II.,  46 

self-inflicted  or  by  another.       .         .         .         .         .     II. ,71,  90.  94 

which  of  several  was  first  inflicted?           .'....  II..  100 

of  two  or  more  was  cause  of  death?           ....  II..  4(5 

WYOMING,  legal  status  of  dead  body  in. I..  80S 

statutes  regulating  the  practice  of  medicine  in.         .         .         .  I..  537 

statutes  relating  to  incompetent  persons  in.     ....  III..  75(5 


982  GENERAL   INDEX    TO    VOLS.    I,   It  AND    III. 

PAGE 

A'-HAY  dermatitis.  III.,  783,  794 

in  forensic  medicine,         .        '.         ,         .         .         .                  .  III.,  773 

malpractice  suits.     .                   .         .         .         .         .         .         .  III.,  799 

used  as  a  therapeutic  agent,  responsibility  of  physician,         .  III.,  800 

used  for  diagnostic  purposes,  responsibility  of  physician,          .  III..  800 

A*-KAYS  AND  SKIAGRAPHS,  as  evidence  in  gunshot  wounds.               .  II.,  172 

medico-legal  relations  of,          .         .         .         .         .         .III.,  771-806 

measurements  and  dosage,       .......  III..  786 

chromoradiometer  of  Bordier,         '    .         .         .                   .  III.,  788 

of  Holzknecht,            .         .         .         .         .         .         .  III.,  788 

fluorometer  of  Williams,    .......  III.,  791 

instrument  of  Dunham.     .......  III.,  791 

ionizing  power  of  the  x-ray, III.,  790 

meter  of  G.  C.  Johnston, III.,  791 

method  of  Contremoulins.          .         .         .         .     -  .         .  III.,  791 

milliamperemeter,     .         .         .         .         .         .         .         .  III.,  787 

modification  of  Guilleminot-Oourtade,       .         .         .        ..  III..  791 

precipitation  test,      .         .         .         .         ....         .  III.,  790 

quantimeter  of  Kienbock.          .         .         .         ,   •'-'•'r.         .  III.,  789 

radiochromometer  of  Benoist .             .         .         .        \-        .  III.,  787 

radiometer  of  Courtade, ..'".'•  •      .  III.,  791 

of  Freund <       .         .  III..  789 

of  Sabouraud  and  Noire III..  788 

selenium  cell  as  a  photometer.            .         ,         .         .    "    .  III.,  791 

spintermeter  of  Beclere,              .         .         .         .         .  III.,  787 

physician's  responsibility  in  case  of  x-ray  dermatitis,      .         .  III.,  798 

when  used  as  a  therapeutic  agent.     .         .         .         .         .  III..  800 

when  used  for  diagnostic  purposes,             .         .         .         .  III..  800 

radio-dermatitis,      .........  III..  783 

x-ray  dermatitis,  nature  of,      .......  III.,  794 

theories  of.         . .  III.,  794 

cathode  rays,      ........  III.,  796 

faulty  technique III.,  797 

forcing  of  metallic  substances  into  the  skin,        .         .  III..  795 

idiosyncrasy,      ........  III..  797 

production  of  ozone  upon  the  skin.     .         .         .  '•      .  III..  796 

static  field  surrounding  the  tube.        .         ...         .  III..  796 

ultra-violet  rays III..  795 

.'-ray  in  forensic  medicine,        - III..  773 

.r-ray  in  therapeutics,  and  its  libility  to  cause  dermatitis.          .  III..  794 

YUKON,  statutes  regulating  the  practice  of  medicine  in.           .         .  I.,  672 


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